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Kaye AD, Plaisance TR, Smith SA, Ragland AR, Alfred MJ, Nguyen CG, Chami AA, Kataria S, Dufrene K, Shekoohi S, Robinson CL. Peripheral Nerve Stimulation in Postoperative Analgesia: A Narrative Review. Curr Pain Headache Rep 2024:10.1007/s11916-024-01257-z. [PMID: 38642233 DOI: 10.1007/s11916-024-01257-z] [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: 04/08/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE OF REVIEW Recent research has shown the effectiveness of peripheral nerve stimulators (PNS) in managing chronic pain conditions. Ongoing studies aim to explore its potential application in treating acute postoperative pain states. The purpose of this systematic review is to assess the role of PNS in providing relief for postoperative pain. RECENT FINDINGS Clinical studies investigating the use of peripheral nerve stimulators (PNS) for analgesia following various surgeries, such as total knee arthroplasty, anterior cruciate ligament repair, ankle arthroplasty, rotator cuff repair, hallux valgus correction, and extremity amputation, have shown promising results. Lead placement locations include the brachial plexus, sciatic, femoral, tibial, genicular, perineal, sural, radial, median, and ulnar nerves. These studies consistently report clinically significant reductions in pain scores, and some even indicate a decrease in opioid consumption following PNS for postoperative pain. PNS involves the subcutaneous placement of electrode leads to target peripheral nerve(s) followed by delivery of an electric current via an external pulse generator. While the precise mechanism is not fully understood, the theory posits that PNS modulates electrical stimulation, hindering the signaling of nociceptive pain. PNS presents itself as an alternative to opioid therapy, holding promise to address the opioid epidemic by offering a nonpharmacologic approach for both acute and chronic pain states.
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Affiliation(s)
- Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
- Department of Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - Taylor R Plaisance
- School of Medicine, Louisiana State University Health Sciences Center at New Orleans, 2020 Gravier Street, New Orleans, LA, 70112, USA
| | - Summer A Smith
- School of Medicine, Louisiana State University Health Sciences Center at New Orleans, 2020 Gravier Street, New Orleans, LA, 70112, USA
| | - Amanda R Ragland
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Michael J Alfred
- School of Medicine, Louisiana State University Health Sciences Center at New Orleans, 2020 Gravier Street, New Orleans, LA, 70112, USA
| | - Catherine G Nguyen
- School of Medicine, Louisiana State University Health Sciences Center at New Orleans, 2020 Gravier Street, New Orleans, LA, 70112, USA
| | - Azem A Chami
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - Saurabh Kataria
- Department of Neurology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Kylie Dufrene
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA.
| | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
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Moreau S, Thérond A, Cerda IH, Studer K, Pan A, Tharpe J, Crowther JE, Abd-Elsayed A, Gilligan C, Tolba R, Ashina S, Schatman ME, Kaye AD, Yong RJ, Robinson CL. Virtual Reality in Acute and Chronic Pain Medicine: An Updated Review. Curr Pain Headache Rep 2024:10.1007/s11916-024-01246-2. [PMID: 38587725 DOI: 10.1007/s11916-024-01246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE OF REVIEW This review critically analyzes the recent literature on virtual reality's (VR) use in acute and chronic pain management, offering insights into its efficacy, applications, and limitations. RECENT FINDINGS Recent studies, including meta-analyses and randomized controlled trials, have demonstrated VR's effectiveness in reducing pain intensity in various acute pain scenarios, such as procedural/acute pain and in chronic pain conditions. The role of factors such as immersion and presence in enhancing VR's efficacy has been emphasized. Further benefits have been identified in the use of VR for assessment as well as symptom gathering through conversational avatars. However, studies are limited, and strong conclusions will require further investigation. VR is emerging as a promising non-pharmacological intervention in pain management for acute and chronic pain. However, its long-term efficacy, particularly in chronic pain management, remains an area requiring further research. Key findings highlight that VR programs vary in efficacy depending on the specificity of the origin of pain.
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Affiliation(s)
- Sacha Moreau
- Massachusetts Institute of Technology, Boston, MA, USA
| | - Alexandra Thérond
- Department of Psychology, Université du Québec a Montréal, 100 Sherbrooke St W, Montréal, QC, H2X 3P2, Canada.
| | - Ivo H Cerda
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kachina Studer
- Department of Earth and Planetary Science, Harvard University, Cambridge, MA, USA
- Department Mechanical Engineering, Massachusetts Institute of Technology (MIT), Cambridge, MA, USA
| | - Alicia Pan
- Northeastern University, Boston, MA, USA
| | - Jacob Tharpe
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts, Worcester, MA, USA
| | - Jason E Crowther
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts, Worcester, MA, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | | | - Reda Tolba
- Pain Management Department in the Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Sait Ashina
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health-Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | | | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Vu PD, Gul F, Robinson CL, Chen GH, Hasoon J. Peripheral Nerve Stimulation After Total Knee Arthroplasty and Non-Operable Patella Fracture. Orthop Rev (Pavia) 2024; 16:115599. [PMID: 38586247 PMCID: PMC10994825 DOI: 10.52965/001c.115599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/01/2024] [Indexed: 04/09/2024] Open
Abstract
Chronic knee pain, affecting over 25% of adults in the United States, has surged by 65% over the past two decades leading to rising functional deficits, mobility problems, and a diminished quality of life. While conservative management with pharmacologic and minimally invasive injections are pursued early in the disease process, total knee arthroplasty for refractory osteoarthritis of the knee is often considered. This procedure usually improves pain and functionality within the first three months. However, a significant portion of patients often suffer from postoperative pain that can become chronic and debilitating. We detail the case of a patient with a previous TKA as well as a non-operable patella fracture who obtained significant relief with PNS despite prior conservative and minimally invasive management.
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Affiliation(s)
- Peter D Vu
- Department of Physical Medicine & Rehabilitation The University of Texas Health Science Center at Houston
| | | | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine Beth Israel Deaconess Medical Center
| | - Grant H Chen
- Department of Anesthesiology, Critical Care, and Pain Medicine The University of Texas Health Science Center at Houston
| | - Jamal Hasoon
- Department of Anesthesiology, Critical Care, and Pain Medicine The University of Texas Health Science Center at Houston
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Kaye AD, Dufrene K, Cooley J, Walker M, Shah S, Hollander A, Shekoohi S, Robinson CL. Neuropsychiatric Effects Associated with Opioid-Based Management for Palliative Care Patients. Curr Pain Headache Rep 2024:10.1007/s11916-024-01248-0. [PMID: 38564124 DOI: 10.1007/s11916-024-01248-0] [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: 03/19/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE OF REVIEW The abundance of opioids administered in the palliative care setting that was once considered a standard of care is at present necessitating that providers evaluate patients for unintentional and deleterious symptomology related to aberrant opioid use and addiction. Polypharmacy with opioids is dynamic in affecting patients neurologically, and increased amounts of prescriptions have had inimical effects, not only for the individual, but also for their families and healthcare providers. The purpose of this review is to widen the perspective of opioid consequences and bring awareness to the numerous neuropsychiatric effects associated with the most commonly prescribed opioids for patients receiving palliative care. RECENT FINDINGS Numerous clinical and research studies have found evidence in support for increased incidence of opioid usage and abuse as well as undesirable neurological outcomes. The most common and concerning effects of opioid usage in this setting are delirium and problematic drug-related behavioral changes such as deceitful behavior towards family and physicians, anger outbursts, overtaking of medications, and early prescription refill requests. Other neuropsychiatric effects detailed by recent studies include drug-seeking behavior, tolerance, dependence, addictive disorder, anxiety, substance use disorder, emotional distress, continuation of opioids to avoid opioid withdrawal syndrome, depression, and suicidal ideation. Opioid usage has detrimental and confounding effects that have been overlooked for many years by palliative care providers and patients receiving palliative care. It is necessary, even lifesaving, to be cognizant of potential neuropsychiatric effects that opioids can have on an individual, especially for those under palliative care. By having an increased understanding and awareness of potential opioid neuropsychiatric effects, patient quality of life can be improved, healthcare system costs can be decreased, and patient outcomes can be met and exceeded.
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Affiliation(s)
- Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
- Department of Pharmacology, Louisiana State University Health Sciences Center at Shreveport, Toxicology, and Neurosciences, Shreveport, LA, 71103, USA
| | - Kylie Dufrene
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Jada Cooley
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Madeline Walker
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Shivam Shah
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Alex Hollander
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
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Abd-Elsayed A, Robinson CL, Marshall Z, Diwan S, Peters T. Applications of Artificial Intelligence in Pain Medicine. Curr Pain Headache Rep 2024; 28:229-238. [PMID: 38345695 DOI: 10.1007/s11916-024-01224-8] [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] [Accepted: 01/30/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE OF REVIEW This review explores the current applications of artificial intelligence (AI) in the field of pain medicine with a focus on machine learning. RECENT FINDINGS Utilizing a literature search conducted through the PubMed database, several current trends were identified, including the use of AI as a tool for diagnostics, predicting pain progression, predicting treatment response, and performance of therapy and pain management. Results of these studies show promise for the improvement of patient outcomes. Current gaps in the research and subsequent directions for future study involve AI in optimizing and improving nerve stimulation and more thoroughly predicting patients' responses to treatment.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, 750 Highland Ave, Madison, WI, 53726, USA.
| | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Sudhir Diwan
- Albert Einstein College of Medicine, Lenox Hill Hospital, New York City, NY, USA
| | - Theodore Peters
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, 750 Highland Ave, Madison, WI, 53726, USA
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Abd-Elsayed A, Robinson CL, Shehata P, Koh Y, Patel M, Fiala KJ. Neuromodulation's Role in Functional Restoration in Paraplegic and Quadriplegic Patients. Biomedicines 2024; 12:720. [PMID: 38672076 PMCID: PMC11047848 DOI: 10.3390/biomedicines12040720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/09/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
Neuromodulation is an alternative, minimally invasive treatment option that, at times, is used as a last resort for chronic pain conditions that are often refractory to other treatment modalities. Moreover, it offers promising prospects for individuals grappling with the formidable challenges posed by paraplegia and quadriplegia resulting from spinal cord injuries. This review article provides a comprehensive assessment of current treatment modalities specifically tailored for paraplegic and quadriplegic patients. We aim to evaluate the existing surgical and non-surgical interventions while delving into the role of neuromodulation in the restoration of function for individuals afflicted with these debilitating conditions. Additionally, we review the efficacy, limitations, and comparative outcomes of diverse treatment strategies available for the management of paraplegia and quadriplegia. Emphasizing the critical need for effective interventions beyond the initial 24 h surgical window, we elucidate the challenges associated with conventional therapies and their limited success in achieving comprehensive functional restoration. Central to this review is an in-depth exploration of neuromodulation's transformative potential in ameliorating the deficits caused by spinal cord injuries. With a particular focus on spinal cord stimulation (SCS), we analyze and compare the outcomes of neuromodulation modalities and traditional treatment regimens, shedding light on the promising strides made in fostering sensory perception, motor function, and patient satisfaction.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (P.S.); (Y.K.); (M.P.); (K.J.F.)
| | - Christopher L. Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA 02115, USA;
| | - Peter Shehata
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (P.S.); (Y.K.); (M.P.); (K.J.F.)
| | - Yerin Koh
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (P.S.); (Y.K.); (M.P.); (K.J.F.)
| | - Milan Patel
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (P.S.); (Y.K.); (M.P.); (K.J.F.)
| | - Kenneth J. Fiala
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (P.S.); (Y.K.); (M.P.); (K.J.F.)
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Ruan QZ, Chang J, Pak D, Supra R, Yazdi C, Kollenburg L, Kurt E, Reece D, Fonseca ACG, Abd-Elsayed A, Robinson CL. Literature Review: Mechanism, Indications, and Clinical Efficacy of Peripheral Nerve Stimulators in Lower Extremity Pain. Curr Pain Headache Rep 2024:10.1007/s11916-024-01240-8. [PMID: 38512600 DOI: 10.1007/s11916-024-01240-8] [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: 03/13/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE OF REVIEW Lower extremity pain is deemed by Center for Disease Control and Prevention (CDC) to be a significant source of chronic pain in adults. If not appropriately managed, patients are subjected to risks of prolonged musculoskeletal dysfunction, disruption to quality of life, and elevated healthcare expenditures. Peripheral nerve stimulation (PNS) has shown great potential in recent years demonstrating efficacy in multiple diagnoses ranging from acute post-surgical pain to complex regional pain syndrome (CRPS). This study seeks to delineate efficacy of peripheral neuromodulation in the context of chronic lower extremity pain. RECENT FINDINGS Prevailing clinical studies demonstrate evidence levels ranging from II to V (Oxford Centre of Level of Evidence) in lower limb PNS, attaining positive outcomes in pain scores, opioid use, and quality of life measures. Nerves most frequently targeted are the sciatic and femoral nerves with post-amputation pain and CRPS most commonly investigated for efficacy. PNS is a promising therapeutic modality demonstrated to be effective for a variety of nociceptive and neuropathic pain conditions in the lower extremity. PNS offers chronic pain physicians a powerful tool in the multi-modal management of lower limb chronic pain.
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Affiliation(s)
- Qing Zhao Ruan
- Department of Anesthesiology, Weill Cornell Medicine, 1300 York Ave, New York City, NY, 10021, USA.
| | - Jason Chang
- Department of Anesthesiology, Weill Cornell Medicine, 1300 York Ave, New York City, NY, 10021, USA
| | - Daniel Pak
- Department of Anesthesiology, Weill Cornell Medicine, 1300 York Ave, New York City, NY, 10021, USA
| | - Rajesh Supra
- Georgetown University School of Medicine, Washington, DC, USA
| | - Cyrus Yazdi
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School-Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Linda Kollenburg
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erkan Kurt
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David Reece
- Absolute Pain Management, Rockville, MD, USA
| | - Alexandra C G Fonseca
- Harvard Medical School, Brigham and Women's Hospital, Department of Anesthesiology, Perioperative, and Pain Medicine, Boston, MA, USA
| | - Alaa Abd-Elsayed
- Chronic Pain Medicine, Department of Anesthesiology, University of Wisconsin-Madison, Madison, USA
| | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School-Beth Israel Deaconess Medical Center, Boston, MA, USA
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Robinson CL, Fonseca ACG, Diejomaoh EM, D’Souza RS, Schatman ME, Orhurhu V, Emerick T. Scoping Review: The Role of Psychedelics in the Management of Chronic Pain. J Pain Res 2024; 17:965-973. [PMID: 38496341 PMCID: PMC10941794 DOI: 10.2147/jpr.s439348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/27/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction Amid a lack of effective chronic pain treatments, psychedelics have gained attention as a potential solution, although their Schedule 1 classification poses challenges. Psychedelics, such as lysergic acid diethylamide (LSD) and psilocybin, have gained popularity as alternatives and adjuncts for chronic pain treatment. Studies suggest that they may modulate pain processing through agonism primarily at the serotonin receptor, 5-HT2A. One of the first of its nature, we present an artificial intelligence (AI)-powered scoping review primarily focusing on evaluating psychedelics for chronic pain conditions such as cluster headache, phantom limb pain, and fibromyalgia. Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we used an AI-powered comprehensive search strategy utilizing the ChatGPT4.0 Bing chat to search Medline, Embase, Cochrane, and Google Scholar for articles addressing chronic pain. The query was performed on June 1, 2023, focusing on psychedelics for chronic, non-cancer pain including headache disorders. Inclusion criteria were English-only, peer-reviewed articles involving human participants >18 years, focusing on chronic pain conditions (eg, phantom limb pain and cluster headache), using LSD, 2.5-dimethoxy-4-bromophenethylamine (2C-B), N, N-dimethyltryptamine (DMT), psilocybin, or mescaline. Exclusion criteria were reviews, editorials, and opinion articles and studies focusing on tetrahydrocannabinol/cannabis and/or ketamine. Results A total of 186 unique database entries were retrieved, of which nine studies were included in the scoping review. These included four case reports/series, an open-label study, a cohort study, two online surveys, and a randomized, double-blind, placebo-controlled trial. They comprised three studies addressing phantom limb pain, four addressing cluster headaches, and two addressing fibromyalgia, spinal cord injury, complex regional pain syndrome, and lumbar radiculopathy. Conclusion Psychedelics may have potential in alleviating pain symptoms secondary to a multitude of chronic pain conditions. However, further randomized, double-blind, placebo-controlled trials are needed to further explore and evaluate the role of psychedelics in chronic, non-cancer pain.
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Affiliation(s)
- Christopher L Robinson
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Alexandra C G Fonseca
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women’s Hospital, Boston, MA, USA
| | - Efemena M Diejomaoh
- Department of Psychiatry & Behavioral Science, Meharry Medical College, Nashville, TN, USA
| | - Ryan S D’Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, MN, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health-Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
| | - Vwaire Orhurhu
- University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA
- MVM Health, East Stroudsburg, PA, USA
| | - Trent Emerick
- University of Pittsburgh Medical Center, Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, Pittsburgh, PA, USA
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Robinson CL, D'Souza RS, Yazdi C, Diejomaoh EM, Schatman ME, Emerick T, Orhurhu V. Reviewing the Potential Role of Artificial Intelligence in Delivering Personalized and Interactive Pain Medicine Education for Chronic Pain Patients. J Pain Res 2024; 17:923-929. [PMID: 38464902 PMCID: PMC10924768 DOI: 10.2147/jpr.s439452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/18/2024] [Indexed: 03/12/2024] Open
Abstract
The integration of artificial intelligence (AI) in patient pain medicine education has the potential to revolutionize pain management. By harnessing the power of AI, patient education becomes more personalized, interactive, and supportive, empowering patients to understand their pain, make informed decisions, and actively participate in their pain management journey. AI tailors the educational content to individual patients' needs, providing personalized recommendations. It introduces interactive elements through chatbots and virtual assistants, enhancing engagement and motivation. AI-powered platforms improve accessibility by providing easy access to educational resources and adapting content to diverse patient populations. Future AI applications in pain management include explaining pain mechanisms, treatment options, predicting outcomes based on individualized patient-specific factors, and supporting monitoring and adherence. Though the literature on AI in pain medicine and its applications are scarce yet growing, we propose avenues where AI may be applied and review the potential applications of AI in pain management education. Additionally, we address ethical considerations, patient empowerment, and accessibility barriers.
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Affiliation(s)
- Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Cyrus Yazdi
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Efemena M Diejomaoh
- Department of Psychiatry & Behavioral Science, Meharry Medical College, Nashville, TN, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health-Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
| | - Trent Emerick
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Vwaire Orhurhu
- University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA
- MVM Health, East Stroudsburg, PA, USA
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Vu PD, Robinson CL, Viswanath O, Urits I, Hasoon J. Techniques in medicine: ipsilateral transforaminal epidural steroid injection in Bertolotti's syndrome. Pain Manag 2024; 14:125-128. [PMID: 38385170 DOI: 10.2217/pmt-2023-0105] [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] [Indexed: 02/23/2024] Open
Abstract
Bertolotti's syndrome, also known as lumbosacral transitional vertebrae, is a relatively rare spinal condition characterized by an anatomical variation in the lower spine. Conservative approaches such as physical therapy, anti-inflammatory medications and lifestyle modifications may be recommended for mild cases. In more severe cases or when conservative measures fail to provide relief, injections such as may be considered to alleviate pain. This case is unique in that we document a challenging technique of ipsilateral transforaminal epidural steroid injection in a patient with Bertolotti's syndrome.
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Affiliation(s)
- Peter D Vu
- UTHealth McGovern Medical School, Department of Physical Medicine & Rehabilitation, Houston, TX 77030, USA
| | - Christopher L Robinson
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, & Pain Medicine, Harvard Medical School, Boston, MA 02215, USA
| | - Omar Viswanath
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA 71103, USA
| | - Ivan Urits
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA 71103, USA
| | - Jamal Hasoon
- UTHealth McGovern Medical School, Department of Anesthesia & Pain Medicine, Houston, TX 77030, USA
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Cerda IH, Therond A, Moreau S, Studer K, Donjow AR, Crowther JE, Mazzolenis ME, Lang M, Tolba R, Gilligan C, Ashina S, Kaye AD, Yong RJ, Schatman ME, Robinson CL. Telehealth and Virtual Reality Technologies in Chronic Pain Management: A Narrative Review. Curr Pain Headache Rep 2024; 28:83-94. [PMID: 38175490 DOI: 10.1007/s11916-023-01205-3] [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] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW This review provides medical practitioners with an overview of the present and emergent roles of telehealth and associated virtual reality (VR) applications in chronic pain (CP) management, particularly in the post-COVID-19 healthcare landscape. RECENT FINDINGS Accumulated evidence points to the efficacy of now well-established telehealth modalities, such as videoconferencing, short messaging service (SMS), and mobile health (mHealth) applications in complementing remote CP care. More recently, and although still in early phases of clinical implementation, a wide range of VR-based interventions have demonstrated potential for improving the asynchronous remote management of CP. Additionally, VR-associated technologies at the leading edge of science and engineering, such as VR-assisted biofeedback, haptic technology, high-definition three-dimensional (HD3D) conferencing, VR-enabled interactions in a Metaverse, and the use of wearable monitoring devices, herald a new era for remote, synchronous patient-physician interactions. These advancements hold the potential to facilitate remote physical examinations, personalized remote care, and innovative interventions such as ultra-realistic biofeedback. Despite the promise of VR-associated technologies, several limitations remain, including the paucity of robust long-term effectiveness data, heterogeneity of reported pain-related outcomes, challenges with scalability and insurance coverage, and demographic-specific barriers to patient acceptability. Future research efforts should be directed toward mitigating these limitations to facilitate the integration of telehealth-associated VR into the conventional management of CP. Despite ongoing barriers to widespread adoption, recent evidence suggests that VR-based interventions hold an increasing potential to complement and enhance the remote delivery of CP care.
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Affiliation(s)
- Ivo H Cerda
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
| | - Alexandra Therond
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Sacha Moreau
- Massachusetts Institute of Technology, Boston, MA, USA
| | - Kachina Studer
- Department of Earth and Planetary Science, Harvard University, Cambridge, MA, USA
- Department Mechanical Engineering, Cambridge, Massachusetts Institute of Technology (MIT), Cambridge, MA, USA
| | | | - Jason E Crowther
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts, Worcester, MA, USA
| | - Maria Emilia Mazzolenis
- Paulson School of Engineering and Applied Sciences, John A, Harvard University, Boston, MA, USA
| | - Min Lang
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Reda Tolba
- Pain Management Department in the Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Christopher Gilligan
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sait Ashina
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - R Jason Yong
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health-Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
| | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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12
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Upshaw WC, Soileau LG, Storey NR, Perkinson KA, Luther PM, Spillers NJ, Robinson CL, Miller BC, Ahmadzadeh S, Viswanath O, Shekoohi S, Kaye AD. An extract of phase II and III trials on recent developments in managing neuropathic pain syndromes: diabetic peripheral neuropathy, trigeminal neuralgia, and postherpetic neuralgia. Expert Opin Emerg Drugs 2024:1-10. [PMID: 38410863 DOI: 10.1080/14728214.2024.2323193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/21/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Neuropathic pain (NP) conditions involve lesions to the somatosensory nervous system leading to chronic and debilitating pain. Many patients suffering from NP utilize pharmacological treatments with various drugs that seek to reduce pathologic neuronal states. However, many of these drugs show poor efficacy as well as cause significant adverse effects. Because of this, there is a major need for the development of safer and more efficacious drugs to treat NP. AREAS COVERED In this review, we analyzed current treatments being developed for a variety of NP conditions. Specifically, we sought drugs in phase II/III clinical trials with indications for NP conditions. Various databases were searched including Google Scholar, PubMed, and clinicaltrials.gov. EXPERT OPINION All the mentioned targets for treatments of NP seem to be promising alternatives for existing treatments that often possess poor side effect profiles for patients. However, gene therapy potentially offers the unique ability to inject a plasmid containing growth factors leading to nerve growth and repair. Because of this, gene therapy appears to be the most intriguing new treatment for NP.
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Affiliation(s)
- William C Upshaw
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Lenise G Soileau
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Nicholas R Storey
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | | | - Patrick M Luther
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Noah J Spillers
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Christopher L Robinson
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Benjamin C Miller
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA
- Creighton University School of Medicine, Phoenix, AZ, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA
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13
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Ehioghae M, Vippa TK, Askins D, Slusarczyk S, Bobo E, Montoya A, Anderson D, Robinson CL, Kaye AD, Urits I. Exploring Orthopedic Stem-Cell Approaches for Osteoarthritis Management: Current Trends and Future Horizons. Curr Pain Headache Rep 2024; 28:27-35. [PMID: 38010488 DOI: 10.1007/s11916-023-01191-6] [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] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE OF REVIEW Osteoarthritis (OA) is a prevalent and debilitating condition characterized by joint degeneration and pain. Current treatment options aim to alleviate symptoms and slow disease progression but lack curative potential. Stem cell therapies have emerged as a promising alternative. This article explores the epidemiology, pathophysiology, clinical manifestations of hip and knee OA, and the evolving role of stem cell therapies in their treatment. RECENT FINDINGS The global prevalence of OA, with knee OA being the most common form, has fueled the demand for stem cell therapies. Despite limited robust evidence supporting their efficacy, clinical trials investigating stem-cell treatments for OA have reported encouraging radiological and clinical improvements. Stem cell therapies offer potential disease-modifying benefits through immunomodulatory actions, growth factor secretion, and chondrogenic capabilities. Adipose-derived mesenchymal stem cells (ADMSCs) have shown promise in clinical trials for OA treatment, offering potential pain relief and functional improvement. ADMSCs possess advantages such as accessibility and a favorable safety profile, making them a viable option for OA management. Although other stem-cell types, including human embryonic stem cells (hESCs) and induced pluripotent stem cells (iPSCs), have been used in OA treatment, ADMSCs have demonstrated superior outcomes. By providing a comprehensive overview of the evolving landscape of stem cell therapies for hip and knee OA, this article highlights the potential of stem-cell treatments to address the limitations of current therapies. However, further research is required to establish their long-term efficacy, identify optimal stem-cell types, and develop standardized protocols.
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Affiliation(s)
| | | | | | | | - Elena Bobo
- Tulane University School of Medicine, New Orleans, USA
| | - Alexis Montoya
- University of Arizona College of Medicine-Phoenix, Phoenix, USA
| | | | | | - Alan D Kaye
- Louisiana State University Health Shreveport, Shreveport, USA
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14
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Fabian IM, Maddox K, Robicheaux C, Islam RK, Anwar A, Dorius B, Robinson CL, Kaye AM, Varrassi G, Ahmadzadeh S, Shekoohi S, Kaye AD. Stevens-Johnson Syndrome From Combined Allopurinol and Angiotensin-Converting Enzyme Inhibitors: A Narrative Review. Cureus 2024; 16:e51899. [PMID: 38333456 PMCID: PMC10850002 DOI: 10.7759/cureus.51899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Stevens-Johnson syndrome (SJS) is a severe and potentially debilitating skin reaction frequently related to medication use. Allopurinol and angiotensin-converting enzyme (ACE) inhibitors are commonly prescribed medications for prevalent health conditions worldwide, and their interaction associated with SJS warrants further investigation. A comprehensive literature search was performed to investigate cases as studies related to SJS occurring in patients with concomitant use of allopurinol and ACE inhibitors. We identified case reports and studies detailing hypersensitivity reactions, including SJS, attributed to a combination of allopurinol and ACE inhibitors. Despite the drug-drug interactions or lack thereof seen in patient populations, there is no definitive evidence of a pharmacokinetic interaction between allopurinol and ACE inhibitors. We were only able to find one case report specifically detailing SJS in a patient on combined ACE inhibitors and allopurinol. While the exact mechanism of the interaction is unclear, those reported cases of severe hypersensitivity reactions suggest a previous history of impaired renal function as a predisposing factor in the development of SJS. The potential risk of SJS with coadministration of ACE inhibitors and allopurinol is a drug-drug interaction that physicians should be aware of. This topic requires additional attention to determine if this drug combination should be avoided entirely in certain patients.
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Affiliation(s)
- Isabella M Fabian
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Kirsten Maddox
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Cameron Robicheaux
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Rahib K Islam
- School of Medicine, Louisiana State University Health Sciences Center (LSUHSC) New Orleans, New Orleans, USA
| | - Ahmed Anwar
- Department of Psychology, Quinnipiac University, Hamden, USA
| | - Bradley Dorius
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Adam M Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences University of the Pacific, Stockton, USA
| | | | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
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15
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Robinson CL, Phung A, Dominguez M, Remotti E, Ricciardelli R, Momah DU, Wahab S, Kim RS, Norman M, Zhang E, Hasoon J, Orhurh V, Viswanath O, Yazdi C, Chen GH, Simopoulos TT, Gill J. Pain Scales: What Are They and What Do They Mean. Curr Pain Headache Rep 2024; 28:11-25. [PMID: 38060102 DOI: 10.1007/s11916-023-01195-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE OF REVIEW It is essential to have validated and reliable pain measurement tools that cover a wide range of areas and are tailored to individual patients to ensure effective pain management. The main objective of this review is to provide comprehensive information on commonly used pain scales and questionnaires, including their usefulness, intended purpose, applicability to different patient populations, and associated advantages and disadvantages. RECENT FINDINGS Acute pain questionnaires typically focus on measuring the severity of pain and the extent of relief achieved through interventions. Chronic pain questionnaires evaluate additional aspects such as pain-related functional limitations, psychological distress, and psychological well-being. The selection of an appropriate pain scale depends on the specific assessment objectives. Additionally, each pain scale has its strengths and limitations. Understanding the differences among these pain scales is essential for selecting the most appropriate tool tailored to individual patient needs in different settings. CONCLUSION Medical professionals encounter challenges in accurately assessing pain. Physicians must be familiar with the different pain scales and their applicability to specific patient population.
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Affiliation(s)
- Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Anh Phung
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Moises Dominguez
- Department of Neurology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Edgar Remotti
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ryan Ricciardelli
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - D Uju Momah
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephanie Wahab
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rosa S Kim
- Department of General Surgery, Georgetown University Hospital, MedStar, Washington, DC, USA
| | | | - Evan Zhang
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jamal Hasoon
- Department of Anesthesiology, Critical Care and Pain Medicine, UTHealth McGovern Medical School, Houston, TX, USA.
| | - Vwaire Orhurh
- University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA
- MVM Health, East Stroudsburg, PA, USA
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Cyrus Yazdi
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Grant H Chen
- Department of Anesthesiology, Critical Care and Pain Medicine, UTHealth McGovern Medical School, Houston, TX, USA
| | - Thomas T Simopoulos
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jatinder Gill
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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16
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Vu PD, Robinson CL, Kaye AD, Hasoon J. Stimulating Superior Cluneal Nerves via Peripheral Nerve Stimulation as a Treatment for Chronic Low Back Pain. Cureus 2024; 16:e51952. [PMID: 38333464 PMCID: PMC10851039 DOI: 10.7759/cureus.51952] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
Low back pain (LBP) is a challenging clinical condition for both patients and physicians. It requires a comprehensive initial diagnosis to avoid missing potential causes. One less common cause is superior cluneal neuralgia (SCN), which can present with limited lumbar motion, LBP, buttock pain, or an antalgic gait. While conservative therapies are often first line for LBP, neuromodulation, such as peripheral nerve stimulation (PNS), can be considered for more refractory cases. This case report is unique in that SCN was treated with a temporary PNS system, which provided sustained analgesic benefits without the need for permanent implantation.
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Affiliation(s)
- Peter D Vu
- Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston McGovern Medical School, Houston, USA
| | - Christopher L Robinson
- Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Alan D Kaye
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Jamal Hasoon
- Anesthesiology, Critical Care and Pain Medicine, University of Texas Health Science Center at Houston McGovern Medical School, Houston, USA
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Vu PD, Bansal V, Chitneni A, Robinson CL, Viswanath O, Urits I, Kaye AD, Nguyen A, Govindaraj R, Chen GH, Hasoon J. Buprenorphine for Chronic Pain Management: a Narrative Review. Curr Pain Headache Rep 2023; 27:811-820. [PMID: 37897592 DOI: 10.1007/s11916-023-01185-4] [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] [Accepted: 10/19/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to educate healthcare professionals regarding buprenorphine for the use of opioid use disorder (OUD) as well as for chronic pain management. This review provides physicians and practitioners with updated information regarding the distinct characteristics and intricacies of prescribing buprenorphine. RECENT FINDINGS Buprenorphine is approved by the US Food and Drug Administration (FDA) for acute pain, chronic pain, opioid use disorder (OUD), and opioid dependence. When compared to most other opioids, buprenorphine offers superior patient tolerability, an excellent half-life, and minimal respiratory depression. Buprenorphine does have notable side effects as well as pharmacokinetic properties that require special attention, especially if patients require future surgical interventions. Many physicians are not trained to initiate or manage patients on buprenorphine. However, buprenorphine offers a potentially safer alternative for medication management for patients who require chronic opioid therapy for pain or have OUD. This review provides updated information on buprenorphine for both chronic pain and OUD.
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Affiliation(s)
- Peter D Vu
- Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Vishal Bansal
- Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Ahish Chitneni
- Department of Rehabilitation and Regenerative Medicine, New York-Presbyterian Hospital - Columbia and Cornell, New York, NY, USA
| | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Ivan Urits
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Anvinh Nguyen
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
| | - Ranganathan Govindaraj
- Department of Anesthesiology, Critical Care, and Pain Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Grant H Chen
- Department of Anesthesiology, Critical Care, and Pain Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Jamal Hasoon
- Department of Anesthesiology, Critical Care, and Pain Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA.
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Ruan QZ, Robinson CL, Simopoulos TT, Burns JC, Madabhushi SV, Gill JS. Comparative Descriptive Analysis of Physician Versus Patient-Directed Gabapentin Usage In Chronic Pain - A Preliminary Report. Pain Physician 2023; 26:E687-E693. [PMID: 37847922] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND Gabapentin is one of the most common medications employed in Pain Medicine, specifically targeting the management of neuropathic pain. We are most familiar with the incremental dosing strategy where a ceiling dose is eventually attained guided by efficacy and patient tolerance, after which a fixed dosing regimen is prescribed. We propose that autonomous short-term dose variations per patient could have rapid clinically significant effects in the management of chronic pain. OBJECTIVES This study examines the frequency at which patients take gabapentin on a fixed vs variable schedule and how the pattern of gabapentin use correlates with efficacy, side effects, and patient satisfaction. STUDY DESIGN Single institution, cross-sectional observational survey study with data collection performed over 2 phases as a pilot for proof of concept. SETTING Remote contact via telephone with researchers calling from a quiet, private location within the hospital complex conducive for confidential conversation. METHODS Patients recently prescribed gabapentin were queried on the patterns of use and self-perceived efficacy, satisfaction, and side effects in accordance to a standardized oral script. Patients selected met the criteria of being new patients freshly prescribed gabapentin who have been consistently on the medication for at least a month, while having chronic pain symptoms for over 3 months. Responses were collected in the form of a 5-point Likert scale. Statistical analyses were performed using GraphPad Prism. RESULTS Of the 222 patients, 92 patients agreed to participate in the survey for a response rate of 41.4. Of these, 51% had terminated the medication for various reasons. Of the patients still taking gabapentin, 73% were on a fixed schedule, while 27% were on a variable dosing schedule. Variable dosing cohort reported better efficacy (P = 0.027) and satisfaction (P = 0.036), while the side-effect profile between the 2 groups was similar. LIMITATIONS The study is limited by its nature of being a pilot, single-institution study performed on a relatively small sample size. None of the patients we surveyed had been given the autonomy to adjust gabapentin doses by their providers and this could significantly reduce the proportion of patients who would be encouraged to run a variable dosing regimen. CONCLUSIONS This pilot study suggests that a significant portion of patients choose to administer variable doses of gabapentin and associate this with better efficacy and satisfaction. A larger study is needed to confirm this supposition. Based upon this pilot study, the variable dosing option may be an option for improved therapeutic efficacy or as an alternative to those whose lifestyles do not allow for fixed dosing regimens. Discussion of the risks of gabapentin, including respiratory depression, and clear dosage parameters of use, would need to be outlined when considering a variable dose regimen.
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Affiliation(s)
- Qing Zhao Ruan
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Christopher L Robinson
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Thomas T Simopoulos
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - James C Burns
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sravya V Madabhushi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jatinder S Gill
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Remotti E, Nduaguba C, Woolley PA, Ricciardelli R, Phung A, Kim R, Urits I, Kaye AD, Hasoon J, Simopoulos T, Yazdi C, Robinson CL. Review: Discogenic Back Pain: Update on Treatment. Orthop Rev (Pavia) 2023; 15:84649. [PMID: 37641793 PMCID: PMC10460631 DOI: 10.52965/001c.84649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Purpose of Review Lower back pain (LBP) has a lifetime prevalence of 80% in the United States population. Discogenic back pain (DBP), a subcategory of LBP, occurs as a result of the interverbal disc degeneration without disc herniation. Diagnosis relies on history, physical exam, and imaging such as MRI, provocative discography, or CT discography. Recent Findings Treatment of DBP involves a multifaceted approach with an emphasis on conservative measures including behavioral modification, pharmacologic management, and other non-pharmacologic interventions with invasive therapy reserved for select patients. Due to the paucity of data on the treatment of DBP, treatment also relies on data derived from treatment of chronic LBP (CLBP). Summary Despite the scarcity of data for the treatment of DBP, treatments do exist with varying efficacy for DBP. Novel techniques such as the use of biologics may provide another avenue for treatment though further studies are needed to better evaluate the most efficacious regimen for both novel and existing treatments.
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Affiliation(s)
- Edgar Remotti
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Chinoso Nduaguba
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Parker A Woolley
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Ryan Ricciardelli
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Anh Phung
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Rosa Kim
- Georgetown University Hospital, Department of General Surgery, Medstar, Washington, DC
| | | | - Alan David Kaye
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Jamal Hasoon
- UTHealth McGovern Medical School, Department of Anesthesiology, Critical Care and Pain Medicine, Houston, TX
| | - Thomas Simopoulos
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Cyrus Yazdi
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Christopher L Robinson
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
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El-Mansi S, Robinson CL, Kostelnik KB, McCormack JJ, Mitchell TP, Lobato-Márquez D, Rajeeve V, Cutillas P, Cutler DF, Mostowy S, Nightingale TD. Proximity proteomics identifies septins and PAK2 as decisive regulators of actomyosin-mediated expulsion of von Willebrand factor. Blood 2023; 141:930-944. [PMID: 36564030 PMCID: PMC10023740 DOI: 10.1182/blood.2022017419] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/07/2022] [Accepted: 11/27/2022] [Indexed: 12/25/2022] Open
Abstract
In response to tissue injury, within seconds the ultra-large glycoprotein von Willebrand factor (VWF) is released from endothelial storage organelles (Weibel-Palade bodies) into the lumen of the blood vasculature, where it leads to the recruitment of platelets. The marked size of VWF multimers represents an unprecedented burden on the secretory machinery of endothelial cells (ECs). ECs have evolved mechanisms to overcome this, most notably an actomyosin ring that forms, contracts, and squeezes out its unwieldy cargo. Inhibiting the formation or function of these structures represents a novel therapeutic target for thrombotic pathologies, although characterizing proteins associated with such a dynamic process has been challenging. We have combined APEX2 proximity labeling with an innovative dual loss-of-function screen to identify proteins associated with actomyosin ring function. We show that p21 activated kinase 2 (PAK2) recruits septin hetero-oligomers, a molecular interaction that forms a ring around exocytic sites. This cascade of events controls actomyosin ring function, aiding efficient exocytic release. Genetic or pharmacological inhibition of PAK2 or septins led to inefficient release of VWF and a failure to form platelet-catching strings. This new molecular mechanism offers additional therapeutic targets for the control of thrombotic disease and is highly relevant to other secretory systems that employ exocytic actomyosin machinery.
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Affiliation(s)
- Sammy El-Mansi
- Centre for Microvascular Research, William Harvey Research Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Christopher L. Robinson
- Centre for Microvascular Research, William Harvey Research Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Katja B. Kostelnik
- Centre for Microvascular Research, William Harvey Research Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Jessica J. McCormack
- MRC Laboratory of Molecular Cell Biology, University College London, London, United Kingdom
| | - Tom P. Mitchell
- Centre for Microvascular Research, William Harvey Research Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Damián Lobato-Márquez
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Vinothini Rajeeve
- Cell Signalling & Proteomics Group, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Pedro Cutillas
- Cell Signalling & Proteomics Group, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Daniel F. Cutler
- MRC Laboratory of Molecular Cell Biology, University College London, London, United Kingdom
| | - Serge Mostowy
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Thomas D. Nightingale
- Centre for Microvascular Research, William Harvey Research Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Wahab S, Kataria S, Woolley P, O'Hene N, Odinkemere C, Kim R, Urits I, Kaye AD, Hasoon J, Yazdi C, Robinson CL. Literature Review: Pericranial Nerve Blocks for Chronic Migraines. Health Psychol Res 2023; 11:74259. [PMID: 37139462 PMCID: PMC10151122 DOI: 10.52965/001c.74259] [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: 05/05/2023] Open
Abstract
Purpose of Review Headaches, especially migraines, are one of the most pervasive neurological disorders affecting up to 15.9% of the population. Current methods of migraine treatment include lifestyle changes, pharmacologic, and minimally invasive techniques such as peripheral nerve stimulation (PNS) and pericranial nerve blocks (PNB). Recent Findings PNBs are used to treat and prevent migraines and involves injection of local anesthetics with or without corticosteroids. PNBs include the greater occipital, supraorbital, supratrochlear, lesser occipital, auriculotemporal, sphenopalantine ganglion, and cervical root nerve blocks. Of the PNBs, the most extensively studied is the greater occipital nerve block (GONB) which has been shown to be an efficacious treatment for migraines, trigeminal neuralgia, hemi-crania continua, and post-lumbar puncture, post-concussive, cluster, and cervicogenic headaches but not medication overuse and chronic tension type headaches. Summary In this review, we aim to summarize the recent literature on PNBs and their efficacy in the treatment of migraines including a brief discussion of peripheral nerve stimulation.
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Affiliation(s)
- Stephanie Wahab
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston, MA
| | - Saurabh Kataria
- Louisiana State University Health Shreveport, Department of Neurology, Shreveport, LA
| | - Parker Woolley
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston, MA
| | - Naanama O'Hene
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston, MA
| | - Chima Odinkemere
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston, MA
| | - Rosa Kim
- Georgetown University Hospital, Department of General Surgery, Medstar, Washington, DC
| | | | - Alan D Kaye
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Jamal Hasoon
- UTHealth McGovern Medical School, Department of Anesthesiology, Critical Care and Pain Medicine, Houston, TX
| | - Cyrus Yazdi
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston, MA
| | - Christopher L Robinson
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston, MA
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Gomez YDLC, Remotti E, Momah DU, Zhang E, Swanson DD, Kim R, Urits I, Kaye AD, Robinson CL. Meralgia Paresthetica Review: Update on Presentation, Pathophysiology, and Treatment. Health Psychol Res 2023; 11:71454. [PMID: 36937080 PMCID: PMC10019995 DOI: 10.52965/001c.71454] [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: 03/17/2023] Open
Abstract
Purpose of Review Meralgia paresthetica (MP) is a condition characterized by paresthesias, neuropathic pain, and alterations in sensorium of the anterolateral thigh secondary to impingement of the lateral femoral cutaneous nerve (LFCN). MP is generally diagnosed by clinical history and is often a diagnosis of exclusion. When diagnosis remains a challenge, diagnostic modalities such as ultrasound, MRI, electromyography, and nerve conduction studies have been utilized as an adjunct. This review summarizes the most recent medical literature regarding MP, its pathophysiology, presentation, and current treatment options. Recent Findings Treatment options for patients with MP range from lifestyle modifications and conservative management to surgical procedures. Initial management is often conservative with symptoms managed with medications. When conservative management fails, the next step is regional blocks followed by surgical management. The conflicting data for treatment options for MP highlight how the evidence available does not point to a single approach that's universally effective for treating all patients with MP. Summary Despite the apparent success at treating MP with regional blocks and surgical interventions, much remains to be known about the dosing, frequency, and optimal interventions due to the inconclusive results of current studies. Further research including randomized controlled trials are needed to better understand the most optimal treatment options for MP including studies with a larger number of participants.
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Affiliation(s)
| | - Edgar Remotti
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Deandra Uju Momah
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Emily Zhang
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Daniel D Swanson
- Georgetown University Hospital, Department of General Surgery, Medstar, Washington, DC
| | - Rosa Kim
- Georgetown University Hospital, Department of General Surgery, Medstar, Washington, DC
| | | | - Alan D Kaye
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Christopher L Robinson
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
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Robinson CL, Parker K, Kataria S, Downs E, Supra R, Kaye AD, Viswanath O, Urits I. Viloxazine for the Treatment of Attention Deficit Hyperactivity Disorder. Health Psychol Res 2022; 10:38360. [DOI: 10.52965/001c.38360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose of Review Attention deficit hyperactivity disorder (ADHD) is a widely diagnosed neurodevelopmental disorder giving rise to symptoms of hyperactivity, impulsivity, and inattentiveness that can impair daily functioning. Stimulants, such as methylphenidate and amphetamines, are the mainstay of treatment for ADHD. However, nonstimulant drugs such as viloxazine, atomoxetine, guanfacine, and clonidine are becoming more popular due to minimal adverse effects when compared to stimulants. Recent Findings Viloxazine is a selective norepinephrine reuptake inhibitor (NRI) originally used to treat depression in adults with activity in both the noradrenergic as well as serotonergic pathways. Studies have demonstrated its efficacy for its use in the treatment of ADHD. Unlike stimulants, viloxazine has a decreased chance of substance abuse, drug dependance, and withdrawal symptoms upon the cessation of therapy. Additionally, dopamine levels in the nucleus accumbens after treatment with viloxazine are elevated considerably less in comparison with traditional stimulant ADHD treatments. Viloxazine provides an alternative, nonstimulant approach to treating ADHD. Summary Viloxazine is a recently approved, non-stimulant medication functions by inhibiting the uptake of norepinephrine which has been seen to be decreased in patients with ADHD. When patients do not respond to first-line stimulants, cannot tolerate the side effects, or have contraindications to stimulants, viloxazine may be a nonstimulant option offering patients an increasing arsenal of medications to treat ADHD.
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Affiliation(s)
| | - Katelyn Parker
- Louisiana State University Health New Orleans School of Medicine
| | - Saurabh Kataria
- Louisiana State University Health Science Center at Shreveport
| | - Evan Downs
- Louisiana State University Health New Orleans School of Medicine
| | | | - Alan D. Kaye
- Louisiana State University Health New Orleans School of Medicine
| | - Omar Viswanath
- Valley Anesthesiology and Pain Consultants, Envision Physician Services
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Robinson CL, Berger A, Sottosanti E, Li M, Kaneb A, Keefe J, Kim E, Kaye A, Viswanath O, Urits I. Acupuncture as Part of Multimodal Analgesia for Chronic Pain. Orthop Rev (Pavia) 2022; 14:38321. [DOI: 10.52965/001c.38321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Chronic pain is a multifactorial condition that is afflicting populations worldwide causing an increasing economic, physical, mental, and emotional burden. Treatments range from medications to interventional procedures to complementary and alternative medicine (CAM), such as acupuncture. This review aims to discuss the use of acupuncture in the treatment of chronic pain, proposed mechanisms, indications, and efficacy for various chronic pain conditions. Results Evidence is varied on the efficacy and quality of data on the use of acupuncture in the treatment of chronic pain. Recent studies have demonstrated promising results in the support of acupuncture for the use in the treatment of cancer, neck, and back pain, functional dyspepsia, and various chronic abdominal pain syndromes. Conclusion Acupuncture, deemed well-tolerated and safe to use, has been increasingly studied and is regarded as effective in clinical practice, but its efficacy is limited by the lack of well-conducted, high-quality clinical trials, lower quality evidence, and conflicting study results. Additionally, the exact analgesic mechanism of acupuncture remains to be fully elucidated. Increasing evidence supports the role of acupuncture as therapy in the treatment of cancer, neck, and back pain and functional dyspepsia. Further rigorous studies are needed to fully assess the use of acupuncture in various chronic pain conditions, determine its indications, and optimal treatment schedule. Overall, future studies could benefit from better designed experimental studies, larger groups, and more objectives ways to measure pain reduction and symptom improvement.
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Vij N, Kaley HN, Robinson CL, Issa PP, Kaye AD, Viswanath O, Urits I. Clinical Results Following Conservative Management of Tarsal Tunnel Syndrome Compared With Surgical Treatment: A Systematic Review. Orthop Rev (Pavia) 2022; 14:37539. [PMID: 36072502 DOI: 10.52965/001c.37539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction Posterior tarsal tunnel syndrome involves entrapment of the posterior tibial nerve as it travels in the groove posterior to the medial malleolus. Conventional wisdom dictates that patients with tarsal tunnel syndrome be treated with conservative treatment and medical management, with surgical options available for patients with refractory symptoms and good candidacy. Minimally invasive options for neuropathic entrapment syndromes have developed in recent years and may provide a therapeutic role in tarsal tunnel syndrome. Objective The present investigation provides a summary of the current state of knowledge on tarsal tunnel syndrome and a comparison between minimally invasive and surgical treatment options. Methods The literature search was performed in Mendeley. Search fields were varied until redundant. All articles were screened by title and abstract and a preliminary decision to include an article was made. A full-text screening was performed on the selected articles. Any question regarding the inclusion of an article was discussed by 3 authors until an agreement was reached. Results Most commonly tarsal tunnel syndrome is idiopathic. Other reported causes include post-traumatic, lipomas, cysts, ganglia, schwannomas, ganglia, varicose plantar veins, anatomic anomalies, and systematic inflammatory conditions. Several risk factors have been described including female gender, athletic participation, hypothyroidism, diabetes mellitus, systemic sclerosis, chronic renal failure, and hemodialysis use. A few recent studies demonstrate anatomic variants that have not previously been summarized. Three articles describe clinical outcomes after conservative treatment with acceptable results for first line treatment. Two primary articles report on the use of minimally invasive treatment for tarsal tunnel syndrome. Fourteen articles report on the clinical outcomes after surgical management. Conclusion Clinical understanding of tarsal tunnel syndrome has evolved significantly, particularly with regards to the pathoanatomy of the tarsal canal over the past twelve years. A few novel anatomic studies shed light on variants that can be helpful in diagnosis. Conservative management remains a good option that can resolve the symptoms of many patients. As more prospective cohorts and clinical trials are performed on minimally invasive options, pulsed radiofrequency and neuromodulation may evolve to play a larger role in the treatment of this condition. Currently, surgical treatment is only pursued in a very select group of patients with refractory symptoms that do not respond to medical or minimally invasive options. Surgical outcomes in the literature are good and current evidence is stronger than that for minimally invasive options.
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Affiliation(s)
- Neeraj Vij
- University of Arizona College of Medicine - Phoenix
| | | | - Christopher L Robinson
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Peter P Issa
- Louisiana State University Health Shreveport School of Medicine
| | - Alan D Kaye
- Louisiana State University, Department of Anesthesiology
| | - Omar Viswanath
- Louisiana State University Health Shreveport, Department of Anesthesiology; Creighton University School of Medicine, Department of Anesthesiology
| | - Ivan Urits
- Department of Anesthesiology, Louisiana State University Health Shreveport
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Robinson CL, Supra R, Downs E, Kataria S, Parker K, Kaye A, Viswanath O, Urits I. Daridorexant for the Treatment of Insomnia. Health Psychol Res 2022; 10:37400. [PMID: 36045942 DOI: 10.52965/001c.37400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/19/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose of Review Insomnia is a complex sleeping disorder that affects the lives of many individuals worldwide. Insomnia often occurs in the presence of coexisting comorbidities making it a complex disorder that requires a multifactorial approach to therapy. First-line therapy is cognitive-behavioral therapy for insomnia (CBT-I). Pharmacotherapy for insomnia falls into four classes based on mechanism of action: benzodiazepine receptor agonists (BZRAs), histamine receptor antagonists, melatonin receptor agonists, and dual orexin receptor antagonists (DORAs). Recent Findings Daridorexant is a dual orexin type 1 and types 2 (OX1 and OX2) receptor antagonist that was recently approved by the US FDA for the treatment of adults suffering from insomnia. It was shown to be effective in reducing insomnia symptoms, increasing daytime functioning, and improving the overall quality of sleep. Daridorexant offers patients relief from insomnia while avoiding the severe side effects and dependency issues of traditional treatments like benzodiazepines and sedatives. Summary In this article, we review the most recent data on insomnia treatments and summarize the safety and efficacy of daridorexant in treating insomnia.
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Affiliation(s)
| | | | - Evan Downs
- Louisiana State University Health New Orleans School of Medicine
| | - Saurabh Kataria
- Department of Neurology, Louisiana State University Health Science Center at Shreveport
| | - Katelyn Parker
- Louisiana State University Health New Orleans School of Medicine
| | - Alan Kaye
- Department of Anesthesia, Louisiana State University Health New Orleans School of Medicine
| | - Omar Viswanath
- Envision Physician Services, Valley Anesthesiology and Pain Consultants
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Robinson CL, Kim RS, Li M, Ruan QZ, Surapaneni S, Jones M, Pak DJ, Southerland W. The Impact of Smoking on the Development and Severity of Chronic Pain. Curr Pain Headache Rep 2022; 26:575-581. [PMID: 35731364 DOI: 10.1007/s11916-022-01060-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to examine the impact of smoking and its role on the development of chronic pain and provide a critical review of recent literature. RECENT FINDINGS Recent studies demonstrate the bidirectional and dependent relationship between smoking and chronic pain. Those who are in pain have a more difficult time in the cessation of smoking as well as an increased sensitivity to pain during abstinence, lower confidence, and higher relapse rates. The fear of pain and the anxiety and depression that abstinence causes results in a grim outcome for long-term cessation. The dependent nature between chronic pain and smoking is affected by numerous variables. Providers should consider a multiprong approach to treating chronic pain and targeting smoking cessation treatment by providing motivational therapy, nicotine replacement, and medication therapies to prevent relapse, and providing those who are more likely to relapse with a higher level of care.
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Affiliation(s)
- Christopher L Robinson
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
| | - Rosa S Kim
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, USA
| | - Michael Li
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Qing Zhao Ruan
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Sindhuja Surapaneni
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Mark Jones
- Department of Anesthesia, Weill Cornell Medical College, New York, NY, USA
| | - Daniel J Pak
- Department of Anesthesia, Weill Cornell Medical College, New York, NY, USA
| | - Warren Southerland
- Department of Anesthesia, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Robinson CL, Sethupathi SK, Fairley JA, Link BK, Liu V. A mutilating, persistent lip ulcer as a presenting sign of oral mycosis fungoides with large cell transformation. JAAD Case Rep 2021; 10:14-17. [PMID: 33732838 PMCID: PMC7941007 DOI: 10.1016/j.jdcr.2021.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Christopher L Robinson
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | | | - Janet A Fairley
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Brian K Link
- Division of Hematology, Oncology and Blood & Bone Marrow Transplantation, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Vincent Liu
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City, Iowa.,Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Alzahofi N, Welz T, Robinson CL, Page EL, Briggs DA, Stainthorp AK, Reekes J, Elbe DA, Straub F, Kallemeijn WW, Tate EW, Goff PS, Sviderskaya EV, Cantero M, Montoliu L, Nedelec F, Miles AK, Bailly M, Kerkhoff E, Hume AN. Rab27a co-ordinates actin-dependent transport by controlling organelle-associated motors and track assembly proteins. Nat Commun 2020; 11:3495. [PMID: 32661310 PMCID: PMC7359353 DOI: 10.1038/s41467-020-17212-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 06/04/2020] [Indexed: 11/09/2022] Open
Abstract
Cell biologists generally consider that microtubules and actin play complementary roles in long- and short-distance transport in animal cells. On the contrary, using melanosomes of melanocytes as a model, we recently discovered that the motor protein myosin-Va works with dynamic actin tracks to drive long-range organelle dispersion in opposition to microtubules. This suggests that in animals, as in yeast and plants, myosin/actin can drive long-range transport. Here, we show that the SPIRE-type actin nucleators (predominantly SPIRE1) are Rab27a effectors that co-operate with formin-1 to generate actin tracks required for myosin-Va-dependent transport in melanocytes. Thus, in addition to melanophilin/myosin-Va, Rab27a can recruit SPIREs to melanosomes, thereby integrating motor and track assembly activity at the organelle membrane. Based on this, we suggest a model in which organelles and force generators (motors and track assemblers) are linked, forming an organelle-based, cell-wide network that allows their collective activity to rapidly disperse the population of organelles long-distance throughout the cytoplasm.
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Affiliation(s)
- Noura Alzahofi
- School of Life Sciences, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Tobias Welz
- University Hospital Regensburg, Regensburg, Germany
| | | | - Emma L Page
- School of Life Sciences, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Deborah A Briggs
- School of Life Sciences, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Amy K Stainthorp
- School of Life Sciences, University of Nottingham, Nottingham, NG7 2UH, UK
| | - James Reekes
- School of Life Sciences, University of Nottingham, Nottingham, NG7 2UH, UK
| | - David A Elbe
- School of Life Sciences, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Felix Straub
- University Hospital Regensburg, Regensburg, Germany
| | - Wouter W Kallemeijn
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, London, W12 0BZ, UK
| | - Edward W Tate
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, London, W12 0BZ, UK
| | - Philip S Goff
- Cell Biology and Genetics Research Centre, St. George's, University of London, London, SW17 0RE, UK
| | - Elena V Sviderskaya
- Cell Biology and Genetics Research Centre, St. George's, University of London, London, SW17 0RE, UK
| | - Marta Cantero
- Centro Nacional de Biotecnologia (CNB-CSIC), Madrid, 28049, Spain
- CIBERER-ISCIII, Madrid, Spain
| | - Lluis Montoliu
- Centro Nacional de Biotecnologia (CNB-CSIC), Madrid, 28049, Spain
- CIBERER-ISCIII, Madrid, Spain
| | - Francois Nedelec
- Sainsbury Laboratory, Cambridge University, Cambridge, CB2 1LR, UK
| | - Amanda K Miles
- John van Geest Cancer Research Centre, Nottingham Trent University, Nottingham, NG11 8NS, UK
| | - Maryse Bailly
- UCL Institute of Ophthalmology, 11-43 Bath St, London, EC1V 9EL, UK
| | | | - Alistair N Hume
- School of Life Sciences, University of Nottingham, Nottingham, NG7 2UH, UK.
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Robinson CL, Evans RD, Sivarasa K, Ramalho JS, Briggs DA, Hume AN. The adaptor protein melanophilin regulates dynamic myosin-Va:cargo interaction and dendrite development in melanocytes. Mol Biol Cell 2019; 30:742-752. [PMID: 30699046 PMCID: PMC6589771 DOI: 10.1091/mbc.e18-04-0237] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The regulation of organelle transport by the cytoskeleton is fundamental for eukaryotic survival. Cytoskeleton motors are typically modular proteins with conserved motor and diverse cargo-binding domains. Motor:cargo interactions are often indirect and mediated by adaptor proteins, for example, Rab GTPases. Rab27a, via effector melanophilin (Mlph), recruits myosin-Va (MyoVa) to melanosomes and thereby disperses them into melanocyte dendrites. To better understand how adaptors regulate motor:cargo interaction, we used single melanosome fluorescence recovery after photobleaching (smFRAP) to characterize the association kinetics among MyoVa, its adaptors, and melanosomes. We found that MyoVa and Mlph rapidly recovered after smFRAP, whereas Rab27a did not, indicating that MyoVa and Mlph dynamically associate with melanosomes and Rab27a does not. This suggests that dynamic Rab27a:effector interaction rather than Rab27a melanosome:cytosol cycling regulates MyoVa:melanosome association. Accordingly, a Mlph-Rab27a fusion protein reduced MyoVa smFRAP, indicating that it stabilized melanosomal MyoVa. Finally, we tested the functional importance of dynamic MyoVa:melanosome interaction. We found that whereas a MyoVa-Rab27a fusion protein dispersed melanosomes in MyoVa-deficient cells, dendrites were significantly less elongated than in wild-type cells. Given that dendrites are the prime sites of melanosome transfer from melanocytes to keratinocytes, we suggest that dynamic MyoVa:melanosome interaction is important for pigmentation in vivo.
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Affiliation(s)
| | - Richard D Evans
- School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Kajana Sivarasa
- School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Jose S Ramalho
- CEDOC Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
| | - Deborah A Briggs
- School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Alistair N Hume
- School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, United Kingdom
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Zhou T, Kim TW, Chong CN, Tan L, Amin S, Sadat Badieyan Z, Mukherjee S, Ghazizadeh Z, Zeng H, Guo M, Crespo M, Zhang T, Kenyon R, Robinson CL, Apostolou E, Wang H, Xiang JZ, Evans T, Studer L, Chen S. A hPSC-based platform to discover gene-environment interactions that impact human β-cell and dopamine neuron survival. Nat Commun 2018; 9:4815. [PMID: 30446643 PMCID: PMC6240096 DOI: 10.1038/s41467-018-07201-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 10/23/2018] [Indexed: 01/12/2023] Open
Abstract
Common disorders, including diabetes and Parkinson’s disease, are caused by a combination of environmental factors and genetic susceptibility. However, defining the mechanisms underlying gene-environment interactions has been challenging due to the lack of a suitable experimental platform. Using pancreatic β-like cells derived from human pluripotent stem cells (hPSCs), we discovered that a commonly used pesticide, propargite, induces pancreatic β-cell death, a pathological hallmark of diabetes. Screening a panel of diverse hPSC-derived cell types we extended this observation to a similar susceptibility in midbrain dopamine neurons, a cell type affected in Parkinson’s disease. We assessed gene-environment interactions using isogenic hPSC lines for genetic variants associated with diabetes and Parkinson’s disease. We found GSTT1−/− pancreatic β-like cells and dopamine neurons were both hypersensitive to propargite-induced cell death. Our study identifies an environmental chemical that contributes to human β-cell and dopamine neuron loss and validates a novel hPSC-based platform for determining gene-environment interactions. Diseases such as diabetes and Parkinson's manifest based on interactions between genes and environment. Here, the authors find among a panel of cell types that propargite, a common pesticide, induces pancreatic β-cell and dopamine neuron death and that loss of the gene GSTT1 confers hypersensitivity.
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Affiliation(s)
- Ting Zhou
- Department of Surgery, Weill Cornell Medical College, 1300 York Ave, New York, 10065, NY, USA
| | - Tae Wan Kim
- The Center for Stem Cell Biology, Sloan-Kettering Institute for Cancer Research, New York, NY, 10065, USA.,Developmental Biology Program, Sloan-Kettering Institute for Cancer Research, New York, NY, 10065, USA
| | - Chi Nok Chong
- Department of Surgery, Weill Cornell Medical College, 1300 York Ave, New York, 10065, NY, USA
| | - Lei Tan
- Department of Surgery, Weill Cornell Medical College, 1300 York Ave, New York, 10065, NY, USA.,School of Public health, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200000, China
| | - Sadaf Amin
- Department of Surgery, Weill Cornell Medical College, 1300 York Ave, New York, 10065, NY, USA
| | - Zohreh Sadat Badieyan
- Department of Surgery, Weill Cornell Medical College, 1300 York Ave, New York, 10065, NY, USA
| | - Suranjit Mukherjee
- Department of Surgery, Weill Cornell Medical College, 1300 York Ave, New York, 10065, NY, USA
| | - Zaniar Ghazizadeh
- Department of Surgery, Weill Cornell Medical College, 1300 York Ave, New York, 10065, NY, USA
| | - Hui Zeng
- Department of Surgery, Weill Cornell Medical College, 1300 York Ave, New York, 10065, NY, USA
| | - Min Guo
- Department of Surgery, Weill Cornell Medical College, 1300 York Ave, New York, 10065, NY, USA
| | - Miguel Crespo
- Department of Surgery, Weill Cornell Medical College, 1300 York Ave, New York, 10065, NY, USA
| | - Tuo Zhang
- Genomic Resource Core Facility, Weill Cornell Medical College, 1300 York Ave, New York, 10065, NY, USA
| | - Reyn Kenyon
- Department of Surgery, Weill Cornell Medical College, 1300 York Ave, New York, 10065, NY, USA
| | - Christopher L Robinson
- Department of Surgery, Weill Cornell Medical College, 1300 York Ave, New York, 10065, NY, USA
| | - Effie Apostolou
- Department of Medicine, Weill Cornell Medical College, 1300 York Ave, New York, 10065, NY, USA
| | - Hui Wang
- School of Public health, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200000, China
| | - Jenny Zhaoying Xiang
- Genomic Resource Core Facility, Weill Cornell Medical College, 1300 York Ave, New York, 10065, NY, USA
| | - Todd Evans
- Department of Surgery, Weill Cornell Medical College, 1300 York Ave, New York, 10065, NY, USA
| | - Lorenz Studer
- The Center for Stem Cell Biology, Sloan-Kettering Institute for Cancer Research, New York, NY, 10065, USA. .,Developmental Biology Program, Sloan-Kettering Institute for Cancer Research, New York, NY, 10065, USA.
| | - Shuibing Chen
- Department of Surgery, Weill Cornell Medical College, 1300 York Ave, New York, 10065, NY, USA. .,Department of Biochemistry, Weill Cornell Medical College, 1300 York Ave, New York, 10065, NY, USA.
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Robinson CL, Chong ACN, Ashbrook AW, Jeng G, Jin J, Chen H, Tang EI, Martin LA, Kim RS, Kenyon RM, Do E, Luna JM, Saeed M, Zeltser L, Ralph H, Dudley VL, Goldstein M, Rice CM, Cheng CY, Seandel M, Chen S. Male germ cells support long-term propagation of Zika virus. Nat Commun 2018; 9:2090. [PMID: 29844387 PMCID: PMC5974187 DOI: 10.1038/s41467-018-04444-w] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/26/2018] [Indexed: 01/22/2023] Open
Abstract
Evidence of male-to-female sexual transmission of Zika virus (ZIKV) and viral RNA in semen and sperm months after infection supports a potential role for testicular cells in ZIKV propagation. Here, we demonstrate that germ cells (GCs) are most susceptible to ZIKV. We found that only GCs infected by ZIKV, but not those infected by dengue virus and yellow fever virus, produce high levels of infectious virus. This observation coincides with decreased expression of interferon-stimulated gene Ifi44l in ZIKV-infected GCs, and overexpression of Ifi44l results in reduced ZIKV production. Using primary human testicular tissue, we demonstrate that human GCs are also permissive for ZIKV infection and production. Finally, we identified berberine chloride as a potent inhibitor of ZIKV infection in both murine and human testes. Together, these studies identify a potential cellular source for propagation of ZIKV in testes and a candidate drug for preventing sexual transmission of ZIKV.
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Affiliation(s)
- Christopher L Robinson
- Department of Surgery, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Angie C N Chong
- Department of Surgery, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Alison W Ashbrook
- Laboratory of Virology and Infectious Disease, Center for the Study of Hepatitis C, The Rockefeller University, New York, NY, 10065, USA
| | - Ginnie Jeng
- Department of Surgery, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Julia Jin
- Department of Surgery, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Haiqi Chen
- The Mary M. Wohlford Laboratory for Male Contraceptive Research, Center for Biomedical Research, Population Council, 1230 York Avenue, New York, NY, 10065, USA
| | - Elizabeth I Tang
- The Mary M. Wohlford Laboratory for Male Contraceptive Research, Center for Biomedical Research, Population Council, 1230 York Avenue, New York, NY, 10065, USA
| | - Laura A Martin
- Department of Surgery, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Rosa S Kim
- Penn State College of Medicine, Hershey, PA, 17033, USA
| | - Reyn M Kenyon
- Department of Surgery, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Eileen Do
- Department of Surgery, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Joseph M Luna
- Laboratory of Virology and Infectious Disease, Center for the Study of Hepatitis C, The Rockefeller University, New York, NY, 10065, USA
| | - Mohsan Saeed
- Laboratory of Virology and Infectious Disease, Center for the Study of Hepatitis C, The Rockefeller University, New York, NY, 10065, USA
| | - Lori Zeltser
- Naomi Berrie Diabetes Center, Columbia University, New York, NY, 10032, USA.,Department of Pathology and Cell Biology, Columbia University, New York, NY, 10032, USA
| | - Harold Ralph
- Weill Cornell Medical College-Microscopy and Image Analysis Core Facility, 1300 York Avenue, New York, NY, 10065, USA
| | - Vanessa L Dudley
- Institute of Reproductive Medicine at Weill Cornell Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, 10065, USA
| | - Marc Goldstein
- Department of Urology and Institute for Reproductive Medicine, Weill Cornell Medical College of Cornell University, New York, NY, 10065, USA
| | - Charles M Rice
- Laboratory of Virology and Infectious Disease, Center for the Study of Hepatitis C, The Rockefeller University, New York, NY, 10065, USA
| | - C Yan Cheng
- The Mary M. Wohlford Laboratory for Male Contraceptive Research, Center for Biomedical Research, Population Council, 1230 York Avenue, New York, NY, 10065, USA.
| | - Marco Seandel
- Department of Surgery, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA.
| | - Shuibing Chen
- Department of Surgery, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA. .,Department of Biochemistry, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA.
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Zhang L, Schütz LF, Robinson CL, Totty ML, Spicer LJ. Evidence that gene expression of ovarian follicular tight junction proteins is regulated in vivo and in vitro in cattle. J Anim Sci 2017; 95:1313-1324. [PMID: 28380519 DOI: 10.2527/jas.2016.0892] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Tight junctions (TJ) are common paracellular sealing structures that control the transport of water, ions, and macromolecules across cell layers. Because the role of TJ in bovine follicular development is unknown, we investigated the developmental and hormonal regulation of the transmembrane TJ protein, occludin (OCLN), and the cytoplasmic TJ proteins, TJ protein 1 (TJP1) and cingulin (CGN) in bovine granulosa cells (GC) and theca cells (TC). For this purpose, bovine GC and TC were isolated from large (>8 mm) and/or small (1 to 5 mm) follicles and either extracted for real-time PCR (qPCR) or cultured in vitro. The abundances of both and mRNA were greater ( < 0.05) in TC than GC, whereas the mRNA abundance was greater ( < 0.05) in GC than TC. The abundance of mRNA in both GC and TC was greater ( < 0.05) in small follicles compared with large follicles, whereas the GC of large follicles had less ( < 0.05) mRNA abundance than the GC of small follicles. The abundance of mRNA in GC or TC did not differ ( > 0.10) among follicle sizes. In vitro treatment with various growth factors known to affect ovarian folliculogenesis indicated that , , and were hormonally regulated. Fibroblast growth factor 9 (FGF9) decreased ( < 0.05) the and mRNA abundances. Tumor necrosis factor α (TNFα) and vascular endothelial growth factor A (VEGFA) increased ( < 0.05) the mRNA abundance but decreased ( < 0.05) the mRNA abundance. Dexamethasone (DEX) increased ( < 0.05) and mRNA abundances. Epidermal growth factor (EGF) decreased ( < 0.05) and dihydrotestosterone (DHT) increased ( < 0.05) the abundances of , , and mRNA. We propose that the downregulation of OCLN and other TJ proteins during follicular development could reduce barrier function, thereby participating in increasing follicle size by allowing for an increase in the volume of follicular fluid as well as by allowing additional serum factors into the follicular fluid that potentially may directly impact GC functions. The results of the current study indicate the following in cattle: 1) gene expression of TJ proteins (i.e., , , and ) differs between GC and TC and changes with follicle size, and 2) autocrine, paracrine, and endocrine regulators, such as FGF9, EGF, DHT, TNFα, and glucocorticoids, modulate , , and mRNA abundance in TC in vitro.
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Robinson CL, Evans RD, Briggs DA, Ramalho JS, Hume AN. Inefficient recruitment of kinesin-1 to melanosomes precludes it from facilitating their transport. J Cell Sci 2017; 130:2056-2065. [PMID: 28490438 PMCID: PMC5482976 DOI: 10.1242/jcs.186064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/03/2017] [Indexed: 12/25/2022] Open
Abstract
Microtubules and F-actin, and their associated motor proteins, are considered to play complementary roles in long- and short-range organelle transport. However, there is growing appreciation that myosin/F-actin networks can drive long-range transport. In melanocytes, myosin-Va and kinesin-1 have both been proposed as long-range centrifugal transporters moving melanosomes into the peripheral dendrites. Here, we investigated the role of kinesin-1 heavy chain (Kif5b) and its suggested targeting factor Rab1a in transport. We performed confocal microscopy and subcellular fractionation, but did not detect Kif5b or Rab1a on melanosomes. Meanwhile functional studies, using siRNA knockdown and dominant negative mutants, did not support a role for Kif5b or Rab1a in melanosome transport. To probe the potential of Kif5b to function in transport, we generated fusion proteins that target active Kif5b to melanosomes and tested their ability to rescue perinuclear clustering in myosin-Va-deficient cells. Expression of these chimeras, but not full-length Kif5b, dispersed melanosomes with similar efficiency to myosin-Va. Our data indicate that kinesin and microtubules can compensate for defects in myosin-Va and actin-based transport in mammals, but that endogenous Kif5b does not have an important role in transport of melanocytes due to its inefficient recruitment to melanosomes. Highlighted Article: We show that Kif5b can compensate for defects in myosin-Va-based transport in mammals, but that endogenous Kif5b plays a minimal role in transport in melanocytes due to inefficient recruitment to melanosomes.
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Affiliation(s)
| | - Richard D Evans
- School of Life Sciences, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Deborah A Briggs
- School of Life Sciences, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Jose S Ramalho
- CEDOC Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
| | - Alistair N Hume
- School of Life Sciences, University of Nottingham, Nottingham, NG7 2UH, UK
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Kim RS, Hasegawa D, Goossens N, Tsuchida T, Athwal V, Sun X, Robinson CL, Bhattacharya D, Chou HI, Zhang DY, Fuchs BC, Lee Y, Hoshida Y, Friedman SL. The XBP1 Arm of the Unfolded Protein Response Induces Fibrogenic Activity in Hepatic Stellate Cells Through Autophagy. Sci Rep 2016; 6:39342. [PMID: 27996033 PMCID: PMC5172197 DOI: 10.1038/srep39342] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/18/2016] [Indexed: 02/07/2023] Open
Abstract
Autophagy and the unfolded protein response (UPR) both promote activation of hepatic stellate cells (HSC), however the link between the two stimuli remains unclear. Here we have explored the role of X-box binding protein 1 (XBP1), one of three UPR effector pathways and sought to establish the interdependence between autophagy and the UPR during HSC activation. XBP1 induction accompanied both culture-based HSC activation and ER stress induced by tunicamycin. Ectopic overexpression of XBP1 induced collagen 1-alpha expression in HSCs, which was inhibited by knockdown of ATG7, a critical autophagy mediator. Genome-wide transcriptomic profiling indicated an upregulation of collagen synthesis pathways, but not of the transforming growth factor (TGF)-b pathway, a canonical fibrogenic driver, suggesting that XBP1 activates a specific subset of fibrogenesis pathways independent of TGF-β1. XBP1 target gene signatures were significantly induced in rodent liver fibrosis models (n = 3-5) and in human samples of non-alcoholic fatty liver disease (NAFLD) (n = 72-135). Thus, XBP1-mediated UPR contributes to fibrogenic HSC activation and is functionally linked to cellular autophagy.
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Affiliation(s)
- Rosa S. Kim
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, US
| | - Daisuke Hasegawa
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, US
- Divisions of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Nicolas Goossens
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, US
- Divisions of Gastroenterology and Hepatology, Geneva University Hospital, Geneva, Switzerland
| | - Takuma Tsuchida
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, US
- Research Division, Mitsubishi Tanabe Pharma Corporation, Saitama, Japan
| | - Varinder Athwal
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, US
- Institute of Human Development, University of Manchester, United Kingdom
| | - Xiaochen Sun
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, US
| | | | - Dipankar Bhattacharya
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, US
| | - Hsin-I Chou
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, US
| | - David Y. Zhang
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, US
| | - Bryan C. Fuchs
- Division of Surgical Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, US
| | - Youngmin Lee
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, US
| | - Yujin Hoshida
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, US
| | - Scott L. Friedman
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, US
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Simsek S, Zhou T, Robinson CL, Tsai SY, Crespo M, Amin S, Lin X, Hon J, Evans T, Chen S. Modeling Cystic Fibrosis Using Pluripotent Stem Cell-Derived Human Pancreatic Ductal Epithelial Cells. Stem Cells Transl Med 2016; 5:572-9. [PMID: 27034411 DOI: 10.5966/sctm.2015-0276] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/07/2015] [Indexed: 01/25/2023] Open
Abstract
UNLABELLED We established an efficient strategy to direct human pluripotent stem cells, including human embryonic stem cells (hESCs) and an induced pluripotent stem cell (iPSC) line derived from patients with cystic fibrosis, to differentiate into pancreatic ductal epithelial cells (PDECs). After purification, more than 98% of hESC-derived PDECs expressed functional cystic fibrosis transmembrane conductance regulator (CFTR) protein. In addition, iPSC lines were derived from a patient with CF carrying compound frameshift and mRNA splicing mutations and were differentiated to PDECs. PDECs derived from Weill Cornell cystic fibrosis (WCCF)-iPSCs showed defective expression of mature CFTR protein and impaired chloride ion channel activity, recapitulating functional defects of patients with CF at the cellular level. These studies provide a new methodology to derive pure PDECs expressing CFTR and establish a "disease in a dish" platform to identify drug candidates to rescue the pancreatic defects of patients with CF. SIGNIFICANCE An efficient strategy was established to direct human pluripotent stem cells, including human embryonic stem cells (hESCs) and an induced pluripotent stem cell line derived from patients with cystic fibrosis (CF-iPSCs), to differentiate into pancreatic ductal epithelial cells (PDECs). After purification, more than 98% of hESC-PDECs derived from CF-iPSCs showed defective expression of mature cystic fibrosis transmembrane conductance regulator (CFTR) protein and impaired chloride ion channel activity, recapitulating functional pancreatic defects of patients with CF at the cellular level. These studies provide a new methodology for deriving pure PDECs expressing CFTR, and they establish a "disease-in-a-dish" platform for identifying drug candidates to rescue the pancreatic defects of these patients.
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Affiliation(s)
- Senem Simsek
- Department of Surgery, Weill Cornell Medical College, New York, New York, USADepartment of Biochemistry, Weill Cornell Medical College, New York, New York, USA
| | - Ting Zhou
- Department of Surgery, Weill Cornell Medical College, New York, New York, USADepartment of Biochemistry, Weill Cornell Medical College, New York, New York, USA
| | - Christopher L Robinson
- Department of Surgery, Weill Cornell Medical College, New York, New York, USADepartment of Biochemistry, Weill Cornell Medical College, New York, New York, USA
| | - Su-Yi Tsai
- Department of Surgery, Weill Cornell Medical College, New York, New York, USADepartment of Biochemistry, Weill Cornell Medical College, New York, New York, USA
| | - Miguel Crespo
- Department of Surgery, Weill Cornell Medical College, New York, New York, USADepartment of Biochemistry, Weill Cornell Medical College, New York, New York, USA
| | - Sadaf Amin
- Department of Surgery, Weill Cornell Medical College, New York, New York, USADepartment of Biochemistry, Weill Cornell Medical College, New York, New York, USA
| | - Xiangyi Lin
- Department of Surgery, Weill Cornell Medical College, New York, New York, USADepartment of Biochemistry, Weill Cornell Medical College, New York, New York, USA
| | - Jane Hon
- Department of Surgery, Weill Cornell Medical College, New York, New York, USADepartment of Biochemistry, Weill Cornell Medical College, New York, New York, USA
| | - Todd Evans
- Department of Surgery, Weill Cornell Medical College, New York, New York, USADepartment of Biochemistry, Weill Cornell Medical College, New York, New York, USA
| | - Shuibing Chen
- Department of Surgery, Weill Cornell Medical College, New York, New York, USADepartment of Biochemistry, Weill Cornell Medical College, New York, New York, USA
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Checkley W, Robinson CL, Baumann LM, Hansel NN, Romero KM, Pollard SL, Wise RA, Gilman RH, Mougey E, Lima JJ. 25-hydroxy vitamin D levels are associated with childhood asthma in a population-based study in Peru. Clin Exp Allergy 2015; 45:273-82. [PMID: 24666565 DOI: 10.1111/cea.12311] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 02/06/2014] [Accepted: 02/09/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Vitamin D deficiency may be associated with an increased risk of asthma. OBJECTIVE We studied the association between 25-hydroxy (25-OH) vitamin D deficiency and asthma prevalence in two Peruvian populations close to the equator but with disparate degrees of urbanization. METHODS We conducted a population-based study in 1441 children in two communities in Peru, of which 1134 (79%) provided a blood sample for 25-OH vitamin D analysis. RESULTS In these 1134 children, mean age was 14.8 years; 52% were boys; asthma and atopy prevalence was 12% in Lima vs. 3% in Tumbes (P < 0.001) and 59% in Lima vs. 41% in Tumbes (P < 0.001), respectively; and, mean 25-OH vitamin D level was 20.8 ng/mL in Lima vs. 30.1 ng/mL in Tumbes (P < 0.001). Prevalence of 25-OH vitamin D deficiency (< 20 ng/mL) was 47% in Lima vs. 7% in Tumbes (P < 0.001). In multi-variable logistic regression, we found that lower 25-OH vitamin D levels were associated with an increased odds of asthma (OR = 1.7 per each 10 ng/mL decrease in 25-OH vitamin D levels, 95% CI 1.2-2.6; P < 0.01). In stratified analyses, the association between lower 25-OH vitamin D levels and asthma was limited to children with atopy (OR = 2.2, 95% CI 1.3-3.6) and not in those without atopy (OR = 0.9, 95% CI 0.5-2.0). We did not find associations between 25-OH vitamin D levels and other clinical biomarkers for asthma, including exhaled nitric oxide, total serum IgE and pulmonary function. CONCLUSION AND CLINICAL RELEVANCE Both asthma and 25-OH vitamin D deficiency were common among children living in Lima (latitude = 12.0 °S) but not among those in Tumbes (3.6 °S). The relationship between 25-OH vitamin D deficiency and asthma was similar in both sites and was limited among children with atopy. Future supplementation trials may need to consider stratification by atopy at the time of design.
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Affiliation(s)
- W Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Program in Global Disease Epidemiology and Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Baumann LM, Romero KM, Robinson CL, Hansel NN, Gilman RH, Hamilton RG, Lima JJ, Wise RA, Checkley W. Prevalence and risk factors for allergic rhinitis in two resource-limited settings in Peru with disparate degrees of urbanization. Clin Exp Allergy 2015; 45:192-9. [PMID: 25059756 DOI: 10.1111/cea.12379] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 05/25/2014] [Accepted: 05/31/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Allergic rhinitis is a disease with a high global disease burden, but risk factors that contribute to this condition are not well understood. OBJECTIVE To assess the prevalence and risk factors of allergic rhinitis in two Peruvian populations with disparate degrees of urbanization. METHODS We conducted a population-based, cross-sectional study on 1441 children aged 13-15 years at enrollment (mean age 14.9 years, 51% boys) to investigate the prevalence of allergic disease. We used a standardized, Spanish validated questionnaire to determine the prevalence of allergic rhinitis and asked about sociodemographics and family history of allergies. Children also underwent spirometry, exhaled nitric oxide, allergy skin testing to 10 common household allergens and provided a blood sample for measurement of 25OH vitamin D and total serum IgE. RESULTS Overall prevalence of allergic rhinitis was 18% (95% CI 16% to 20%). When stratified by site, the prevalence of allergic rhinitis was 23% Lima vs. 13% in Tumbes (P < 0.001); however, this difference was no longer significant after controlling for subject-specific factors (P = 0.95). There was a strong association with other allergic diseases: 53% of children with asthma had allergic rhinitis vs. 15% in those without asthma (P < 0.001) and 42% of children with eczema vs. 17% of those without eczema (P < 0.001). Important risk factors for allergic rhinitis were parental rhinitis (adjusted OR = 3.0, 95% CI 1.9-4.7 for 1 parent and adjusted OR = 4.4, 95% CI 1.5-13.7 for 2 parents); allergic sensitization to common household aeroallergens (1.6, 1.1-2.3); being overweight (1.5, 1.0-2.3); exhaled nitric oxide ≥ 20 ppb (1.9, 1.3-2.7); and total serum IgE ≥ 95th percentile (2.4, 1.2-4.8). Population attributable risk of important factors for allergic rhinitis were 25% for high exhaled nitric oxide, 22% for allergic sensitization to common household aeroallergens, 22% for paternal rhinitis, 10% for being overweight and 7% for an elevated total serum IgE. CONCLUSION AND CLINICAL RELEVANCE Allergic rhinitis was prevalent in both settings, and important risk factors include elevated exhaled nitric oxide, allergic sensitization to common household aeroallergens, parental rhinitis, being overweight and high total serum IgE. When considering subject-specific factors, the difference in prevalence between the urban and rural settings became non-important.
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Affiliation(s)
- L M Baumann
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Robinson CL, Jouni H, Kruisselbrink TM, Austin EE, Christensen KD, Green RC, Kullo IJ. Disclosing genetic risk for coronary heart disease: effects on perceived personal control and genetic counseling satisfaction. Clin Genet 2015; 89:251-7. [PMID: 25708169 DOI: 10.1111/cge.12577] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 02/10/2015] [Accepted: 02/19/2015] [Indexed: 11/28/2022]
Abstract
We investigated whether disclosure of coronary heart disease (CHD) genetic risk influences perceived personal control (PPC) and genetic counseling satisfaction (GCS). Participants (n = 207, age: 45-65 years) were randomized to receive estimated 10-year risk of CHD based on a conventional risk score (CRS) with or without a genetic risk score (GRS). Risk estimates were disclosed by a genetic counselor who also reviewed how GRS altered risk in those randomized to CRS+GRS. Each participant subsequently met with a physician and then completed surveys to assess PPC and GCS. Participants who received CRS+GRS had higher PPC than those who received CRS alone although the absolute difference was small (25.2 ± 2.7 vs 24.1 ± 3.8, p = 0.04). A greater proportion of CRS+GRS participants had higher GCS scores (17.3 ± 5.3 vs 15.9 ± 6.3, p = 0.06). In the CRS+GRS group, PPC and GCS scores were not correlated with GRS. Within both groups, PPC and GCS scores were similar in patients with or without family history (p = NS). In conclusion, patients who received their genetic risk of CHD had higher PPC and tended to have higher GCS. Our findings suggest that disclosure of genetic risk of CHD together with conventional risk estimates is appreciated by patients. Whether this results in improved outcomes needs additional investigation.
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Affiliation(s)
- C L Robinson
- School of Medicine, Saint Louis University, St. Louis, MO, USA
| | - H Jouni
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - T M Kruisselbrink
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - E E Austin
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - K D Christensen
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - R C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - I J Kullo
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Mir DIA, Gupta A, Dunning A, Puchi L, Robinson CL, Epstein HAB, Sanelli PC. CT perfusion for detection of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. AJNR Am J Neuroradiol 2013; 35:866-71. [PMID: 24309123 DOI: 10.3174/ajnr.a3787] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Delayed cerebral ischemia is a significant cause of morbidity and mortality after aneurysmal SAH, leading to poor outcomes. The purpose of this study was to evaluate the usefulness of CTP in determining delayed cerebral ischemia in patients with aneurysmal SAH. MATERIALS AND METHODS We conducted a systematic review evaluating studies that assessed CTP in patients with aneurysmal SAH for determining delayed cerebral ischemia. Studies using any of the following definitions of delayed cerebral ischemia were included in the systematic review: 1) new onset of clinical deterioration, 2) cerebral infarction identified on follow-up CT or MR imaging, and 3) functional disability. A random-effects meta-analysis was performed assessing the strength of association between a positive CTP result and delayed cerebral ischemia. RESULTS The systematic review identified 218 studies that met our screening criteria, of which 6 cohort studies met the inclusion criteria. These studies encompassed a total of 345 patients, with 155 (45%) of 345 patients classified as having delayed cerebral ischemia and 190 (55%) of 345 patients as not having delayed cerebral ischemia. Admission disease severity was comparable across all groups. Four cohort studies reported CTP test characteristics amenable to the meta-analysis. The weighted averages and ranges of the pooled sensitivity and specificity of CTP in the determination of delayed cerebral ischemia were 0.84 (0.7-0.95) and 0.77 (0.66-0.82), respectively. The pooled odds ratio of 23.14 (95% CI, 5.87-91.19) indicates that patients with aneurysmal SAH with positive CTP test results were approximately 23 times more likely to experience delayed cerebral ischemia compared with patients with negative CTP test results. CONCLUSIONS Perfusion deficits on CTP are a significant finding in determining delayed cerebral ischemia in aneurysmal SAH. This may be helpful in identifying patients with delayed cerebral ischemia before development of infarction and neurologic deficits.
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Affiliation(s)
- D I A Mir
- From the Departments of Radiology (D.I.A.M., A.G., L.P., C.L.R., P.C.S.)
| | - A Gupta
- From the Departments of Radiology (D.I.A.M., A.G., L.P., C.L.R., P.C.S.)
| | | | - L Puchi
- From the Departments of Radiology (D.I.A.M., A.G., L.P., C.L.R., P.C.S.)
| | - C L Robinson
- From the Departments of Radiology (D.I.A.M., A.G., L.P., C.L.R., P.C.S.)
| | - H-A B Epstein
- the Samuel J. Wood Library and C.V. Starr Biomedical Information Center (H.-A.B.E.), Weill Cornell Medical College, New York, NY
| | - P C Sanelli
- From the Departments of Radiology (D.I.A.M., A.G., L.P., C.L.R., P.C.S.)Public Health (A.D., P.C.S.)
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Tang RS, MacPhail M, Schickli JH, Kaur J, Robinson CL, Lawlor HA, Guzzetta JM, Spaete RR, Haller AA. Parainfluenza virus type 3 expressing the native or soluble fusion (F) Protein of Respiratory Syncytial Virus (RSV) confers protection from RSV infection in African green monkeys. J Virol 2004; 78:11198-207. [PMID: 15452239 PMCID: PMC521851 DOI: 10.1128/jvi.78.20.11198-11207.2004] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [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: 11/20/2022] Open
Abstract
Respiratory syncytial virus (RSV) causes respiratory disease in young children, the elderly, and immunocompromised individuals, often resulting in hospitalization and/or death. After more than 40 years of research, a Food and Drug Administration-approved vaccine for RSV is still not available. In this study, a chimeric bovine/human (b/h) parainfluenza virus type 3 (PIV3) expressing the human PIV3 (hPIV3) fusion (F) and hemagglutinin-neuraminidase (HN) proteins from an otherwise bovine PIV3 (bPIV3) genome was employed as a vector for RSV antigen expression with the aim of generating novel RSV vaccines. b/h PIV3 vaccine candidates expressing native or soluble RSV F proteins were evaluated for efficacy and immunogenicity in a nonhuman primate model. b/h PIV3 is suited for development of pediatric vaccines since bPIV3 had already been evaluated in clinical studies in 1- and 2-month-old infants and was found to be safe, immunogenic, and nontransmissible in a day care setting (Karron et al., Pediatr. Infect. Dis. J. 15:650-654, 1996; Lee et al., J. Infect. Dis. 184:909-913, 2001). African green monkeys immunized with b/h PIV3 expressing either the native or soluble RSV F protein were protected from challenge with wild-type RSV and produced RSV neutralizing and RSV F-protein specific immunoglobulin G serum antibodies. The PIV3-vectored RSV vaccines evaluated here further underscore the utility of this vector system for developing safe and immunogenic pediatric respiratory virus vaccines.
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Affiliation(s)
- Roderick S Tang
- MedImmune Vaccines Inc., 297 N. Bernerdo Avenue, Mountain View, CA 94043, USA.
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Haack KR, Robinson CL, Miller KJ, Fowlkes JW, Mellies JL. Interaction of Ler at the LEE5 (tir) operon of enteropathogenic Escherichia coli. Infect Immun 2003; 71:384-92. [PMID: 12496188 PMCID: PMC143144 DOI: 10.1128/iai.71.1.384-392.2003] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2002] [Revised: 05/07/2002] [Accepted: 09/18/2002] [Indexed: 01/28/2023] Open
Abstract
The genome of enteropathogenic Escherichia coli (EPEC) encodes a global regulator, Ler (locus of enterocyte effacement [LEE]-encoded regulator), which activates expression of several polycistronic operons within the 35.6-kb LEE pathogenicity island, including the LEE2-LEE3 divergent operon pair containing overlapping -10 regions and the LEE5 (tir) operon. Ler is a predicted 15-kDa protein that exhibits amino acid similarity with the nucleoid protein H-NS. In order to study Ler-mediated activation of virulence operons in EPEC, we used a molecular approach to characterize the interactions of purified Ler protein with the upstream regulatory sequences of the LEE5 operon. We determined the cis-acting DNA sequences necessary for Ler binding at LEE5 by mobility shift and DNase I protection assays, demonstrating that Ler acts directly at LEE5 by binding sequences between positions -190 and -73 in relation to the transcriptional start site. Based on the molecular weight of Ler, the similarity to H-NS, and the extended region of protection observed in a DNase I footprint at LEE5, we hypothesized that multiple Ler proteins bind upstream of the LEE5 promoter to increase transcriptional activity from a distance. Using an hns deletion strain, we demonstrated that like the LEE2-LEE3 operon pair, H-NS represses LEE5 transcription. We describe a model in which Ler activates transcription at both divergent overlapping paired and single promoters by displacing H-NS, which results in the disruption of a repressing nucleoprotein complex.
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Affiliation(s)
- Kenneth R Haack
- Biology Department, Reed College, Portland, Oregon 97202, USA
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Maxwell JG, Robinson CL, Maxwell TG, Maxwell BG, Smith CR, Brinker CC. Deriving the indications for laparoscopic appendectomy from a comparison of the outcomes of laparoscopic and open appendectomy. Am J Surg 2001; 182:687-92. [PMID: 11839339 DOI: 10.1016/s0002-9610(01)00798-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [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: 10/18/2022]
Abstract
BACKGROUND Indications for laparoscopic appendectomy (LA) remain controversial and poorly defined. We sought to identify indications for LA through a comparison of LA and open appendectomies (OA). METHODS We reviewed demographics, coexisting medical conditions, radiology and pathology data, hospital course, and complications from charts on all LA patients and a comparison group of OA done from 1991 to 1998. RESULTS The following were significantly associated with LA: female sex, higher mean body mass index (BMI), coexisting medical problems, private insurance, and daytime surgery. The OA group was significantly more likely to have: a radiology report suggesting the diagnosis of acute appendicitis, perforation of the appendix, intensive care unit admission, and complications in their hospital course. Forty-one percent of the LA patients did not have appendicitis, compared with 20% of the OA patients. CONCLUSIONS Daytime surgery, women, private insurance, coexisting medical problems, prior abdominal surgery, higher BMI, and less severe disease appear to be used by surgeons as indicators for LA. The threshold for surgical exploration appears to be lower for LA.
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Affiliation(s)
- J G Maxwell
- Department of Surgery, University of North Carolina at Chapel Hill, USA.
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Robinson CL. New bronchoscopic instruments: a toothpick and a corkscrew. Can J Surg 1991; 34:13-4. [PMID: 1997142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- C L Robinson
- Faculty of Medicine, University of British Columbia, Vancouver
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Fox TC, Robinson CL. Establishing procedures to implement drug therapy rules. Provider 1990; 16:65-6. [PMID: 10107243] [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: 02/11/2023]
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Robinson CL. Faculty Fellowship Program brings classroom to facility. Provider 1990; 16:7-8. [PMID: 10113329] [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: 02/11/2023]
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Hong GC, Robinson CL. Independent ownership. Managing the price of quality. Provider 1990; 16:14-6, 19. [PMID: 10106751] [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: 04/12/2023]
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Robinson CL, Müller NL, Essery C. Clinical significance and measurement of the length of the right main bronchus. Can J Surg 1989; 32:27-8. [PMID: 2642720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
It is important for surgeons, pathologists, anesthetists and anatomists to know the length of the right main bronchus. It extends from the carina of the trachea to the origin of the right upper lobe bronchus, but an exact method for measuring it has never been described. Using bronchography, the authors measured the length of the right main bronchus in 24 patients. The posteroanterior projection taken at a standard distance (1.8 m) from the patient was used to minimize distortion due to the technique; if present, the distortion would not be more than 5% and would be an increase rather than a decrease in length. The mean length of the right main bronchus was found to be 1.09 cm (range from 0 to 2.9 cm). The clinical importance of this measurement is discussed. The authors conclude that many anatomy textbooks err in describing the length of the right main bronchus as 2.0 to 5.0 cm, but are correct in describing the left main bronchus as being about 5 cm long.
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Affiliation(s)
- C L Robinson
- Department of Surgery, Vancouver General Hospital, BC
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Robinson CL. Further remembrances of that revered anatomist, Dr. J. C. Boileau Grant. Can J Surg 1988; 31:203-4. [PMID: 3284625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
From access to a detailed curriculum vitae written by Dr. Grant when he was about 75 years old, the author has learned some little-known facts of his background and life. His ancestors came from France and had been ennobled. One predecessor was a mayor of Paris. Several of his family decided to emigrate to Great Britain with the Huguenot movement. Grant graduated from the University of Edinburgh in 1908 in the same class as his future brother-in-law, William Boyd. When World War I was declared, he immediately volunteered for the army. During service on the Western Front, he was mentioned in dispatches in 1916, won the Military Cross in 1917 and a bar to the Military Cross in 1918. At the outbreak of World War II, Grant, who had been a professor of anatomy first in Winnipeg and then in Toronto for many years, volunteered again for war service, but was rejected as being too valuable a teacher to be allowed to enlist.
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Robinson CL. Autologous blood for pleurodesis in recurrent and chronic spontaneous pneumothorax. Can J Surg 1987; 30:428-9. [PMID: 3664409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Open operation for recurrent pneumothorax may be necessary to resect or oversew a bulla. At the same time, to stimulate adhesions, the pleura may be abraded with gauze, chemicals used to cause inflammation or a partial pleurectomy performed. Operation is necessary to decorticate the lung if it has developed a thick peel, in the presence of gross bleeding (hemopneumothorax) or if a large bulla is present. Occasionally, a chronic pneumothorax is due to a persistent leak caused by an adhesion holding open a bulla. The adhesion may be cut at thoracoscopy, using diathermy, and the leak will close. Many chemical agents have been used to encourage adhesions: iodized talcum powder, silver nitrate, 50% glucose and water, Atabrine, nitrogen mustard and tetracycline. In this series, one to three instillations each of 50 ml of autologous blood were used after the lung was fully expanded, usually after the use of an apical chest tube. This procedure was successful in 21 (85%) of 25 patients with difficult, chronic or recurrent pneumothoraces. It is a practical and easy method of causing a chemical pleurodesis, without serious side effects.
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Affiliation(s)
- C L Robinson
- Department of Surgery, University of British Columbia, Vancouver
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