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Steinfort DP, Evison M, Witt A, Tsaknis G, Kheir F, Manners D, Madan K, Sidhu C, Fantin A, Korevaar DA, Van Der Heijden EHFM. Proposed quality indicators and recommended standard reporting items in performance of EBUS bronchoscopy: An official World Association for Bronchology and Interventional Pulmonology Expert Panel consensus statement. Respirology 2023; 28:722-743. [PMID: 37463832 DOI: 10.1111/resp.14549] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/28/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Since their introduction, both linear and radial endobronchial ultrasound (EBUS) have become an integral component of the practice of Pulmonology and Thoracic Oncology. The quality of health care can be measured by comparing the performance of an individual or a health service with an ideal threshold or benchmark. The taskforce sought to evaluate quality indicators in EBUS bronchoscopy based on clinical relevance/importance and on the basis that observed significant variation in outcomes indicates potential for improvement in health care outcomes. METHODS A comprehensive literature review informed the composition of a comprehensive list of candidate quality indicators in EBUS. A multiple-round modified Delphi consensus process was subsequently performed with the aim of reaching consensus over a final list of quality indicators and performance targets for these indicators. Standard reporting items were developed, with a strong preference for items where evidence demonstrates a relationship with quality indicator outcomes. RESULTS Twelve quality Indicators are proposed, with performance targets supported by evidence from the literature. Standardized reporting items for both radial and linear EBUS are recommended, with evidence supporting their utility in assessing procedural outcomes presented. CONCLUSION This statement is intended to provide a framework for individual proceduralists to assess the quality of EBUS they provide their patients through the identification of clinically relevant, feasible quality measures. Emphasis is placed on outcome measures, with a preference for consistent terminology to allow communication and benchmarking between centres.
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Affiliation(s)
- Daniel P Steinfort
- Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Matthew Evison
- Lung Cancer & Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ashleigh Witt
- Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Georgios Tsaknis
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- Department of Respiratory Medicine, Kettering General Hospital, UK
| | - Fayez Kheir
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David Manners
- St John of God Midland Public and Private Hospitals, Midland, Western Australia, Australia
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Calvin Sidhu
- School of Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Alberto Fantin
- Department of Pulmonology, University Hospital of Udine (ASUFC), Udine, Italy
| | - Daniel A Korevaar
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- University of Amsterdam, Amsterdam, The Netherlands
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2
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Ch’ng SN, McVeigh JA, Manners D, Boyle T, Peddle-McIntyre CJ, Thomas R, Leong J, Bowyer S, Mooney K, Straker L, Galvão DA, Cavalheri V. Sedentary Behaviour, Physical Activity, and Their Associations with Health Outcomes at the Time of Diagnosis in People with Inoperable Lung Cancer. J Clin Med 2022; 11:jcm11195870. [PMID: 36233738 PMCID: PMC9572651 DOI: 10.3390/jcm11195870] [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: 09/19/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/19/2022] Open
Abstract
This study aimed to examine sedentary behaviour (SB), physical activity (PA) and their associations with health-related measures at the time of diagnosis in people with inoperable lung cancer. People newly diagnosed with inoperable lung cancer were invited to participate in the study and asked to wear an accelerometer for seven consecutive days. Variables analysed included time spent in SB, light intensity PA (LIPA) and moderate-to-vigorous intensity PA (MVPA). Daily steps were also recorded. Data on symptoms, health-related quality of life (HRQoL), hand grip force, comorbidities and lung function were collected. Of the 120 patients referred to the study, 89 (74%) consented to participate, and SB/PA data were available for 79 (age 71 ± 11 years; 29 females). Participants spent 71% of their waking time in SB, 28% in LIPA and 1% in MVPA. Regression models demonstrated that increased SB was associated with more symptoms of fatigue and dyspnoea (p ≤ 0.02 for both), poorer HRQoL (general health and physical component score; p ≤ 0.02 for all) and lower hand grip force. For PA variables, higher daily step count was associated with better scores in all health-related measures (p < 0.05 for all). LIPA was associated with more health-related outcomes than MVPA. These findings may guide future interventions in this population.
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Affiliation(s)
- Shu Ning Ch’ng
- Curtin School of Allied Health, Curtin University, Perth 6845, Australia
| | - Joanne A. McVeigh
- Curtin School of Allied Health, Curtin University, Perth 6845, Australia
- enAble Institute, Faculty of Health Sciences, Curtin University, Perth 6845, Australia
| | - David Manners
- St John of God Midland Public and Private Hospitals, Perth 6056, Australia
| | - Terry Boyle
- Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia Cancer Research Institute, Adelaide 5000, Australia
| | | | - Rajesh Thomas
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth 6009, Australia
| | - Jeanie Leong
- Department of Respiratory Medicine, Royal Perth Hospital, Perth 6000, Australia
| | - Samantha Bowyer
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth 6009, Australia
| | - Kirsten Mooney
- WA Cancer and Palliative Care Network, North Metropolitan Health Service, Perth 6009, Australia
| | - Leon Straker
- Curtin School of Allied Health, Curtin University, Perth 6845, Australia
- enAble Institute, Faculty of Health Sciences, Curtin University, Perth 6845, Australia
| | - Daniel A. Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Perth 6027, Australia
| | - Vinicius Cavalheri
- Curtin School of Allied Health, Curtin University, Perth 6845, Australia
- enAble Institute, Faculty of Health Sciences, Curtin University, Perth 6845, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth 6027, Australia
- Allied Health, South Metropolitan Health Service, Perth 6009, Australia
- Correspondence:
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Bonney A, Malouf R, Marchal C, Manners D, Fong KM, Marshall HM, Irving LB, Manser R. Impact of low-dose computed tomography (LDCT) screening on lung cancer-related mortality. Cochrane Database Syst Rev 2022; 8:CD013829. [PMID: 35921047 PMCID: PMC9347663 DOI: 10.1002/14651858.cd013829.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Lung cancer is the most common cause of cancer-related death in the world, however lung cancer screening has not been implemented in most countries at a population level. A previous Cochrane Review found limited evidence for the effectiveness of lung cancer screening with chest radiography (CXR) or sputum cytology in reducing lung cancer-related mortality, however there has been increasing evidence supporting screening with low-dose computed tomography (LDCT). OBJECTIVES: To determine whether screening for lung cancer using LDCT of the chest reduces lung cancer-related mortality and to evaluate the possible harms of LDCT screening. SEARCH METHODS We performed the search in collaboration with the Information Specialist of the Cochrane Lung Cancer Group and included the Cochrane Lung Cancer Group Trial Register, Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library, current issue), MEDLINE (accessed via PubMed) and Embase in our search. We also searched the clinical trial registries to identify unpublished and ongoing trials. We did not impose any restriction on language of publication. The search was performed up to 31 July 2021. SELECTION CRITERIA: Randomised controlled trials (RCTs) of lung cancer screening using LDCT and reporting mortality or harm outcomes. DATA COLLECTION AND ANALYSIS: Two review authors were involved in independently assessing trials for eligibility, extraction of trial data and characteristics, and assessing risk of bias of the included trials using the Cochrane RoB 1 tool. We assessed the certainty of evidence using GRADE. Primary outcomes were lung cancer-related mortality and harms of screening. We performed a meta-analysis, where appropriate, for all outcomes using a random-effects model. We only included trials in the analysis of mortality outcomes if they had at least 5 years of follow-up. We reported risk ratios (RRs) and hazard ratios (HRs), with 95% confidence intervals (CIs) and used the I2 statistic to investigate heterogeneity. MAIN RESULTS: We included 11 trials in this review with a total of 94,445 participants. Trials were conducted in Europe and the USA in people aged 40 years or older, with most trials having an entry requirement of ≥ 20 pack-year smoking history (e.g. 1 pack of cigarettes/day for 20 years or 2 packs/day for 10 years etc.). One trial included male participants only. Eight trials were phase three RCTs, with two feasibility RCTs and one pilot RCT. Seven of the included trials had no screening as a comparison, and four trials had CXR screening as a comparator. Screening frequency included annual, biennial and incrementing intervals. The duration of screening ranged from 1 year to 10 years. Mortality follow-up was from 5 years to approximately 12 years. None of the included trials were at low risk of bias across all domains. The certainty of evidence was moderate to low across different outcomes, as assessed by GRADE. In the meta-analysis of trials assessing lung cancer-related mortality, we included eight trials (91,122 participants), and there was a reduction in mortality of 21% with LDCT screening compared to control groups of no screening or CXR screening (RR 0.79, 95% CI 0.72 to 0.87; 8 trials, 91,122 participants; moderate-certainty evidence). There were probably no differences in subgroups for analyses by control type, sex, geographical region, and nodule management algorithm. Females appeared to have a larger lung cancer-related mortality benefit compared to males with LDCT screening. There was also a reduction in all-cause mortality (including lung cancer-related) of 5% (RR 0.95, 95% CI 0.91 to 0.99; 8 trials, 91,107 participants; moderate-certainty evidence). Invasive tests occurred more frequently in the LDCT group (RR 2.60, 95% CI 2.41 to 2.80; 3 trials, 60,003 participants; moderate-certainty evidence). However, analysis of 60-day postoperative mortality was not significant between groups (RR 0.68, 95% CI 0.24 to 1.94; 2 trials, 409 participants; moderate-certainty evidence). False-positive results and recall rates were higher with LDCT screening compared to screening with CXR, however there was low-certainty evidence in the meta-analyses due to heterogeneity and risk of bias concerns. Estimated overdiagnosis with LDCT screening was 18%, however the 95% CI was 0 to 36% (risk difference (RD) 0.18, 95% CI -0.00 to 0.36; 5 trials, 28,656 participants; low-certainty evidence). Four trials compared different aspects of health-related quality of life (HRQoL) using various measures. Anxiety was pooled from three trials, with participants in LDCT screening reporting lower anxiety scores than in the control group (standardised mean difference (SMD) -0.43, 95% CI -0.59 to -0.27; 3 trials, 8153 participants; low-certainty evidence). There were insufficient data to comment on the impact of LDCT screening on smoking behaviour. AUTHORS' CONCLUSIONS: The current evidence supports a reduction in lung cancer-related mortality with the use of LDCT for lung cancer screening in high-risk populations (those over the age of 40 with a significant smoking exposure). However, there are limited data on harms and further trials are required to determine participant selection and optimal frequency and duration of screening, with potential for significant overdiagnosis of lung cancer. Trials are ongoing for lung cancer screening in non-smokers.
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Affiliation(s)
- Asha Bonney
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Reem Malouf
- National Perinatal Epidemiology Unit (NPEU), University of Oxford, Oxford, UK
| | | | - David Manners
- Respiratory Medicine, Midland St John of God Public and Private Hospital, Midland, Australia
| | - Kwun M Fong
- Thoracic Medicine Program, The Prince Charles Hospital, Brisbane, Australia
- UQ Thoracic Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Henry M Marshall
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Louis B Irving
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Renée Manser
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
- Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Fitzgerald DB, Waterer GW, Budgeon C, Shrestha R, Fysh ET, Muruganandan S, Stanley C, Saghaie T, Badiei A, Sidhu C, Harryanto H, Duong V, Azzopardi M, Manners D, Lan NSH, Popowicz ND, Peddle-McIntyre CJ, Rahman NM, Read CA, Tan AL, Gan SK, Murray K, Lee YCG. Steroid Therapy and Outcome of Parapneumonic Pleural Effusions (STOPPE): A Pilot Randomized Clinical Trial. Am J Respir Crit Care Med 2022; 205:1093-1101. [PMID: 35081010 DOI: 10.1164/rccm.202107-1600oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rationale: Pleural effusion commonly complicates community-acquired pneumonia and is associated with intense pleural inflammation. Whether antiinflammatory treatment with corticosteroids improves outcomes is unknown. Objectives: To assess the effects of corticosteroids in an adult population with pneumonia-related pleural effusion. Methods: The STOPPE (Steroid Therapy and Outcome of Parapneumonic Pleural Effusions) trial was a pilot, multicenter, double-blinded, placebo-controlled, randomized trial involving six Australian centers. Patients with community-acquired pneumonia and pleural effusion were randomized (2:1) to intravenous dexamethasone (4 mg twice daily for 48 h) or placebo and followed for 30 days. Given the diverse effects of corticosteroids, a comprehensive range of clinical, serological, and imaging outcomes were assessed in this pilot trial (ACTRN12618000947202). Measurements and Main Results: Eighty patients were randomized (one withdrawn before treatment) and received dexamethasone (n = 51) or placebo (n = 28). This pilot trial found no preliminary evidence of benefits of dexamethasone in improving time to sustained (>12 h) normalization of vital signs (temperature, oxygen saturations, blood pressure, heart, and respiratory rates): median, 41.0 (95% confidence interval, 32.3-54.5) versus 27.8 (15.4-49.5) hours in the placebo arm (hazard ratio, 0.729 [95% confidence interval, 0.453-1.173]; P = 0.193). Similarly, no differences in C-reactive protein or leukocyte counts were observed, except for a higher leukocyte count in the dexamethasone group at Day 3. Pleural drainage procedures were performed in 49.0% of dexamethasone-treated and 42.9% of placebo-treated patients (P = 0.60). Radiographic pleural opacification decreased over time with no consistent intergroup differences. Mean duration of antibiotic therapy (22.4 [SD, 15.4] vs. 20.4 [SD, 13.8] d) and median hospitalization (6.0 [interquartile range, 5.0-10.0] vs. 5.5 [interquartile range, 5.0-8.0] d) were similar between the dexamethasone and placebo groups. Serious adverse events occurred in 25.5% of dexamethasone-treated and 21.4% of placebo-treated patients. Transient hyperglycemia more commonly affected the dexamethasone group (15.6% vs. 7.1%). Conclusions: Systemic corticosteroids showed no preliminary benefits in adults with parapneumonic effusions. Clinical trial registered with www.anzctr.org.au (ACTRN12618000947202).
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Affiliation(s)
- Deirdre B Fitzgerald
- Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Medical School, Faculty of Health and Medical Sciences.,Pleural Medicine Unit, Institute for Respiratory Health, Perth, Western Australia, Australia
| | - Grant W Waterer
- Medical School, Faculty of Health and Medical Sciences.,Department of Respiratory Medicine and
| | | | - Ranjan Shrestha
- Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Edward T Fysh
- Medical School, Faculty of Health and Medical Sciences.,Department of Respiratory Medicine, St. John of God Midland Public and Private Hospitals, Midland, Western Australia, Australia
| | | | | | - Tajalli Saghaie
- Department of Respiratory Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Arash Badiei
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Calvin Sidhu
- Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Pleural Medicine Unit, Institute for Respiratory Health, Perth, Western Australia, Australia.,School of Medical and Health Sciences and
| | - Hilman Harryanto
- Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Victor Duong
- Department of Respiratory Medicine, Northern Health, Epping, Victoria, Australia
| | - Maree Azzopardi
- Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - David Manners
- Department of Respiratory Medicine, St. John of God Midland Public and Private Hospitals, Midland, Western Australia, Australia
| | - Norris S H Lan
- Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Natalia D Popowicz
- Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,School of Allied Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Carolyn J Peddle-McIntyre
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Western Australia, Australia.,School of Medical and Health Sciences and.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Najib M Rahman
- Oxford Respiratory Trials Unit and.,National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom; and
| | - Catherine A Read
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Western Australia, Australia.,North Metropolitan Health Service, Perth, Western Australia, Australia
| | - Ai Ling Tan
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Western Australia, Australia
| | - Seng Khee Gan
- Medical School, Faculty of Health and Medical Sciences.,Department of Endocrinology and Diabetes, Royal Perth Hospital, Perth, Western Australia, Australia
| | | | - Y C Gary Lee
- Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Medical School, Faculty of Health and Medical Sciences.,Pleural Medicine Unit, Institute for Respiratory Health, Perth, Western Australia, Australia
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Cecins E, Hill K, Taaffe DR, Manners D, Hill AM, Newton RU, Galvão DA, Cavalheri V. Feasibility, tolerance and effects of adding impact loading exercise to pulmonary rehabilitation in people with chronic obstructive pulmonary disease: study protocol for a pilot randomised controlled trial. Pilot Feasibility Stud 2021; 7:151. [PMID: 34344482 PMCID: PMC8330032 DOI: 10.1186/s40814-021-00893-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a disorder linked with a multitude of extra pulmonary manifestations (also known as treatable traits), including low bone mineral density (BMD). To date, no specific guidelines exist for the management of BMD in this population. Impact loading exercise has been identified as an intervention that improves or maintains BMD in other populations. However, the feasibility of and tolerance to impact loading exercise has not been tested in people with COPD. The aim of the proposed study will be to investigate the feasibility and tolerance of adding impact loading exercise to a standard pulmonary rehabilitation programme (PRP) in people with COPD and report its effects on bone health, balance and falls risk. METHODS This is a protocol for a pilot feasibility and tolerance randomised controlled trial (RCT). Fifty-eight people with COPD will be randomly allocated, on a 1:1 ratio, to either the experimental or control group. Initially, participants in both groups will complete a standard 8-week (twice-weekly) PRP followed by a 32-week period of maintenance exercises. Over the initial 8-week period, participants allocated to the experimental group will also undertake targeted lower limb resistance exercises and commence a programme of impact loading exercises (e.g. bounding and drop jumps). On completion of the initial 8-week PRP, in addition to the standard maintenance exercises, participants in the experimental group will continue with home-based impact loading exercises, four times a week, for the extra 32 weeks. The primary outcome of this study is feasibility of and tolerance to impact loading exercises. Feasibility will be measured using data collected pertaining to recruitment, withdrawal and completion. Adherence to the exercises will be collected using exercise logs. Tolerance to the exercises will be determined using outcomes to assess pain, recording any adverse effects such as a fall and feedback from the participants in semi-structured interviews on completing of the trial. The effects of the 40-week experimental intervention on bone health, balance and falls risk will be reported. DISCUSSION This pilot RCT will test the feasibility and tolerance of an intervention that has never been trialed in people with COPD. It will also provide initial information regarding the size of the effect this intervention has on outcomes such as BMD, balance and falls risk. These data will be critical when designing a definitive RCT to advance this area of research. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (ANZCTR): 12620001085965 (20/10/2020).
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Affiliation(s)
- Erin Cecins
- Curtin School of Allied Health, Faculty of Health Science, Curtin University, Perth, WA Australia
- Physiotherapy Department, St John of God Midland Hospital, Perth, WA Australia
| | - Kylie Hill
- Curtin School of Allied Health, Faculty of Health Science, Curtin University, Perth, WA Australia
- Institute for Respiratory Health, Perth, WA Australia
| | - Dennis R. Taaffe
- Curtin School of Allied Health, Faculty of Health Science, Curtin University, Perth, WA Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
| | - David Manners
- Respiratory Medicine, St John of God Midland Hospital, Perth, WA Australia
| | - Anne-Marie Hill
- Curtin School of Allied Health, Faculty of Health Science, Curtin University, Perth, WA Australia
| | - Robert U. Newton
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD Australia
| | - Daniel A. Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
| | - Vinicius Cavalheri
- Curtin School of Allied Health, Faculty of Health Science, Curtin University, Perth, WA Australia
- Institute for Respiratory Health, Perth, WA Australia
- Allied Health, South Metropolitan Health Service, Perth, Australia
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Manners D, Pettigrew S, Lake FR, Piccolo F, McWilliams AM, Brims FJH. Development and evaluation of a consumer information resource, including Patient Decision Aid, for lung cancer screening: a quasi-experimental study. Transl Behav Med 2021; 10:404-412. [PMID: 30855087 DOI: 10.1093/tbm/ibz029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Lung cancer screening of high-risk individuals with computed tomography is a promising intervention to reduce lung cancer mortality. Patient Decision Aids (PtDAs) may assist eligible individuals assess the risks and benefits associated with screening. Screening preference is high among lower-risk, screening-ineligible individuals and strategies are needed to reduce screening demand among this group. We developed and evaluated a resource comprising a recruitment pamphlet combined with either a PtDA for screening-eligible individuals or an education pamphlet for screening-ineligible individuals. Quasi-experimental pre-post pamphlet exposure design. Ever-smokers aged 55-80 years attending hospital outpatient clinics were invited. Among screening-eligible participants, the assessed outcome was change in score on the Decisional Conflict Scale (DCS). Among screening-ineligible participants, the assessed outcomes were change in screening preference. In the study 51% (55/107) of invited individuals participated, with mean ± standard deviation age 66.9 ± 6.4 years, 53% (29/55) male, and 65% (36/55) eligible for screening. Median (interquartile range) DCS among screening-eligible participants reduced from 28.9 (22.7-45.3) pre-PtDA to 25 (1.6-29.7) post-PtDA (p < .001), but there was no significant change in the proportion that reached the accepted threshold for decisional certainty (DCS < 25, 10/36 [28%] pre-exposure vs. 14/36 [39%] post-exposure, p = .1). Screening preference among screening-ineligible individuals reduced after viewing the screening-ineligible brochure (pre-exposure median of "Prefer" to post-exposure median of "Unsure," p = .001). Our consumer information pamphlets about lung cancer screening may reduce decisional conflict and improve alignment of screening preference with eligibility.
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Affiliation(s)
- David Manners
- St John of God Midland Public and Private Hospital, Midland, Western Australia, Australia.,Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
| | - Simone Pettigrew
- School of Psychology, Curtin University, Bentley, Western Australia, Australia
| | - Fiona R Lake
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Medical School, University of Western Australia, Nedlands, Western Australia, Australia
| | - Francesco Piccolo
- St John of God Midland Public and Private Hospital, Midland, Western Australia, Australia
| | - Annette M McWilliams
- Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Fraser J H Brims
- Curtin Medical School, Curtin University, Bentley, Western Australia, Australia.,Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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7
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Johnson A, Norman R, Piccolo F, Manners D. The optimal timing of FDG-PET/CT in non-small cell lung cancer diagnosis and staging in an Australian centre. BMC Pulm Med 2021; 21:209. [PMID: 34210303 PMCID: PMC8252249 DOI: 10.1186/s12890-021-01564-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/31/2021] [Indexed: 12/24/2022] Open
Abstract
Background Clinical practice guidelines and re-imbursement schedules vary in the recommended timing of FDG-PET/CT in the diagnostic evaluation of suspected or confirmed lung cancer. The aim was to estimate the probability of requiring more than one invasive test to complete diagnosis and staging in non-small cell lung cancer if FDG-PET/CT was used prior to initial biopsy (FDG-PET/CT First) compared to current Australian funding criteria (CT First). Methods Single-centre retrospective study of individuals with pathologically confirmed NSCLC without evidence of metastatic disease on baseline computed tomography (CT) of the chest. Decision tree analysis based on diagnosis and staging approaches estimated the probability of requiring more than one invasive biopsy. A Monte Carlo analysis with 1000 simulations was used to estimate decision tree precision. Results After exclusions, 115 patients were included with median (IQR) age of 71 (63–79) and 55.6% were male. The majority of cases were early stage (Stage I 43.5%, Stage II 19.1%) and adenocarcinoma (65.2%) histological subtype. The estimated probability of requiring more than one invasive biopsy with FDG-PET/CT prior was 0.12 compared to 0.19 when using the base case CT First scenario. Using the Monte Carlo analysis, the mean (95% CI) probability using the FDG-PET First approach was 0.15 (95%CI 0.12–0.20) versus 0.20 (95% CI 0.15–0.27) for the CT First approach. Only 7.8% had CT Chest-occult metastatic disease on FDG-PET that was accessible by percutaneous biopsy. Conclusion FDG-PET/CT performed prior to initial biopsy may reduce the proportion of people with NSCLC who require more than one biopsy attempt, but the clinical significance and overall cost-utility requires evaluation. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01564-w.
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Affiliation(s)
- Anne Johnson
- St John of God Midland Public and Private Hospitals, Midland, WA, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Bentley, WA, Australia
| | - Francesco Piccolo
- St John of God Midland Public and Private Hospitals, Midland, WA, Australia
| | - David Manners
- St John of God Midland Public and Private Hospitals, Midland, WA, Australia.
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8
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Manners D, Dawkins P, Pascoe D, Crengle S, Bartholomew K, Leong TL. Lung cancer screening in Australia and New Zealand: the evidence and the challenge. Intern Med J 2021; 51:436-441. [PMID: 33738936 DOI: 10.1111/imj.15230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/23/2020] [Indexed: 11/27/2022]
Abstract
Lung cancer remains the commonest cause of cancer death in Australia and New Zealand. Targeted screening of individuals at highest risk of lung cancer aims to detect early stage disease, which may be amenable to potentially curative treatment. While current policy recommendations in Australia and New Zealand have acknowledged the efficacy of lung cancer screening in clinical trials, there has been no implementation of national programmes. With the recent release of findings from large international trials, the evidence and experience in lung cancer screening has broadened. This article discusses the latest evidence and implications for Australia and New Zealand.
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Affiliation(s)
- David Manners
- Department of Respiratory Medicine, St John of God, Perth, Western Australia, Australia
| | - Paul Dawkins
- Department of Respiratory Medicine, Middlemore Hospital, Auckland, New Zealand
| | - Diane Pascoe
- Department of Radiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Sue Crengle
- Department of Preventative and Social Medicine, University of Otago, Otago, New Zealand
| | - Karen Bartholomew
- Planning Funding and Outcomes, Waitematã and Auckland District Health Boards, Auckland, New Zealand
| | - Tracy L Leong
- Department of Respiratory Medicine, Austin Health, Melbourne, Victoria, Australia.,Institute of Breathing and Sleep, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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9
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Bonney A, Malouf R, Marchal C, Manners D, Fong KM, Marshall HM, Irving LB, Manser R. Low-dose computed tomography (LDCT) screening for lung cancer-related mortality. Hippokratia 2021. [DOI: 10.1002/14651858.cd013829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Asha Bonney
- Department of Respiratory and Sleep Medicine; Royal Melbourne Hospital; Parkville Australia
| | - Reem Malouf
- National Perinatal Epidemiology Unit (NPEU); University of Oxford; Oxford UK
| | | | - David Manners
- Respiratory Medicine; Midland St John of God Public and Private Hospital; Midland Australia
| | - Kwun M Fong
- Thoracic Medicine Program; The Prince Charles Hospital; Brisbane Australia
- UQ Thoracic Research Centre, School of Medicine; The University of Queensland; Brisbane Australia
| | - Henry M Marshall
- School of Medicine; The University of Queensland; Brisbane Australia
| | - Louis B Irving
- Department of Respiratory and Sleep Medicine; Royal Melbourne Hospital; Parkville Australia
| | - Renée Manser
- Department of Respiratory and Sleep Medicine; Royal Melbourne Hospital; Parkville Australia
- Department of Haematology and Medical Oncology; Peter MacCallum Cancer Centre; Melbourne Australia
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10
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Quigley D, Jones S, Piccolo F, Huseini T, Manners D. Midland non‐invasive ventilation score: a tool to predict non‐invasive ventilation failure in people with acute hypercapnic respiratory failure. Intern Med J 2020; 50:1412-1415. [DOI: 10.1111/imj.15058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 11/28/2022]
Affiliation(s)
- David Quigley
- Respiratory Department St John of God Midland Public and Private Hospital (SJGMPPH) Perth Western Australia Australia
| | - Simon Jones
- Respiratory Department St John of God Midland Public and Private Hospital (SJGMPPH) Perth Western Australia Australia
| | - Francesco Piccolo
- Respiratory Department St John of God Midland Public and Private Hospital (SJGMPPH) Perth Western Australia Australia
| | - Taha Huseini
- Respiratory Department St John of God Midland Public and Private Hospital (SJGMPPH) Perth Western Australia Australia
| | - David Manners
- Respiratory Department St John of God Midland Public and Private Hospital (SJGMPPH) Perth Western Australia Australia
- Curtin Medical School Curtin University Perth Western Australia Australia
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11
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Abeyweera PD, Brims FJH, Piccolo F, Lei C, Manners D. Australia-wide cross-sectional survey of general practitioners' knowledge and practice of lung cancer screening. Intern Med J 2020; 51:1111-1116. [PMID: 32237100 DOI: 10.1111/imj.14838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/06/2020] [Accepted: 03/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Low-dose computed tomography (LDCT) screening can reduce lung cancer deaths in high-risk individuals, yet current Australian guidelines do not recommend screening. Little is known about current screening practices in Australia. AIM To evaluate the proportion of general practitioners who report ordering lung cancer screening for their patients, identify factors associated with ordering lung cancer screening and assess general practitioners (GP) rationale for recommending screening and preference of composition of any future national targeted screening programme. METHODS A survey was distributed to a nationally representative sample of 4000 Australian GP. The questionnaire included respondent demographics, self-reported screening practices, knowledge of screening recommendations, recent screening education, preference for recruitment methodologies for potential screening programmes and potential factors influencing the screening practices of GP. Two logistic regression models identified factors associated with self-reported chest X-ray (CXR) and LDCT screening within the past 12 months. RESULTS A total of 323 GP completed the survey (participation rate 8.1%). Participants were mostly females (50.6%), from collective/group (79.1%) and metropolitan-based practices (73.5%). Despite the majority of responders understanding that screening is not recommended by Australian professional societies (71.2%), a substantial proportion of participants requested a CXR or LDCT screening (46.4% and 20.8% respectively). A variety of shared (GP reassurance, affordability of screening, believing screening is funded) and unique practice, educational and cognitive factors were associated with self-reported LDCT and CXR screening, with the strongest association being recent education about screening from radiology practices (odds ratio (aOR) for LDCT screening 10.4, P < 0.001). CONCLUSION In Australia, lung cancer screening occurs outside a coordinated programme, and there is discordance between practice and national recommendations. This highlights an urgent need for clearer guidance from national and professional bodies.
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Affiliation(s)
| | - Fraser J H Brims
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Francesco Piccolo
- Midland Physician Service, St John of God Midland Public and Private Hospitals, Perth, Western Australia, Australia
| | - Cory Lei
- Currambine Family Practice, Perth, Western Australia, Australia
| | - David Manners
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia.,Midland Physician Service, St John of God Midland Public and Private Hospitals, Perth, Western Australia, Australia
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12
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See K, Manser R, Park ER, Steinfort D, King B, Piccolo F, Manners D. The impact of perceived risk, screening eligibility and worry on preference for lung cancer screening: a cross-sectional survey. ERJ Open Res 2020; 6:00158-2019. [PMID: 32201692 PMCID: PMC7073421 DOI: 10.1183/23120541.00158-2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 06/20/2019] [Accepted: 01/23/2020] [Indexed: 11/05/2022] Open
Abstract
Lung cancer screening is effective at reducing lung cancer deaths when individuals at greatest risk are screened. Recruitment initiatives target all current and former smokers, of whom only some are eligible for screening, potentially leading to discordance between screening preference and eligibility in ineligible individuals. The objective of the present study was to identify factors associated with preference for screening among ever-smokers. Ever-smokers aged 55-80 years attending outpatient clinics at three Australian hospitals were invited. The survey recorded: 1) demographics; 2) objective lung cancer risk and screening eligibility using the Prostate Lung Colon Ovarian 2012 risk model; and 3) perceived lung cancer risk, worry about and seriousness of lung cancer using a validated questionnaire. Multivariable ordinal logistic regression identified predictors of screening preference. The survey was completed by 283 individuals (response rate 27%). Preference for screening was high (72%) with no significant difference between low-dose computed tomography screening-eligible and -ineligible individuals (77% versus 68%, p=0.11). Worry about lung cancer (adjusted-proportional odds ratio (adj-OR) 1.31, 95% CI 1.08-1.58; p=0.007) and perceived seriousness of lung cancer (adj-OR 1.31, 95% CI 1.05-1.64; p=0.02) were associated with higher preference for lung cancer screening while screening eligibility was not. The concept of "early detection" was the most important driver to have screening while practical obstacles like difficulty travelling to the scan or taking time off work were the least important barriers to screening. Most current or former smokers prefer to undergo screening. Worry about lung cancer and perceived seriousness of the diagnosis are more important drivers for screening preference than eligibility status.
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Affiliation(s)
- Katharine See
- Dept of Respiratory Medicine, Northern Hospital, Epping, Victoria, Australia
| | - Renee Manser
- Dept of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Dept of Medicine (Royal Melbourne Hospital), University of Melbourne, Victoria, Australia.,Dept of Medical Oncology and Haematology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Elyse R Park
- Harvard Medical School, Massachusetts General Hosptial, Boston, MA, USA
| | - Daniel Steinfort
- Dept of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Bridget King
- Dept of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Francesco Piccolo
- Midland Physician Service, St John of God Midland Private and Public Hospitals, Midland, Western Australia, Australia
| | - David Manners
- Midland Physician Service, St John of God Midland Private and Public Hospitals, Midland, Western Australia, Australia.,Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
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13
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Brownell P, Piccolo F, Brims F, Norman R, Manners D. Correction to: Does this lung nodule need urgent review? A discrete choice experiment of Australian general practitioners. BMC Pulm Med 2020; 20:53. [PMID: 32101142 PMCID: PMC7045454 DOI: 10.1186/s12890-020-1085-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- P Brownell
- Department of Respiratory Medicine, St John of God Healthcare Midland Campus, Midland, Western Australia.
| | - F Piccolo
- Department of Respiratory Medicine, St John of God Healthcare Midland Campus, Midland, Western Australia
| | - F Brims
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,Curtin University Medical School, Bentley, Western Australia
| | - R Norman
- Curtin University School of Public Health, Bentley, Western Australia
| | - D Manners
- Department of Respiratory Medicine, St John of God Healthcare Midland Campus, Midland, Western Australia.,Curtin University Medical School, Bentley, Western Australia
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14
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Brownell P, Piccolo F, Brims F, Norman R, Manners D. Does this lung nodule need urgent review? A discrete choice experiment of Australian general practitioners. BMC Pulm Med 2020; 20:24. [PMID: 32000731 PMCID: PMC6993503 DOI: 10.1186/s12890-020-1053-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/13/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer mortality in Australia. Guidelines suggest that patients with suspected lung cancer on thoracic imaging be referred for urgent specialist review. However, the term "suspected" is broad and includes the common finding of lung nodules, which often require periodic surveillance rather than urgent invasive investigation. The British Thoracic Society recommends that a lung nodule with a PanCan risk > 10% be considered for invasive investigation. This study aimed to assess which factors influence general practitioners (GPs) to request urgent review for a lung nodule and if these factors concur with PanCan risk prediction model variables. METHODS A discrete choice experiment was developed that produced 32 individual case vignettes. Each vignette contained eight variables, four of which form the parsimonious PanCan risk prediction model. Two additional vignettes were created that addressed haemoptysis with a normal chest computed tomography (CT) scan and isolated mediastinal lymphadenopathy. The survey was distributed to 4160 randomly selected Australian GPs and they were asked if the patients in the vignettes required urgent (less than two weeks) specialist review. Multivariate logistic regression identified factors associated with request for urgent review. RESULTS Completed surveys were received from 3.7% of participants, providing 152 surveys (1216 case vignettes) for analysis. The factors associated with request for urgent review were nodule spiculation (adj-OR 5.57, 95% CI 3.88-7.99, p < 0.0001), larger nodule size, presentation with haemoptysis (adj-OR 4.79, 95% CI 3.05-7.52, p < 0.0001) or weight loss (adj-OR 4.87, 95% CI 3.13-7.59, p < 0.0001), recommendation for urgent review by the reporting radiologist (adj-OR 4.68, 95% CI 2.86-7.65, p < 0.0001) and female GP gender (adj-OR 1.87, 95% CI 1.36-2.56, p 0.0001). In low risk lung nodules (PanCan risk < 10%), there was significant variability in perceived sense of urgency. Most GPs (83%) felt that a patient with haemoptysis and a normal chest CT scan did not require urgent specialist review but that a patient with isolated mediastinal lymphadenopathy did (75%). CONCLUSION Future lung cancer investigation pathways may benefit from the addition of a risk prediction model to reduce variations in referral behavior for low risk lung nodules.
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Affiliation(s)
- P Brownell
- Department of Respiratory Medicine, St John of God Healthcare Midland Campus, Midland, Western Australia.
| | - F Piccolo
- Department of Respiratory Medicine, St John of God Healthcare Midland Campus, Midland, Western Australia
| | - F Brims
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,Curtin University Medical School, Bentley, Western Australia
| | - R Norman
- Curtin University School of Public Health, Bentley, Western Australia
| | - D Manners
- Department of Respiratory Medicine, St John of God Healthcare Midland Campus, Midland, Western Australia.,Curtin University Medical School, Bentley, Western Australia
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15
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Abeyweera P, Brims F, Piccolo F, Lei C, Manners D. P2.11-09 Australia-Wide Cross-Sectional Survey of General Practitioners’ Knowledge and Practice of Lung Cancer Screening. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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Huseini T, Manners D, Jones S, Piccolo F. External validation of the SAPS3-CNIV score to predict hospital mortality following noninvasive ventilation: a retrospective single-centre study. ERJ Open Res 2019; 5:00232-2018. [PMID: 30972348 PMCID: PMC6452042 DOI: 10.1183/23120541.00232-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/11/2019] [Indexed: 11/11/2022] Open
Abstract
Prognostication tools are developed to assist clinical decision making and provide valid diagnostic and prognostic outcomes including mortality. Given significant disease and demographic heterogeneity, these tools have to be generally applicable to different patient populations. Therefore, once a model is developed it is internally and externally validated with subsequent clinical impact analyses after which its performance is evaluated and that particular model is then established. A retrospective single-centre study suggesting that patients with higher SAPS3-CNIV scores may be monitored in an ICU setting in order to reduce adverse patient events and optimal utilisation of resourceshttp://ow.ly/F5qp30o2OT7
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Affiliation(s)
- Taha Huseini
- Dept of Respiratory Medicine, St. John Of God Midland Public and Private Hospital, Perth, Australia
| | - David Manners
- Dept of Respiratory Medicine, St. John Of God Midland Public and Private Hospital, Perth, Australia.,Curtin Medical School, Curtin University, Bentley, Australia
| | - Simon Jones
- Dept of Respiratory Medicine, St. John Of God Midland Public and Private Hospital, Perth, Australia
| | - Francesco Piccolo
- Dept of Respiratory Medicine, St. John Of God Midland Public and Private Hospital, Perth, Australia
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17
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Brownell P, Piccolo F, Waddington CS, White R, Jones S, Fysh E, Manners D. Addressing barriers to timely lung cancer diagnosis and treatment in an outer metropolitan Western Australian hospital. Intern Med J 2019; 49:279-280. [DOI: 10.1111/imj.14205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 11/11/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Phoebe Brownell
- Department of Respiratory Medicine; St John of God Health Care; Perth Western Australia Australia
| | - Francesco Piccolo
- Department of Respiratory Medicine; St John of God Health Care; Perth Western Australia Australia
| | - Claire S. Waddington
- Department of Respiratory Medicine; St John of God Health Care; Perth Western Australia Australia
| | - Rohen White
- Department of Radiation Oncology; Sir Charles Gairdner Hospital; Perth Western Australia Australia
| | - Simon Jones
- Department of Respiratory Medicine; St John of God Health Care; Perth Western Australia Australia
| | - Edward Fysh
- Department of Respiratory Medicine; St John of God Health Care; Perth Western Australia Australia
| | - David Manners
- Department of Respiratory Medicine; St John of God Health Care; Perth Western Australia Australia
- Curtin Medical School; Curtin University; Perth Western Australia Australia
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18
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Lyne C, Zaw S, King B, See K, Manners D, Al-Kaisey A, Joshi S, Farouque O, Irving L, Johnson D, Steinfort D. Low rates of eligibility for lung cancer screening in patients undergoing computed tomography coronary angiography. Intern Med J 2018; 48:1265-1268. [PMID: 30288901 DOI: 10.1111/imj.14061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/06/2018] [Accepted: 05/13/2018] [Indexed: 11/30/2022]
Abstract
Incidental findings, including pulmonary nodules, on computed tomography coronary angiography (CTCA) are common. Previous authors have suggested CTCA could allow opportunistic screening for lung cancer, though the lung cancer risk profile of this patient group has not previously been established. Smoking histories of 229 patients undergoing CTCA at two tertiary hospitals were reviewed and only 25% were current or former smokers aged 55-80 years old. Less than half of this group were eligible for screening based on the PLCOm2012 risk model. We conclude that routine screening in the form of full thoracic field imaging, of individuals undergoing CTCA is not appropriate as it would likely result in net harm.
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Affiliation(s)
- Christopher Lyne
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Shane Zaw
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Bridget King
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Katharine See
- Department of Respiratory Medicine, The Northern Hospital, Melbourne, Victoria, Australia
| | - David Manners
- Midland Physician Service, St John of God Public and Private Hospital, Perth, Western Australia, Australia
| | - Ahmed Al-Kaisey
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Subodh Joshi
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Louis Irving
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Douglas Johnson
- Department of General Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Daniel Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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19
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Manners D, Wilcox H, McWilliams A, Piccolo F, Liira H, Brims F. Current lung cancer screening practice amongst general practitioners in Western Australia: a cross-sectional study. Intern Med J 2018; 48:78-80. [PMID: 29314524 DOI: 10.1111/imj.13670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 11/28/2022]
Abstract
Lung cancer screening with low dose computed tomography (LDCT) is recommended in the USA and Canada for high-risk smokers but not in Australia. We administered a cross-sectional survey to Western Australian general practitioners (GP). The majority (64/93, 69%) reported requesting a screening chest X-ray (42/93, 45%) and/or LDCT (38/93, 41%) in the past year. LDCT screening was more common if the GP had received education from radiology practices (odds ratio (OR) 2.81, P = 0.03) or if they believed screening is funded by the Medical Benefits Scheme (OR 3.57, P = 0.02). Lung cancer screening with LDCT is occurring outside a coordinated programme, contrary to Australian guidelines.
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Affiliation(s)
- David Manners
- Midland Physician Service, St John of God Public and Private Hospital, Perth, Western Australia, Australia
| | - Helen Wilcox
- School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Western Australia, Australia
| | - Annette McWilliams
- Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Francesco Piccolo
- Midland Physician Service, St John of God Public and Private Hospital, Perth, Western Australia, Australia
| | - Helena Liira
- School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Western Australia, Australia
| | - Fraser Brims
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Curtin Medical School, Curtin University, Perth, Western Australia, Australia
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20
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See K, Manser R, Park E, Steinfort D, Piccolo F, Manners D. MA 14.09 Impact of Lung Cancer Perceived Risk, Screening Eligibility and Worry on LDCT Screening Preference - Challenges for Engaging Patients at High Risk. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Steinfort D, Zaw S, King B, Joshi S, Farouque O, Al-Kaisey A, Johnson D, Irving L, Manners D, See K. P2.13-023 Lung Cancer Risk and Eligibility for Lung Cancer Screening in Patients Undergoing Computed Tomography Coronary Angiography. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Lim K, Manners D, Adler B, Melsom S, Harris E, Brims F, Mcwilliams A. P2.13-002 The LungScreen WA Project: Feasibility of LDCT Screening with the PLCOm2012 Risk Model and PanCan Nodule Risk Calculator. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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Lim K, Manners D, Adler B, Melsom S, Harris E, Brims F, McWilliams A. The lungScreen WA project: Results from a prospective LDCT screening programme of high-risk smokers. Respir Med 2017. [DOI: 10.1016/j.rmed.2017.07.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Weber M, Yap S, Goldsbury D, Manners D, Tammemagi M, Marshall H, Brims F, McWilliams A, Fong K, Kang YJ, Caruana M, Banks E, Canfell K. Identifying high risk individuals for targeted lung cancer screening: Independent validation of the PLCOm2012
risk prediction tool. Int J Cancer 2017; 141:242-253. [DOI: 10.1002/ijc.30673] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/31/2017] [Accepted: 02/08/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Marianne Weber
- Cancer Research Division; Cancer Council NSW; New South Wales Australia
- School of Public Health; Sydney Medical School, University of Sydney; New South Wales Australia
| | - Sarsha Yap
- Cancer Research Division; Cancer Council NSW; New South Wales Australia
| | - David Goldsbury
- Cancer Research Division; Cancer Council NSW; New South Wales Australia
| | - David Manners
- Midland Physician Service; St John of God Public and Private Hospitals Midland; Western Australia Australia
| | | | - Henry Marshall
- Department of Thoracic Medicine; The Prince Charles Hospital; Queensland Australia
| | - Fraser Brims
- Curtin Medical School, Faculty of Health Sciences, Curtin University; Western Australia Australia
| | - Annette McWilliams
- Fiona Stanley Hospital; Respiratory Medicine Department, University of Western Australia; Western Australia Australia
| | - Kwun Fong
- Department of Thoracic Medicine; The Prince Charles Hospital; Queensland Australia
| | - Yoon Jung Kang
- Cancer Research Division; Cancer Council NSW; New South Wales Australia
| | - Michael Caruana
- Cancer Research Division; Cancer Council NSW; New South Wales Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health; Australian National University; Australian Capital Territory Australia
| | - Karen Canfell
- Cancer Research Division; Cancer Council NSW; New South Wales Australia
- School of Public Health; Sydney Medical School, University of Sydney; New South Wales Australia
- Prince of Wales Clinical School, UNSW; New South Wales Australia
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25
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Manners D, Hui J, Hunter M, James A, Knuiman MW, McWilliams A, Mulrennan S, Musk AW(B, Brims FJH. Estimating eligibility for lung cancer screening in an Australian cohort, including the effect of spirometry. Med J Aust 2016; 204:406. [DOI: 10.5694/mja16.00043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/12/2016] [Indexed: 01/12/2023]
Affiliation(s)
| | - Jennie Hui
- Busselton Population Medical Research Institute, Busselton, WA
- University of Western Australia, Perth, WA
| | - Michael Hunter
- Busselton Population Medical Research Institute, Busselton, WA
- University of Western Australia, Perth, WA
| | - Alan James
- Sir Charles Gairdner Hospital, Perth, WA
- University of Western Australia, Perth, WA
| | | | | | - Siobhain Mulrennan
- Sir Charles Gairdner Hospital, Perth, WA
- Busselton Population Medical Research Institute, Busselton, WA
| | - Arthur W (Bill) Musk
- Sir Charles Gairdner Hospital, Perth, WA
- Busselton Population Medical Research Institute, Busselton, WA
| | - Fraser JH Brims
- Sir Charles Gairdner Hospital, Perth, WA
- University of Western Australia, Perth, WA
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Manners D, Emery J, Brims FJ, Pettigrew S. Lung cancer screening - practical challenges of confining participation to those who might benefit. Aust N Z J Public Health 2016; 40:205-6. [PMID: 27028577 DOI: 10.1111/1753-6405.12516] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- David Manners
- Department of General Medicine, St John of God Midland Public and Private Hospitals, Western Australia
| | - Jon Emery
- General Practice and Primary Health Care Academic Centre, University of Melbourne, Victoria
| | - Fraser J Brims
- Department of General Medicine, St John of God Midland Public and Private Hospitals, Western Australia
| | - Simone Pettigrew
- School of Psychology and Speech Pathology, Curtin University, Western Australia
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Abstract
Malignant pleural mesothelioma (MPM) represents a significant diagnostic and therapeutic challenge and is almost always a fatal disease. Imaging abnormalities are common, but have a limited role in distinguishing mesothelioma from metastatic pleural disease. Similarly, minimally invasive biomarkers have shown promise but also have limitations in the diagnosis of mesothelioma. In experienced centers, cytology and immunohistochemistry are now sufficient to diagnose the epithelioid subtype of mesothelioma, which can reduce the need for more invasive diagnostic investigations. Prognosis of MPM is modestly impacted by oncological treatments. Chemotherapy with cisplatin and pemetrexed is considered the standard of care, though the addition of bevacizumab to the platinum doublet may be the new standard of care. New targeted therapies have demonstrated some promise and are being addressed in clinical trials. This review focuses on the current data on the diagnostic and therapeutic issues of MPM.
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Affiliation(s)
- Sanjana Kondola
- Department of Medical Oncology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - David Manners
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Anna K Nowak
- School of Medicine and Pharmacology, University of Western Australia, M503 35 Stirling Hwy Crawley, WA 6009 Australia
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Brims FJH, Murray CP, de Klerk N, Alfonso H, Reid A, Manners D, Wong PM, Teh J, Olsen N, Mina R, Musk AW. Ultra-Low-Dose Chest Computer Tomography Screening of an Asbestos-exposed Population in Western Australia. Am J Respir Crit Care Med 2015; 191:113-6. [DOI: 10.1164/rccm.201409-1687le] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Layec G, Malucelli E, Le Fur Y, Manners D, Yashiro K, Testa C, Cozzone PJ, Iotti S, Bendahan D. Effects of exercise-induced intracellular acidosis on the phosphocreatine recovery kinetics: a 31P MRS study in three muscle groups in humans. NMR Biomed 2013; 26:1403-1411. [PMID: 23703831 DOI: 10.1002/nbm.2966] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 03/22/2013] [Accepted: 03/25/2013] [Indexed: 06/02/2023]
Abstract
Little is known about the metabolic differences that exist among different muscle groups within the same subjects. Therefore, we used (31)P-magnetic resonance spectroscopy ((31)P-MRS) to investigate muscle oxidative capacity and the potential effects of pH on PCr recovery kinetics between muscles of different phenotypes (quadriceps (Q), finger (FF) and plantar flexors (PF)) in the same cohort of 16 untrained adults. The estimated muscle oxidative capacity was lower in Q (29 ± 12 mM min(-1), CV(inter-subject) = 42%) as compared with PF (46 ± 20 mM min(-1), CV(inter-subject) = 44%) and tended to be higher in FF (43 ± 35 mM min(-1), CV(inter-subject) = 80%). The coefficient of variation (CV) of oxidative capacity between muscles within the group was 59 ± 24%. PCr recovery time constant was correlated with end-exercise pH in Q (p < 0.01), FF (p < 0.05) and PF (p < 0.05) as well as proton efflux rate in FF (p < 0.01), PF (p < 0.01) and Q (p = 0.12). We also observed a steeper slope of the relationship between end-exercise acidosis and PCr recovery kinetics in FF compared with either PF or Q muscles. Overall, this study supports the concept of skeletal muscle heterogeneity by revealing a comparable inter- and intra-individual variability in oxidative capacity across three skeletal muscles in untrained individuals. These findings also indicate that the sensitivity of mitochondrial respiration to the inhibition associated with cytosolic acidosis is greater in the finger flexor muscles compared with locomotor muscles, which might be related to differences in permeability in the mitochondrial membrane and, to some extent, to proton efflux rates.
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Affiliation(s)
- Gwenael Layec
- Centre de Resonance Magnetique Biologique et Medicale, UMR CNRS 6612, Faculté de Médecine de Marseille, Marseille, France; Department of Medicine, Division of Geriatrics, University of Utah, Salt Lake City, UT, USA; Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, UT, USA
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Rizzo G, Manners D, Testa C, Tonon C, Vetrugno R, Marconi S, Plazzi G, Pizza F, Provini F, Malucelli E, Gramegna LL, Lodi R. Low brain iron content in idiopathic restless legs syndrome patients detected by phase imaging. Mov Disord 2013; 28:1886-90. [DOI: 10.1002/mds.25576] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/29/2013] [Accepted: 05/09/2013] [Indexed: 01/12/2023] Open
Affiliation(s)
- Giovanni Rizzo
- Functional MR Unit; Department of Biomedical and NeuroMotor Sciences (DiBiNeM); University of Bologna; Bologna Italy
- Neurology Unit; Department of Biomedical and NeuroMotor Sciences (DiBiNeM); University of Bologna; Bologna Italy
- “IRCCS Istituto delle Scienze Neurologiche di Bologna,”; Bologna Italy
| | - David Manners
- Functional MR Unit; Department of Biomedical and NeuroMotor Sciences (DiBiNeM); University of Bologna; Bologna Italy
| | - Claudia Testa
- Functional MR Unit; Department of Biomedical and NeuroMotor Sciences (DiBiNeM); University of Bologna; Bologna Italy
| | - Caterina Tonon
- Functional MR Unit; Department of Biomedical and NeuroMotor Sciences (DiBiNeM); University of Bologna; Bologna Italy
| | | | - Sara Marconi
- Neurology Unit; Department of Biomedical and NeuroMotor Sciences (DiBiNeM); University of Bologna; Bologna Italy
- “IRCCS Istituto delle Scienze Neurologiche di Bologna,”; Bologna Italy
| | - Giuseppe Plazzi
- Neurology Unit; Department of Biomedical and NeuroMotor Sciences (DiBiNeM); University of Bologna; Bologna Italy
- “IRCCS Istituto delle Scienze Neurologiche di Bologna,”; Bologna Italy
| | - Fabio Pizza
- Neurology Unit; Department of Biomedical and NeuroMotor Sciences (DiBiNeM); University of Bologna; Bologna Italy
- “IRCCS Istituto delle Scienze Neurologiche di Bologna,”; Bologna Italy
| | - Federica Provini
- Neurology Unit; Department of Biomedical and NeuroMotor Sciences (DiBiNeM); University of Bologna; Bologna Italy
- “IRCCS Istituto delle Scienze Neurologiche di Bologna,”; Bologna Italy
| | - Emil Malucelli
- Department of Pharmacy and Biotechnology; University of Bologna; Bologna Italy
| | - Laura Ludovica Gramegna
- Functional MR Unit; Department of Biomedical and NeuroMotor Sciences (DiBiNeM); University of Bologna; Bologna Italy
| | - Raffaele Lodi
- Functional MR Unit; Department of Biomedical and NeuroMotor Sciences (DiBiNeM); University of Bologna; Bologna Italy
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Nicoletti G, Rizzo G, Barbagallo G, Tonon C, Condino F, Manners D, Messina D, Testa C, Arabia G, Gambardella A, Lodi R, Quattrone A. Diffusivity of cerebellar hemispheres enables discrimination of cerebellar or parkinsonian multiple system atrophy from progressive supranuclear palsy-Richardson syndrome and Parkinson disease. Radiology 2013; 267:843-50. [PMID: 23329659 DOI: 10.1148/radiol.12120364] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE To explore the usefulness of histogram analysis of mean diffusivity (MD) derived from diffusion-weighted imaging of large infratentorial structures to distinguish parkinsonian syndromes. MATERIALS AND METHODS Local research ethics committee approval and informed consent were obtained. Ten patients with Parkinson disease (PD), nine with the parkinsonian variant of multiple system atrophy (MSA-P), seven with the cerebellar variant of MSA (MSA-C), 17 with progressive supranuclear palsy-Richardson syndrome (PSP-RS), and 10 healthy subjects were recruited. Histograms of MD values were generated for all pixels in the whole infratentorial compartment and separately for the whole brainstem, vermis, and cerebellar hemispheres. To assess the differences in MD values among groups, the Kruskal-Wallis test was used, followed by the Mann-Whitney U test for pairwise comparisons. All P values resulting from pairwise comparisons were corrected with the Bonferroni method. RESULTS MSA-P and MSA-C groups had higher median MD values (P < .01) in the brainstem and cerebellum when compared with other groups; this finding was in line with the known consistent neurodegenerative damage in posterior cranial fossa structures in these diseases. Median MD values from cerebellar hemispheres were used to discriminate patients with MSA-C and those with MSA-P from patients with PD and those with PSP-RS (P < .01; sensitivity, specificity, and positive predictive value equaled 100%). Furthermore, patients with PSP-RS had significantly higher MD values in the vermis than did healthy subjects (P < .05) and patients with PD (P < .001). CONCLUSION These findings support the clinical usefulness of diffusion imaging in the differential diagnosis of parkinsonism, suggesting that the minimally operator-dependent histogram analysis of the infratentorial structures and particularly of the whole cerebellar hemispheres can be used to distinguish patients with MSA-P and those with MSA-C from patients with PSP-RS and those with PD.
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Affiliation(s)
- Giuseppe Nicoletti
- Institute of Neurologic Sciences, National Research Council, Piano Lago di Mangone, Cosenza, Italy
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Rizzo G, Tonon C, Testa C, Manners D, Vetrugno R, Pizza F, Marconi S, Malucelli E, Provini F, Plazzi G, Montagna P, Lodi R. Abnormal medial thalamic metabolism in patients with idiopathic restless legs syndrome. Brain 2012. [PMID: 23183234 DOI: 10.1093/brain/aws266] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Pathophysiology of restless legs syndrome is poorly understood. A role of the thalamus, specifically of its medial portion which is a part of the limbic system, was suggested by functional magnetic resonance imaging and positron emission tomography studies. The aim of this study was to evaluate medial thalamus metabolism and structural integrity in patients with idiopathic restless legs syndrome using a multimodal magnetic resonance approach, including proton magnetic resonance spectroscopy, diffusion tensor imaging, voxel-based morphometry and volumetric and shape analysis. Twenty-three patients and 19 healthy controls were studied in a 1.5 T system. Single voxel proton magnetic resonance spectra were acquired in the medial region of the thalamus. In diffusion tensor examination, mean diffusivity and fractional anisotropy were determined at the level of medial thalamus using regions of interest delineated to outline the same parenchyma studied by spectroscopy. Voxel-based morphometry was performed focusing the analysis on the thalamus. Thalamic volumes were obtained using FMRIB's Integrated Registration and Segmentation Tool software, and shape analysis was performed using the FMRIB Software Library tools. Proton magnetic resonance spectroscopy study disclosed a significantly reduced N-acetylaspartate:creatine ratio and N-acetylaspartate concentrations in the medial thalamus of patients with restless legs syndrome compared with healthy controls (P < 0.01 for both variable). Lower N-acetylaspartate concentrations were significantly associated with a family history of restless legs syndrome (β = -0.49; P = 0.018). On the contrary, diffusion tensor imaging, voxel-based morphometry and volumetric and shape analysis of the thalami did not show differences between the two groups. Proton magnetic resonance spectroscopic findings in patients with restless legs syndrome indicate an involvement of medial thalamic nuclei of a functional nature; however, the other structural techniques of the same region did not show any changes. These findings support the hypothesis that dysfunction of the limbic system plays a role in the pathophysiology of idiopathic restless legs syndrome.
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Affiliation(s)
- Giovanni Rizzo
- Department of Internal Medicine, Aging and Nephrology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
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Rizzo G, Manners D, Vetrugno R, Tonon C, Malucelli E, Plazzi G, Marconi S, Pizza F, Testa C, Provini F, Montagna P, Lodi R. Combined brain voxel-based morphometry and diffusion tensor imaging study in idiopathic Restless Legs Syndrome patients. Eur J Neurol 2011; 19:1045-9. [DOI: 10.1111/j.1468-1331.2011.03604.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Rizzo G, Tonon C, Valentino ML, Manners D, Fortuna F, Gellera C, Pini A, Ghezzo A, Baruzzi A, Testa C, Malucelli E, Barbiroli B, Carelli V, Lodi R. Brain diffusion-weighted imaging in Friedreich's ataxia. Mov Disord 2011; 26:705-12. [PMID: 21370259 DOI: 10.1002/mds.23518] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 09/22/2010] [Accepted: 10/18/2010] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Friedreich ataxia (FRDA) is the commonest form of autosomal recessive ataxia. This study aimed to define the extent of the brain damage in FRDA patients and to identify in vivo markers of neurodegeneration, using diffusion-weighted imaging (DWI). METHODS We studied 27 FRDA patients and 21 healthy volunteers using a 1.5 T scanner. Axial DW images were obtained and mean diffusivity (MD) maps were generated. Region of interests (ROIs) included medulla, pons, inferior, middle and superior cerebellar peduncles (ICP, SCP, MCP), dentate nucleus, cerebellar white matter, thalamus, caudate, putamen, pallidus, pyramidal tracts at level of posterior limb of internal capsule (PLIC), optic radiations (OR), and corpus callosum. Histograms of MD were generated for all pixels in the whole cerebral hemispheres and infratentorial compartment. Disease severity was assessed by the International Cooperative Ataxia Rating Scale (ICARS). RESULTS FRDA patients had significantly higher MD values than controls in medulla (P < 0.001), ICP (P < 0.001), MCP (P < 0.01), SCP (P < 0.001), OR (P < 0.001), and at the level of the infratentorial structures such as brainstem (P < 0.01), cerebellar hemispheres (P < 0.01), and especially in the cerebellar vermis (P < 0.001). MD values were strongly correlated with disease duration and ICARS score. DISCUSSION Our results showed that DWI is a suitable non-invasive technique to quantify the extent of neurodegeneration in FRDA, that appears more extended than previously reported, showing a microstructural involvement of structures such as OR and MCP.
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Affiliation(s)
- Giovanni Rizzo
- MR Spectroscopy Unit, Department of Internal Medicine, Aging and Nephrology, University of Bologna, Bologna, Italy
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Lodi R, Tonon C, Valentino ML, Manners D, Testa C, Malucelli E, La Morgia C, Barboni P, Carbonelli M, Schimpf S, Wissinger B, Zeviani M, Baruzzi A, Liguori R, Barbiroli B, Carelli V. Defective mitochondrial adenosine triphosphate production in skeletal muscle from patients with dominant optic atrophy due to OPA1 mutations. ACTA ACUST UNITED AC 2010; 68:67-73. [PMID: 20837821 DOI: 10.1001/archneurol.2010.228] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess whether impaired energy metabolism in skeletal muscle is a hallmark feature of patients with dominant optic atrophy due to several different mutations in the OPA1 gene. DESIGN We used phosphorus 31 magnetic resonance spectroscopy to assess calf muscle oxidative metabolism in subjects with molecularly defined dominant optic atrophy carrying different mutations in the OPA1 gene. In a subset of patients, we also evaluated serum lactate levels after exercise and muscle biopsy results for histology and mitochondrial DNA analysis. SETTING University neuromuscular and neurogenetics and magnetic resonance imaging units. PATIENTS Eighteen patients with dominant optic atrophy were enrolled from 8 unrelated families, 7 of which carried an OPA1 mutation predicted to induce haploinsufficiency and 1 with a missense mutation in exon 27. Fifteen patients had documented optic atrophy. MAIN OUTCOME MEASURES Presence of skeletal muscle mitochondrial oxidative phosphorylation dysfunction as assessed by phosphorus 31 magnetic resonance spectroscopy, serum lactate levels, and histological and mitochondrial DNA analysis. RESULTS Phosphorus 31 magnetic resonance spectroscopy showed reduced phosphorylation potential in the calf muscle at rest in patients with an OPA1 mutation (-24% from normal mean; P = .003) as well as a reduced maximum rate of mitochondrial adenosine triphosphate synthesis (-36%; P < .001; ranging from -28% to -49% in association with different mutations). In 4 of 10 patients (40%), the serum lactate level after exercise was elevated. Only 2 of 5 muscle biopsies, from the 2 patients with a missense mutation, showed slight myopathic changes. Low levels of mitochondrial DNA multiple deletions were found in all muscle biopsies. CONCLUSIONS Defective oxidative phosphorylation in skeletal muscle is a subclinical feature of patients with OPA1-related dominant optic atrophy, indicating a systemic expression of the OPA1 defect, similar to that previously reported for Leber hereditary optic neuropathy due to complex I dysfunction. This defect of oxidative phosphorylation does not appear to depend on the low amounts of mitochondrial DNA multiple deletions detected in muscle biopsies.
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Affiliation(s)
- Raffaele Lodi
- MR Spectroscopy Unit, Department of Internal Medicine, Aging, and Nephrology, University of Bologna, Bologna, Italy.
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Nicoletti G, Manners D, Novellino F, Condino F, Malucelli E, Barbiroli B, Tonon C, Arabia G, Salsone M, Giofre' L, Testa C, Lanza P, Lodi R, Quattrone A. Diffusion tensor MRI changes in cerebellar structures of patients with familial essential tremor. Neurology 2010; 74:988-94. [DOI: 10.1212/wnl.0b013e3181d5a460] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Lodi R, Parchi P, Tonon C, Manners D, Capellari S, Strammiello R, Rinaldi R, Testa C, Malucelli E, Mostacci B, Rizzo G, Pierangeli G, Cortelli P, Montagna P, Barbiroli B. Magnetic resonance diagnostic markers in clinically sporadic prion disease: a combined brain magnetic resonance imaging and spectroscopy study. Brain 2009; 132:2669-79. [PMID: 19755520 PMCID: PMC2759338 DOI: 10.1093/brain/awp210] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [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] [Indexed: 11/14/2022] Open
Abstract
The intra vitam diagnosis of prion disease is challenging and a definite diagnosis still requires neuropathological examination in non-familial cases. Magnetic resonance imaging has gained increasing importance in the diagnosis of prion disease. The aim of this study was to compare the usefulness of different magnetic resonance imaging sequences and proton magnetic resonance spectroscopy in the differential diagnosis of patients with rapidly progressive neurological signs compatible with the clinical diagnosis of sporadic prion disease. Twenty-nine consecutive patients with an initial diagnosis of possible or probable sporadic prion disease, on the basis of clinical and electroencephalography features, were recruited. The magnetic resonance protocol included axial fluid-attenuated inversion recovery-T2- and diffusion-weighted images, and proton magnetic resonance spectroscopy of the thalamus, striatum, cerebellum and occipital cortex. Based on the clinical follow-up, genetic studies and neuropathology, the final diagnosis was of prion disease in 14 patients out of 29. The percentage of correctly diagnosed cases was 86% for diffusion-weighted imaging (hyperintensity in the striatum/cerebral cortex), 86% for thalamic N-acetyl-aspartate to creatine ratio (cutoff </=1.21), 90% for thalamic N-acetyl-aspartate to myo-inositol (mI) ratio (cutoff </=1.05) and 86% for cerebral spinal fluid 14-3-3 protein. All the prion disease patients had N-acetyl-aspartate to creatine ratios </=1.21 (100% sensitivity and 100% negative predictive value) and all the non-prion patients had N-acetyl-aspartate to myo-inositol ratios >1.05 (100% specificity and 100% positive predictive value). Univariate logistic regression analysis showed that the combination of thalamic N-acetyl-aspartate to creatine ratio and diffusion-weighted imaging correctly classified 93% of the patients. The combination of thalamic proton magnetic resonance spectroscopy (10 min acquisition duration) and brain diffusion-weighted imaging (2 min acquisition duration) may increase the diagnostic accuracy of the magnetic resonance scan. Both sequences should be routinely included in the clinical work-up of patients with suspected prion disease.
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Affiliation(s)
- Raffaele Lodi
- MR Spectroscopy Unit, Department of Internal Medicine, Aging and Nephrology, University of Bologna, Azienda Universitario-Ospedaliera di Bologna, Via Massarenti 9, Bologna, Italy.
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38
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Nicoletti G, Tonon C, Lodi R, Condino F, Manners D, Malucelli E, Morelli M, Novellino F, Paglionico S, Lanza P, Messina D, Barone P, Morgante L, Zappia M, Barbiroli B, Quattrone A. Apparent diffusion coefficient of the superior cerebellar peduncle differentiates progressive supranuclear palsy from Parkinson's disease. Mov Disord 2009; 23:2370-6. [PMID: 18816803 DOI: 10.1002/mds.22279] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The early diagnosis of progressive supranuclear palsy (PSP) may be challenging, because of clinical overlapping features with Parkinson's disease (PD) and other parkinsonian syndromes such as the Parkinsonian variant of multiple system atrophy (MSA-P). Conventional MRI can help in differentiating parkinsonian disorders but its diagnostic accuracy is still unsatisfactory. On the basis of the pathological demonstration of superior cerebellar peduncle (SCP) atrophy in patients with PSP, we assessed the SCP apparent diffusion coefficient (ADC) values in patients with PSP, PD, and MSA-P in order to evaluate its differential diagnostic value in vivo. Twenty-eight patients with PSP (14 with possible-PSP and 14 with probable-PSP), 15 PD, 15 MSA-P, and 16 healthy subjects were studied by using diffusion weighted imaging (DWI). ADC was calculated in regions of interest defined in the left and right SCP by two clinically blinded operators. Intrarater (r = 0.98, P < 0.001) and interrater reliability (r = 0.97; P < 0.001) for SCP measurements were high. Patients with PSP had higher SCP rADC values (median 0.98 x 10(-3)mm(2)/s) than patients with PD (median 0.79 x 10(-3) mm(2)/s, P < 0.001), MSA-P (median 0.79 x 10(-3) mm(2)/s, P < 0.001), and healthy controls (median 0.80 x 10(-3) mm(2)/s, P < 0.001). DWI discriminated patients with PSP from PD and healthy subjects on the basis of SCP rADC individual values (100% sensitivity and specificity) and from patients with MSA-P (96.4% sensitivity and 93.3% specificity). The higher values of rADC in SCP of patients with PSP correspond with the in vivo microstructural feature of atrophy detected postmortem and provide an additional support for early discrimination between PSP and other neurodegenerative parkinsonisms.
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Affiliation(s)
- Giuseppe Nicoletti
- Institute of Neurological Sciences, National Research Council, Piano Lago di Mangone, Cosenza, Italy
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Fortuna F, Barboni P, Liguori R, Valentino ML, Savini G, Gellera C, Mariotti C, Rizzo G, Tonon C, Manners D, Lodi R, Sadun AA, Carelli V. Visual system involvement in patients with Friedreich's ataxia. Brain 2009; 132:116-23. [PMID: 18931386 DOI: 10.1093/brain/awn269] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Optic neuropathy is common in mitochondrial disorders, but poorly characterized in Friedreich's ataxia (FRDA), a recessive condition caused by lack of the mitochondrial protein frataxin. We investigated 26 molecularly confirmed FRDA patients by studying both anterior and posterior sections of the visual pathway using a new, integrated approach. This included visual field testing and optical coherence tomography (OCT), pattern visual evoked potentials (P-VEPs) and diffusion-weighted imaging. The latter was used to study optic radiation by calculating water apparent diffusion coefficients (ADC). All patients suffered optic nerve involvement with their disorder. Different patterns of visual field defects were observed and a variably reduced retinal nerve fiber layer thickness was seen by OCT in all cases. P-VEPs were abnormal in approximately half of the patients. Decreased visual acuity and temporal optic disc pallor were present in advanced stages of the disease, but only five patients were symptomatic. Two of these patients suffered a sudden loss of central vision, mimicking Leber's hereditary optic neuropathy (LHON), and of the other three symptomatic patients two were noted to be compound heterozygotes. ADC values of optic radiations in patients were significantly higher than controls (P < 0.01). Retinal nerve fiber layer thickness at OCT and P-VEPs correlated with age at onset and ICARS total score. ADC values correlated with age at onset, disease duration, GAA triplet expansion size, ICARS total score and P-VEPs. Visual pathway involvement is found consistently in FRDA, being previously underestimated, and we here document that it also involves the optic radiations. Occasional LHON-like cases may occur. However, optic neuropathy in FRDA substantially differs from classic mitochondrial optic neuropathies implying a different pathophysiology of visual system degeneration in this mitochondrial disease.
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Affiliation(s)
- Filippo Fortuna
- Dipartimento di Scienze Neurologiche, Università di Bologna, Bologna, Italy
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Rizzo G, Martinelli P, Manners D, Scaglione C, Tonon C, Cortelli P, Malucelli E, Capellari S, Testa C, Parchi P, Montagna P, Barbiroli B, Lodi R. Diffusion-weighted brain imaging study of patients with clinical diagnosis of corticobasal degeneration, progressive supranuclear palsy and Parkinson's disease. Brain 2008; 131:2690-700. [PMID: 18819991 DOI: 10.1093/brain/awn195] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Corticobasal degeneration (CBD) and progressive supranuclear palsy (PSP) are two neurodegenerative disorders within the category of tauopathies, which must be considered in differential diagnosis of Parkinson's disease. Although specific clinical and neuroradiological features help to guide the clinician to a likely diagnosis of Parkinson's disease, CBD or PSP, differential diagnosis remains difficult. The aim of our study was to analyse apparent diffusion coefficient (ADC(ave)) maps from patients with clinical diagnosis of CBD (corticobasal syndrome, CBS), classical phenotype of PSP (Richardson's syndrome, RS) and Parkinson's disease (PD) in order to identify objective markers to discriminate between these groups. Thirteen Parkinson's disease patients, 10 RS patients, 7 CBS patients and 9 healthy volunteers were recruited and studied in a 1.5 T MR scanner. Axial diffusion-weighted images were obtained and the ADC(ave) map was generated. Regions of interest (ROIs) included mesencephalon, corpus callosum and left and right superior cerebellar peduncle (SCP), thalamus, caudate, putamen, pallidus, posterior limb of internal capsule, frontal and parietal white matter. Histograms of ADC(ave) were generated for all voxels in left and right cerebral hemispheres and in left and right deep grey matter regions separately, and the 50th percentile values (medians) were determined. The ratio of the smaller to the larger median value (symmetry ratio) was calculated for left and right hemispheres and for left and right deep grey matter regions (1 = perfect symmetry). Putaminal ADC(ave) values in CBS and RS were significantly greater than those in Parkinson's disease and healthy volunteers, but could not distinguish CBS from RS patients. In CBS patients, the values of the medians of cerebral hemispheres histograms were significantly higher than those in RS, Parkinson's disease and healthy volunteers, while the hemispheric symmetry ratio in CBS (0.968, range 0.952-0.976) was markedly reduced compared with RS (0.993, range 0.992-0.994), Parkinson's disease (0.991, range 0.988-0.993) and healthy controls (0.990, range 0.988-0.993). The hemispheric symmetry ratio differentiated CBS patients from RS and Parkinson's disease patients with a sensitivity and specificity of 100%. In RS patients, the ADC(ave) values of the SCPs were significantly greater than those in Parkinson's disease and healthy volunteers. Our findings confirm that putaminal ADC(ave) values evaluation provides a good discrimination between Parkinson's disease and atypical parkinsonisms, including RS and CBS. Furthermore, diffusion-weighted imaging, by detecting the brain microstructural correlates of the typical asymmetric signs and symptoms in CBS and the SCP involvement in RS, was shown to aid characterization and differentiation of atypical parkinsonism.
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Affiliation(s)
- Giovanni Rizzo
- MR Spectroscopy Unit, Department of Internal Medicine, Ageing and Nephrology, University of Bologna, Bologna, Italy
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Martinuzzi A, Liava A, Trevisi E, Frare M, Tonon C, Malucelli E, Manners D, Kemp GJ, Testa C, Barbiroli B, Lodi R. Randomized, placebo-controlled, double-blind pilot trial of ramipril in McArdle's disease. Muscle Nerve 2008; 37:350-7. [DOI: 10.1002/mus.20937] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Martinelli P, Rizzo G, Manners D, Tonon C, Pizza F, Testa C, Scaglione C, Barbiroli B, Lodi R. Diffusion-weighted imaging study of patients with essential tremor. Mov Disord 2007; 22:1182-5. [PMID: 17469200 DOI: 10.1002/mds.21287] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The pathophysiology of essential tremor (ET) is unknown. PET and fMRI studies have revealed bilateral activation and (1)H-MRS studies metabolic abnormalities in the cerebellum and other functionally related brain structures in ET. Diffusion-weighted imaging (DWI) was used to search for evidence of tissue integrity abnormalities in these areas in ET patients and 10 matched controls by calculating water apparent diffusion coefficients (ADCs). Regions of interest included the left and right cerebellum, red nucleus, thalamus, caudate, putamen, pallidum, and frontal white matter. Histograms of ADCs were generated for all pixels in the infratentorial compartment and manually segmented areas corresponding to brainstem, vermis, and cerebellar hemispheres. ADC values were similar in all brain areas in patients and controls. Our study did not detect changes affecting the investigated brain regions in ET patients. These findings argue against major structural damage in the ET brain, although more subtle neurodegenerative changes cannot be ruled out.
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Affiliation(s)
- Paolo Martinelli
- Dipartimento di Scienze Neurologiche, Università di Bologna, Bologna, Italy
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43
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Nicoletti G, Lodi R, Condino F, Tonon C, Fera F, Malucelli E, Manners D, Zappia M, Morgante L, Barone P, Barbiroli B, Quattrone A. Apparent diffusion coefficient measurements of the middle cerebellar peduncle differentiate the Parkinson variant of MSA from Parkinson's disease and progressive supranuclear palsy. Brain 2006; 129:2679-87. [PMID: 16815875 DOI: 10.1093/brain/awl166] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Clinical differentiation of parkinsonian syndromes such as the Parkinson variant of multiple system atrophy (MSA-P) and progressive supranuclear palsy (PSP) from Parkinson's disease is difficult in the early stage of the disease. In order to identify objective markers for differential diagnosis, we studied these three groups of patients with diffusion-weighted MRI (DWI). Sixteen MSA-P patients, 16 with PSP, 16 with Parkinson's disease and 15 healthy volunteers were studied. Regional apparent diffusion coefficients (rADC) were determined in different brain regions including basal ganglia, thalamus, white matter, pons and middle cerebellar peduncles (MCPs). rADC calculated in the MCP completely differentiated MSA-P patients (median: 0.93 x 10(-3) mm2/s) from PSP patients (median: 0.82 x 10(-3) mm2/s, P < 0.001), Parkinson's disease patients (median: 0.79 x 10(-3) mm2/s, P < 0.001) and healthy volunteers (median: 0.81 x 10(-3) mm2/s, P < 0.001). Other regions considered showed an overlapping among groups. DWI discriminates MSA-P from PSP and Parkinson's disease and healthy volunteers on the basis of MCP rADC values. These in vivo results confirm the pathological findings that the majority of MSA-P patients have moderate or severe degenerative changes not only in the nigrostriatal but also in the olivopontocerebellar systems. Our findings indicate that, in order to substantially contribute to the in vivo differential diagnosis of MSA-P, PSP and Parkinson's disease, rADC measurements should not be limited to the basal ganglia but should also include the MCP.
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Affiliation(s)
- Giuseppe Nicoletti
- Institute of Neurological Sciences, National Research Council, Mangone, Cosenza, Italy
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Abstract
Over the last two decades magnetic resonance spectroscopy has been extensively used to investigate the role of energy metabolism impairment in the physiopathology of migraine. In this paper we review the studies performed on migraine sufferers during headache attacks as well as interictally. Overall there is currently evidence that migraine is associated with a generalised disorder of energy metabolism and that this, in association with other susceptibility factors, may be an important feature that lowers the threshold for triggering migraine attacks.
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Affiliation(s)
- R Lodi
- Dipartimento di Medicina, Clinica e Biotecnologia Applicata "D. Campanacci", Università di Bologna, Policlinico S. Orsola, Via Massarenti 9, I-40138, Bologna, Italy.
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Hart PE, Lodi R, Rajagopalan B, Bradley JL, Crilley JG, Turner C, Blamire AM, Manners D, Styles P, Schapira AHV, Cooper JM. Antioxidant treatment of patients with Friedreich ataxia: four-year follow-up. Arch Neurol 2005; 62:621-6. [PMID: 15824263 DOI: 10.1001/archneur.62.4.621] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Decreased mitochondrial respiratory chain function and increased oxidative stress have been implicated in the pathogenesis of Friedreich ataxia (FRDA), raising the possibility that energy enhancement and antioxidant therapies may be an effective treatment. OBJECTIVE To evaluate the long-term efficacy of a combined antioxidant and mitochondrial enhancement therapy on the bioenergetics and clinical course of FRDA. DESIGN Open-labeled pilot trial over 47 months.Patients Seventy-seven patients with clinical and genetically defined FRDA. Intervention A combined coenzyme Q(10) (400 mg/d) and vitamin E (2100 IU/d) therapy of 10 patients with FRDA over 47 months. MAIN OUTCOME MEASURES Clinical assessment using echocardiography and the International Cooperative Ataxia Rating Scale and cardiac and skeletal muscle bioenergetics as assessed using phosphorus P 31 magnetic resonance spectroscopy. RESULTS There was a significant improvement in cardiac and skeletal muscle bioenergetics that was maintained throughout the 47 months of therapy. Echocardiographic data revealed significantly increased fractional shortening at the 35- and 47-month time points. Comparison with cross-sectional data from 77 patients with FRDA indicated the changes in total International Cooperative Ataxia Rating Scale and kinetic scores over the trial period were better than predicted for 7 patients, but the posture and gait and hand dexterity scores progressed as predicted. CONCLUSION This therapy resulted in sustained improvement in mitochondrial energy synthesis that was associated with a slowing of the progression of certain clinical features and a significant improvement in cardiac function.
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Affiliation(s)
- Paul E Hart
- University Department of Clinical Neurosciences, Royal Free and University College Medical School, London, England
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46
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Scheuermann-Freestone M, Madsen PL, Manners D, Blamire AM, Buckingham RE, Styles P, Radda GK, Neubauer S, Clarke K. Abnormal cardiac and skeletal muscle energy metabolism in patients with type 2 diabetes. Circulation 2003; 107:3040-6. [PMID: 12810608 DOI: 10.1161/01.cir.0000072789.89096.10] [Citation(s) in RCA: 372] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND It is well known that patients with type 2 diabetes have increased risk of cardiovascular disease, but it is not known whether they have underlying abnormalities in cardiac or skeletal muscle high-energy phosphate metabolism. METHODS AND RESULTS We studied 21 patients with type 2 diabetes with no evidence of coronary artery disease or impaired cardiac function, as determined by echocardiography, and 15 age-, sex-, and body mass index-matched control subjects. Cardiac high-energy phosphate metabolites were measured at rest using 31P nuclear magnetic resonance spectroscopy (MRS). Skeletal muscle high-energy phosphate metabolites, intracellular pH, and oxygenation were measured using 31P MRS and near infrared spectrophotometry, respectively, before, during, and after exercise. Although their cardiac morphology, mass, and function appeared to be normal, the patients with diabetes had significantly lower phosphocreatine (PCr)/ATP ratios, at 1.50+/-0.11, than the healthy volunteers, at 2.30+/-0.12. The cardiac PCr/ATP ratios correlated negatively with the fasting plasma free fatty acid concentrations. Although skeletal muscle energetics and pH were normal at rest, PCr loss and pH decrease were significantly faster during exercise in the patients with diabetes, who had lower exercise tolerance. After exercise, PCr recovery was slower in the patients with diabetes and correlated with tissue reoxygenation times. The exercise times correlated negatively with the deoxygenation rates and the hemoglobin (Hb)A1c levels and the reoxygenation times correlated positively with the HbA1c levels. CONCLUSIONS Type 2 diabetic patients with apparently normal cardiac function have impaired myocardial and skeletal muscle energy metabolism related to changes in circulating metabolic substrates.
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Cea G, Bendahan D, Manners D, Hilton-Jones D, Lodi R, Styles P, Taylor DJ. Reduced oxidative phosphorylation and proton efflux suggest reduced capillary blood supply in skeletal muscle of patients with dermatomyositis and polymyositis: a quantitative 31P-magnetic resonance spectroscopy and MRI study. Brain 2002; 125:1635-45. [PMID: 12077012 DOI: 10.1093/brain/awf163] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Quantitative MRI and phosphorus magnetic resonance spectroscopy ((31)P-MRS) were used to investigate skeletal muscle metabolism in vivo in patients with dermatomyositis (DM) and polymyositis (PM) in order to evaluate the role of mitochondrial abnormalities in the pathogenesis and clinical expression of these conditions. Nine patients with DM (mean age +/- SD, 57 +/- 14 years) and five with PM (42 +/- 12 years) and with age at disease onset 53 +/- 16 and 38 +/- 12 years, respectively, were included in the study together with 18 age-matched controls. Post-exercise (31)P-MRS indices of muscle oxidative metabolism were all impaired in DM and PM. In both groups of patients, the phosphocreatine and adenosine diphosphate recovery half-times were almost twice as long as in controls (P < 0.05 for each variable) and the maximum rate of mitochondrial ATP production was half that found in normal subjects (P < 0.001). The rate of proton efflux from muscle fibres was significantly reduced in DM (P < 0.001) and PM (P = 0.02). The impairment of (31)P-MRS recovery indices in DM and PM patients was similar to that found in a group of 10 patients with a primary mitochondrial disorder that showed a normal proton efflux rate. There was no correlation between the MRS-detectable abnormalities and the degree of inflammation or fatty infiltration of the muscle, as measured by MRI. The in vivo findings in DM and PM patients indicate impaired muscle aerobic function, which, considering the reduced proton efflux, is likely to be secondary to an impaired blood supply. Our results suggest that the abnormal mitochondria seen in some muscle biopsies are unlikely to be the primary cause of the oxidative insufficiency in these patients.
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Affiliation(s)
- Gabriel Cea
- MRC Biochemical and Clinical Magnetic Resonance Unit, Department of Biochemistry, Radcliffe Infirmary, University of Oxford, UK.
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Lodi R, Rajagopalan B, Bradley JL, Taylor DJ, Crilley JG, Hart PE, Blamire AM, Manners D, Styles P, Schapira AHV, Cooper JM. Mitochondrial dysfunction in Friedreich's ataxia: from pathogenesis to treatment perspectives. Free Radic Res 2002; 36:461-6. [PMID: 12069111 DOI: 10.1080/10715760290021324] [Citation(s) in RCA: 24] [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: 10/28/2022]
Abstract
Friedreich's ataxia (FRDA), the most common inherited ataxia, is an autosomal recessive degenerative disorder caused by a GAA triplet expansion or point mutations in the FRDA gene on chromosome 9q13. The FRDA gene product, frataxin, is a widely expressed mitochondrial protein, which is severely reduced in FRDA patients. The demonstration that deficit of frataxin in FRDA is associated with mitochondrial iron accumulation, increased sensitivity to oxidative stress, deficit of respiratory chain complex activities and in vivo impairment of cardiac and skeletal muscle tissue energy metabolism, has established FRDA as a "new" nuclear encoded mitochondrial disease. Pilot studies have shown the potential effect of antioxidant therapy based on idebenone or coenzyme Q10 plus Vitamin E administration in this condition and provide a strong rationale for designing larger randomized clinical trials.
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Affiliation(s)
- R Lodi
- Dipartimento di Medicina Clinica e Biotecnologia Applicata, Universitá di Bologna, Policlinico S. Orsola, Italy.
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Lodi R, Hart PE, Rajagopalan B, Taylor DJ, Crilley JG, Bradley JL, Blamire AM, Manners D, Styles P, Schapira AH, Cooper JM. Antioxidant treatment improves in vivo cardiac and skeletal muscle bioenergetics in patients with Friedreich's ataxia. Ann Neurol 2001; 49:590-6. [PMID: 11357949] [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: 04/16/2023]
Abstract
Friedreich's ataxia (FA) is the most common form of autosomal recessive spinocerebellar ataxia and is often associated with a cardiomyopathy. The disease is caused by an expanded intronic GAA repeat, which results in deficiency of a mitochondrial protein called frataxin. In the yeast YFH1 knockout model of the disease there is evidence that frataxin deficiency leads to a severe defect of mitochondrial respiration, intramitochondrial iron accumulation, and associated production of oxygen free radicals. Recently, the analysis of FA cardiac and skeletal muscle samples and in vivo phosphorus magnetic resonance spectroscopy (31P-MRS) has confirmed the deficits of respiratory chain complexes in these tissues. The role of oxidative stress in FA is further supported by the accumulation of iron and decreased aconitase activities in cardiac muscle. We used 31P-MRS to evaluate the effect of 6 months of antioxidant treatment (Coenzyme Q10 400 mg/day, vitamin E 2,100 IU/day) on cardiac and calf muscle energy metabolism in 10 FA patients. After only 3 months of treatment, the cardiac phosphocreatine to ATP ratio showed a mean relative increase to 178% (p = 0.03) and the maximum rate of skeletal muscle mitochondrial ATP production increased to 139% (p = 0.01) of their respective baseline values in the FA patients. These improvements, greater in prehypertrophic hearts and in the muscle of patients with longer GAA repeats, were sustained after 6 months of therapy. The neurological and echocardiographic evaluations did not show any consistent benefits of the therapy after 6 months. This study demonstrates partial reversal of a surrogate biochemical marker in FA with antioxidant therapy and supports the evaluation of such therapy as a disease-modifying strategy in this neurodegenerative disorder.
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Affiliation(s)
- R Lodi
- Department of Biochemistry, University of Oxford, United Kingdom.
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50
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Abstract
The authors studied the relationship between the percentage level of A3243G mitochondrial DNA mutation and the degree of mitochondrial dysfunction in vivo in nine individuals from four pedigrees using phosphorus MRS in muscle. There was no significant correlation between mutation load and maximum rate of adenosine triphosphate production (V(max)). V(max) was normal in a subject with 32% A3243G in muscle, which is in contrast with a previous observation of markedly reduced V(max) in a patient with only 6% A3243G in muscle. Factors besides mutation load, such as nuclear genes, influence expression of the A3243G mutation in vivo.
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Affiliation(s)
- P F Chinnery
- Department of Neurology, the University of Newcastle upon Tyne, UK.
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