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Osei E, Zandbergen A, Brouwers PJAM, Mulder LJMM, Koudstaal P, Lingsma H, Dippel DWJ, den Hertog H. Safety, feasibility and efficacy of metformin and sitagliptin in patients with a TIA or minor ischaemic stroke and impaired glucose tolerance. BMJ Open 2021; 11:e046113. [PMID: 34531203 PMCID: PMC8449977 DOI: 10.1136/bmjopen-2020-046113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Impaired glucose tolerance (IGT) is highly prevalent after stroke and is associated with recurrent stroke and unfavourable outcome. OBJECTIVES We aimed to assess the feasibility, safety and effects on glucose metabolism of metformin or sitagliptin in patients with transient ischaemic attack (TIA) or minor ischaemic stroke and IGT. DESIGN We performed a multicentre, randomised, controlled, open-label phase II trial with blinded outcome assessment. INTERVENTIONS Patients were randomised in a 2:1:1 ratio to 'no medication', sitagliptin or metformin. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome measures were baseline adjusted differences of 2-hour postload glucose; secondary outcome measures fasting glucose, glycosylated haemoglobin 1c (HbA1c) levels, tolerability and safety of metformin and sitagliptin at 6 months. Patients on metformin or sitagliptin were contacted by telephone for recording of possible adverse events and to support continuation of treatment at 2 weeks, 6 weeks and 3 months after inclusion. These events were not analysed as outcome measures. RESULTS Fifty-three patients were randomised to control group, 26 to metformin and 22 to sitagliptin. We found no significant differences in 2-hour postload glucose between patients on antidiabetic drugs and controls ((-0.04 mmol/L (95% CI -0.53 to 0.45)). Patients in the treatment arms had reduced fasting glucose: ((-0.21 mmol/L (95% CI -0.36 to -0.06)) and HbA1c levels ((-1.16 mmol/mol (95% CI -1.84 to -0.49)). Thirteen patients (50%) on metformin and 7 (32%) on sitagliptin experienced side effects. Sixteen patients (61%) in the metformin and 13 (59%) in the sitagliptin group were still on treatment after 6 months. CONCLUSIONS Metformin and sitagliptin were both effective in reducing fasting glucose and HbA1c levels in patients with recent TIA or minor ischaemic stroke and IGT. However, the reduction of glucose levels and sample size was relatively small. The clinical relevance, therefore, needs to be tempered. A phase III trial is needed to investigate whether medical treatment, compared with lifestyle intervention or a combination of both, not only improves glucose metabolism in IGT, but also leads to reduction of recurrent TIA or ischaemic stroke in these patients. TRIAL REGISTRATION NUMBER NL3048.
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Osei E, den Hertog HM, Fonville S, Brouwers PJAM, Mulder LJMM, Koudstaal PJ, Dippel DWJ, Zandbergen AAM, Lingsma HF. Prediction of Persistent Impaired Glucose Tolerance in Patients with Minor Ischemic Stroke or Transient Ischemic Attack. J Stroke Cerebrovasc Dis 2020; 29:104815. [PMID: 32303400 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104815] [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: 02/14/2020] [Revised: 03/07/2020] [Accepted: 03/13/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Impaired glucose tolerance (IGT) in patients with ischemic stroke can return to normal, reflecting an acute stress response, or persist. Persistent IGT is associated with an increased risk of recurrent stroke, other cardiovascular diseases and unfavorable outcome after stroke. We aim to validate our previously developed model to identify patients at risk of persistent IGT in an independent data set, and, if necessary, update the model. METHODS The validation data set consisted of 239 nondiabetic patients with a minor ischemic stroke or TIA and IGT in the acute phase (2-hour post-load glucose levels between 7.8 and 11.0 mmol/l). The outcome was persistent versus normalized IGT, based on repeated oral glucose tolerance test after a median of 46 days. The discriminative ability of the original model was assessed with the area under the ROC curve (AUC). The updated model was internally validated with bootstrap resampling and cross-validated in the development population of the original model. RESULTS One-hundred eighteen of 239 (49%) patients had persistent IGT. The original model, with the predictors age, current smoking, statin use, triglyceride, hypertension, history of cardiovascular diseases, body mass index (BMI), fasting plasma glucose performed poorly (AUC .60). The newly developed model included only BMI, hypertension, statin use, atrial fibrillation, 2-hour post-load glucose levels, HbA1c, large artery atherosclerosis, and predicted persistent IGT more accurately (internally validated AUC 0.66, externally validated AUC .71). CONCLUSIONS This prediction model with simple clinical variables can be used to predict persistent IGT in patients with IGT directly after minor stroke or TIA, and may be useful to optimize secondary prevention by early identification of patients with disturbed glucose metabolism.
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Niraula R, Saleh A, Bhattarai N, Bajgain R, Kannan N, Osei E, Gowda P, Neel J, Xiao X, Basara J. Understanding the effects of pasture type and stocking rate on the hydrology of the Southern Great Plains. Sci Total Environ 2020; 708:134873. [PMID: 31791796 DOI: 10.1016/j.scitotenv.2019.134873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/26/2019] [Revised: 09/30/2019] [Accepted: 10/05/2019] [Indexed: 06/10/2023]
Abstract
Grassland is one of the major biomes in the United States (US) and the world. In the US, the majority of grasslands are concentrated in the Great Plains and has undergone through significant interventions or management changes over the last few decades. A key economy-driven intervention in the Southern Great Plains (SGP) include the introduction of new forage species and conversion of native grassland to introduced pasture to increase productivity and its nutritive value for improved cattle production. Since water is one of the fundamental resources needed to sustain grassland productivity, it is important to understand how such pasture conversion and prevailing cattle grazing practices affect water balance and biomass production in a given pasture system. In this study, the Nutrient Tracking Tool (NTT) with its core APEX (Agricultural Policy Environmental eXtender) model was used to assess the hydrological impacts of the pasture introduction, i.e., native pasture (little bluestem, Schizachyrium halapense) vs. introduced pasture (old world bluestem, Bothriochloa caucasica), and the stocking rate in the SGP. Monthly evapotranspiration (ET) and biomass estimates from NTT compared well with observed data at two USDA-ARS experimental pastures (native and introduced) near El Reno, Oklahoma, for the years 2015 and 2016. Simulated long-term average annual hydrologic fluxes (i.e., ET, runoff, and groundwater recharge) from the introduced pasture were slightly lower than the observed data but not significantly different than those from the native pasture under the current management conditions. NTT predicted higher water yield (runoff and recharge) and significantly lower ET for the introduced pasture than the native pasture. Results suggest that grazing has the potential to alter the hydrological balance in the SGP. For example, the increase in stocking rate within the carrying capacity of the farm decreases ET and increases runoff and groundwater recharge for both pastures. Comparison of estimated biomass production between native and introduced pastures indicated that introduced pastures are more efficient in using the available water and thus produce a higher forage biomass per unit of water in the SGP. This study highlighted the potential significance of considering hydrological and other biophysical impacts of new forage introduction and stocking rate changes for the sustainable management of grazing and pasture systems in the SGP.
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Affiliation(s)
- R Niraula
- Texas Institute for Applied Environmental Research (TIAER), Tarleton State University, Stephenville, TX, USA.
| | - A Saleh
- Texas Institute for Applied Environmental Research (TIAER), Tarleton State University, Stephenville, TX, USA
| | - N Bhattarai
- School for Environment and Sustainability, University of Michigan, Ann Arbor, MI, USA
| | - R Bajgain
- Department of Microbiology and Plant Biology, University of Oklahoma, Norman, OK, USA
| | - N Kannan
- Texas Institute for Applied Environmental Research (TIAER), Tarleton State University, Stephenville, TX, USA
| | - E Osei
- Agricultural and Consumer Sciences, Tarleton State University, Stephenville, TX, USA
| | - P Gowda
- Forage and Livestock Production Research Unit, USDA-ARS Grazinglands Research Laboratory, El Reno, OK, USA
| | - J Neel
- Forage and Livestock Production Research Unit, USDA-ARS Grazinglands Research Laboratory, El Reno, OK, USA
| | - X Xiao
- Department of Microbiology and Plant Biology, University of Oklahoma, Norman, OK, USA
| | - J Basara
- School of Meteorology, University of Oklahoma, Norman, OK, USA; School of Civil Engineering and Environmental Science, University of Oklahoma, Norman, OK, USA
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Chamorro Á, Brown S, Amaro S, Hill MD, Muir KW, Dippel DWJ, van Zwam W, Butcher K, Ford GA, den Hertog HM, Mitchell PJ, Demchuk AM, Majoie CBLM, Bracard S, Sibon I, Jadhav AP, Lara-Rodriguez B, van der Lugt A, Osei E, Renú A, Richard S, Rodriguez-Luna D, Donnan GA, Dixit A, Almekhlafi M, Deltour S, Epstein J, Guillon B, Bakchine S, Gomis M, du Mesnil de Rochemont R, Lopes D, Reddy V, Rudel G, Roos YBWEM, Bonafe A, Diener HC, Berkhemer OA, Cloud GC, Davis SM, van Oostenbrugge R, Guillemin F, Goyal M, Campbell BCV, Menon BK. Glucose Modifies the Effect of Endovascular Thrombectomy in Patients With Acute Stroke. Stroke 2019; 50:690-696. [PMID: 30777000 DOI: 10.1161/strokeaha.118.023769] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Hyperglycemia is a negative prognostic factor after acute ischemic stroke but is not known whether glucose is associated with the effects of endovascular thrombectomy (EVT) in patients with large-vessel stroke. In a pooled-data meta-analysis, we analyzed whether serum glucose is a treatment modifier of the efficacy of EVT in acute stroke. Methods- Seven randomized trials compared EVT with standard care between 2010 and 2017 (HERMES Collaboration [highly effective reperfusion using multiple endovascular devices]). One thousand seven hundred and sixty-four patients with large-vessel stroke were allocated to EVT (n=871) or standard care (n=893). Measurements included blood glucose on admission and functional outcome (modified Rankin Scale range, 0-6; lower scores indicating less disability) at 3 months. The primary analysis evaluated whether glucose modified the effect of EVT over standard care on functional outcome, using ordinal logistic regression to test the interaction between treatment and glucose level. Results- Median (interquartile range) serum glucose on admission was 120 (104-140) mg/dL (6.6 mmol/L [5.7-7.7] mmol/L). EVT was better than standard care in the overall pooled-data analysis adjusted common odds ratio (acOR), 2.00 (95% CI, 1.69-2.38); however, lower glucose levels were associated with greater effects of EVT over standard care. The interaction was nonlinear such that significant interactions were found in subgroups of patients split at glucose < or >90 mg/dL (5.0 mmol/L; P=0.019 for interaction; acOR, 3.81; 95% CI, 1.73-8.41 for patients < 90 mg/dL versus 1.83; 95% CI, 1.53-2.19 for patients >90 mg/dL), and glucose < or >100 mg/dL (5.5 mmol/L; P=0.004 for interaction; acOR, 3.17; 95% CI, 2.04-4.93 versus acOR, 1.72; 95% CI, 1.42-2.08) but not between subgroups above these levels of glucose. Conclusions- EVT improved stroke outcomes compared with standard treatment regardless of glucose levels, but the treatment effects were larger at lower glucose levels, with significant interaction effects persisting up to 90 to 100 mg/dL (5.0-5.5 mmol/L). Whether tight control of glucose improves the efficacy of EVT after large-vessel stroke warrants appropriate testing.
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Affiliation(s)
- Ángel Chamorro
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C., S.A., A.R.).,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.C., S.A., A.R.)
| | - Scott Brown
- Altair Biostatistics, St Louis Park, MN (S. Brown)
| | - Sergio Amaro
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C., S.A., A.R.).,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.C., S.A., A.R.)
| | - Michael D Hill
- Calgary Stroke Program, Departments of Clinical Neurosciences, Medicine, Community Health Sciences, and Radiology (M.D.H.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada
| | - Keith W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Scotland, United Kingdom (K.W.M.)
| | - Diederik W J Dippel
- Department of Neurology (D.W.J.D., E.O., O.A.B.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Wim van Zwam
- Department of Radiology (W.v.Z.), Maastricht University Medical Center Maastricht, the Netherlands
| | - Ken Butcher
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (K.B.)
| | - Gary A Ford
- Stroke Unit, Oxford University Hospitals and Division of Medical Sciences, Oxford University, United Kingdom (G.A.F.)
| | - Heleen M den Hertog
- Department of Neurology, Isala Klinieken, Zwolle, the Netherlands (H.M.d.H.).,Department of Neurology, Medisch Spectrum Twente, Enschede, Netherlands (H.M.d.H., E.O.)
| | - Peter J Mitchell
- Department of Radiology, Royal Melbourne Hospital (P.J.M.), University of Melbourne, Parkville, Australia
| | - Andrew M Demchuk
- Calgary Stroke Program, Departments of Clinical Neurosciences and Radiology (A.M.D., M.A., M. Goyal, B.K.M.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada
| | - Charles B L M Majoie
- Department of Radiology (C.B.L.M.M., O.A.B.), Academic Medical Center Amsterdam, the Netherlands
| | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, INSERM U 947 (S. Bracard), Université de Lorraine and University Hospital of Nancy, France
| | - Igor Sibon
- Stroke Unit University and University Hospital of CHU Bordeaux, France (I.S.)
| | | | | | - Aad van der Lugt
- Department of Radiology (A.v.d.L., O.A.B.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Elizabeth Osei
- Department of Neurology (D.W.J.D., E.O., O.A.B.), Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Department of Neurology, Medisch Spectrum Twente, Enschede, Netherlands (H.M.d.H., E.O.)
| | - Arturo Renú
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C., S.A., A.R.).,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.C., S.A., A.R.)
| | - Sébastien Richard
- Department of Neurology, University Hospital of Nancy, France (S.R.)
| | - David Rodriguez-Luna
- Stroke Unit, Neurology Department, Vall d'Hebron University Hospital, Spain (D.R.-L.)
| | - Geoffrey A Donnan
- The Florey Institute of Neuroscience and Mental Health (G.A.D.), University of Melbourne, Parkville, Australia
| | - Anand Dixit
- University of Newcastle upon Tyne, United Kingdom (A.D.)
| | - Mohammed Almekhlafi
- Calgary Stroke Program, Departments of Clinical Neurosciences and Radiology (A.M.D., M.A., M. Goyal, B.K.M.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada
| | - Sandrine Deltour
- Urgences Cerebro-Vasculaires Sorbonne University and Pitié-Salpêtrière Hospital, APHP, Paris, France (S.D.)
| | - Jonathan Epstein
- INSERM CIC 1433 Clinical Epidemiology (J.E.), Université de Lorraine and University Hospital of Nancy, France
| | - Benoit Guillon
- Stroke Unit, University and University Hospital of Nantes, France (B.G.)
| | - Serge Bakchine
- Neurology-Stroke Unit University and University Hospital of Reims, France (S. Bakchine)
| | - Meritxell Gomis
- Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain (M. Gomis)
| | | | | | - Vivek Reddy
- Department of Neurology, University of Pittsburgh Medical Center, PA (V.R.)
| | - Gernot Rudel
- Department of Neurology, Klinikum Dortmund, Germany (G.R.)
| | - Yvo B W E M Roos
- Department of Neurology (Y.E.W.E.M.R.), Academic Medical Center Amsterdam, the Netherlands
| | - Alain Bonafe
- Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.)
| | - Hans-Christoph Diener
- Department of Neurology, University Hospital Essen University Duisburg-Essen, Germany (C.D.)
| | - Olvert A Berkhemer
- Department of Neurology (D.W.J.D., E.O., O.A.B.), Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Department of Radiology (A.v.d.L., O.A.B.), Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Department of Radiology (C.B.L.M.M., O.A.B.), Academic Medical Center Amsterdam, the Netherlands
| | - Geoffrey C Cloud
- Department of Clinical Neuroscience, Central Clinical School, Monash University and The Alfred Hospital, Melbourne, Australia (G.C.C.)
| | - Stephen M Davis
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital (S.M.D.), University of Melbourne, Parkville, Australia
| | - Robert van Oostenbrugge
- Department of Neurology (R.v.O.), Maastricht University Medical Center Maastricht, the Netherlands
| | - Francis Guillemin
- INSERM CIC 1433 Clinical Epidemiology (F.G.), Université de Lorraine and University Hospital of Nancy, France
| | - Mayank Goyal
- Calgary Stroke Program, Departments of Clinical Neurosciences and Radiology (A.M.D., M.A., M. Goyal, B.K.M.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital (B.C.V.C.), University of Melbourne, Parkville, Australia
| | - Bijoy K Menon
- Calgary Stroke Program, Departments of Clinical Neurosciences and Radiology (A.M.D., M.A., M. Goyal, B.K.M.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada
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Kleinherenbrink W, Osei E, den Hertog HM, Zandbergen AAM. Prediabetes and macrovascular disease: Review of the association, influence on outcome and effect of treatment. Eur J Intern Med 2018; 55:6-11. [PMID: 30007840 DOI: 10.1016/j.ejim.2018.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 06/11/2018] [Accepted: 07/01/2018] [Indexed: 01/28/2023]
Affiliation(s)
- W Kleinherenbrink
- Erasmus Medisch Centrum, Department of Internal Medicine, Rotterdam, The Netherlands.
| | - E Osei
- Medisch Spectrum Twente, Department of Neurology, Enschede, The Netherlands
| | - H M den Hertog
- Isala Zwolle, Department of Neurology, Zwolle, The Netherlands
| | - A A M Zandbergen
- Erasmus Medisch Centrum, Department of Internal Medicine, Rotterdam, The Netherlands
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Osei E, den Hertog HM, Berkhemer OA, Fransen PSS, Roos YBWEM, Beumer D, van Oostenbrugge RJ, Schonewille WJ, Boiten J, Zandbergen AAM, Koudstaal PJ, Dippel DWJ. Admission Glucose and Effect of Intra-Arterial Treatment in Patients With Acute Ischemic Stroke. Stroke 2017; 48:1299-1305. [PMID: 28389610 DOI: 10.1161/strokeaha.116.016071] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/03/2017] [Accepted: 03/02/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Hyperglycemia on admission is common after ischemic stroke. It is associated with unfavorable outcome after treatment with intravenous thrombolysis and after intra-arterial treatment. Whether hyperglycemia influences the effect of reperfusion treatment is unknown. We assessed whether increased admission serum glucose modifies the effect of intra-arterial treatment in patients with acute ischemic stroke. METHODS We used data from the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands). Hyperglycemia was defined as admission serum glucose >7.8 mmol/L. The primary outcome measure was the adjusted common odds ratio for a shift in the direction of a better outcome on the modified Rankin Scale at 90 days, estimated with ordinal logistic regression. Secondary outcome variable was symptomatic intracranial hemorrhage. We assessed treatment effect modification of hyperglycemia and admission serum glucose levels with multiplicative interaction factors and adjusted for prognostic variables. RESULTS Four hundred eighty-seven patients were included. Mean admission serum glucose was 7.2 mmol/L (SD, 2.2). Fifty-seven of 226 patients (25%) randomized to intra-arterial treatment were hyperglycemic compared with 61 of 261 patients (23%) in the control group. The interaction of either hyperglycemia or admission serum glucose levels and treatment effect on modified Rankin Scale scores was not significant (P=0.67 and P=0.87, respectively). The same applied for occurrence of symptomatic hemorrhage (P=0.39 for hyperglycemia, P=0.39 for admission serum glucose). CONCLUSIONS We found no evidence for effect modification of intra-arterial treatment by admission serum glucose in patients with acute ischemic stroke. CLINICAL TRIAL REGISTRATION URL: www.isrctn.com. Unique identifier: ISRCTN10888758.
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Affiliation(s)
- Elizabeth Osei
- From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.).
| | - Heleen M den Hertog
- From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.)
| | - Olvert A Berkhemer
- From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.)
| | - Puck S S Fransen
- From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.)
| | - Yvo B W E M Roos
- From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.)
| | - Debbie Beumer
- From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.)
| | - Robert J van Oostenbrugge
- From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.)
| | - Wouter J Schonewille
- From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.)
| | - Jelis Boiten
- From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.)
| | - Adrienne A M Zandbergen
- From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.)
| | - Peter J Koudstaal
- From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.)
| | - Diederik W J Dippel
- From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.)
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Osei E, Fonville S, Zandbergen AAM, Koudstaal PJ, Dippel DWJ, den Hertog HM. Glucose in prediabetic and diabetic range and outcome after stroke. Acta Neurol Scand 2017; 135:170-175. [PMID: 26918555 DOI: 10.1111/ane.12577] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Newly diagnosed disturbed glucose metabolism is highly prevalent in patients with stroke. Limited data are available on their prognostic value on outcome after stroke. We aimed to assess the association of glucose in the prediabetic and diabetic range with unfavourable short-term outcome after stroke. MATERIALS AND METHODS We included 839 consecutive patients with ischemic stroke and 168 patients with intracerebral haemorrhage. In all nondiabetic patients, fasting glucose levels were determined on day 2-4. Prediabetic range was defined as fasting glucose of 5.6-6.9 mmol/L, diabetic range as ≥7.0 mmol/L, pre-existent diabetes as the use of anti-diabetic medication prior to admission. Outcome measures were poor functional outcome or death defined as modified Rankin Scale (mRS) score >2 and discharge not to home. The association of prediabetic range, diabetic range and pre-existent diabetes (versus normal glucose) with unfavourable outcome was expressed as odds ratios, estimated with multiple logistic regression, with adjustment for prognostic factors. RESULTS Compared with normal glucose, prediabetic range (aOR 1.8; 95%CI 1.1-2.8), diabetic range (aOR 2.5; 95%CI 1.3-4.9) and pre-existent diabetes (aOR 2.6; 95%CI 1.6-4.0) were associated with poor functional outcome or death. Patients in the prediabetic range (aOR 0.6; 95%CI 0.4-0.9), diabetic range (aOR 0.4; 95%CI 0.2-0.9) and pre-existent diabetes (aOR 0.6; 95%CI 0.4-0.9) were more likely not to be discharged to home. CONCLUSIONS Patients with glucose in the prediabetic and diabetic range have an increased risk of unfavourable short-term outcome after stroke. These findings illustrate the potential impact of early detection and treatment of these patients.
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Affiliation(s)
- E. Osei
- Neurology; Medisch Spectrum Twente; Enschede Overijssel Netherlands
| | - S. Fonville
- Erasmus MC; Rotterdam Zuid-Holland Netherlands
| | | | | | | | - H. M. den Hertog
- Neurology; Medisch Spectrum Twente; Enschede Overijssel Netherlands
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Osei E, den Hertog HM, Berkhemer OA, Fransen PSS, Roos YBWEM, Beumer D, van Oostenbrugge RJ, Schonewille WJ, Boiten J, Zandbergen AAM, Koudstaal PJ, Dippel DWJ. Increased admission and fasting glucose are associated with unfavorable short-term outcome after intra-arterial treatment of ischemic stroke in the MR CLEAN pretrial cohort. J Neurol Sci 2016; 371:1-5. [PMID: 27871427 DOI: 10.1016/j.jns.2016.10.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limited data are available on the impact of fasting glucose on outcome after intra-arterial treatment (IAT). We studied whether hyperglycemia on admission and impaired fasting glucose (IFG) are associated with unfavorable outcome after IAT in acute ischemic stroke. METHODS Patients were derived from the pretrial registry of the MR CLEAN-trial. Hyperglycemia on admission was defined as glucose>7.8mmol/L, IFG as fasting glucose>5.5mmol/L in the first week of admission. Primary effect measure was the adjusted common odds ratio (acOR) for a shift in the direction of worse outcome on the modified Rankin Scale at discharge, estimated with ordinal logistic regression, adjusted for common prognostic factors. RESULTS Of the 335 patients in which glucose on admission was available, 86 (26%) were hyperglycemic, 148 of the 240 patients with available fasting glucose levels (62%) had IFG. Median admission glucose was 6.8mmol/L (IQR 6-8). Increased admission glucose (acOR 1.2, 95%CI 1.1-1.3), hyperglycemia on admission (acOR 2.6, 95%CI 1.5-4.6) and IFG (acOR 2.8, 95%CI 1.4-5.6) were associated with worse functional outcome at discharge. CONCLUSION Increased glucose on admission and IFG in the first week after stroke onset are associated with unfavorable short-term outcome after IAT of acute ischemic stroke.
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Affiliation(s)
- E Osei
- Medisch Spectrum Twente, Haaksbergerstraat 55, 7513ER Enschede, The Netherlands.
| | - H M den Hertog
- Medisch Spectrum Twente, Haaksbergerstraat 55, 7513ER Enschede, The Netherlands.
| | - O A Berkhemer
- Academisch Medisch Centrum, Postbus 22660, 1100 DD Amsterdam, The Netherlands.
| | - P S S Fransen
- Erasmus Medisch Centrum, Postbus 2040, 3000 CA Rotterdam, The Netherlands.
| | - Y B W E M Roos
- Academisch Medisch Centrum, Postbus 22660, 1100 DD Amsterdam, The Netherlands.
| | - D Beumer
- Maastricht Universitair Medisch Centrum, Postbus 5800, 6202 AZ Maastricht, The Netherlands.
| | - R J van Oostenbrugge
- Maastricht Universitair Medisch Centrum, Postbus 5800, 6202 AZ Maastricht, The Netherlands.
| | - W J Schonewille
- St. Antonius Ziekenhuis, Postbus 2500, 3430 EM Nieuwegein, The Netherlands.
| | - J Boiten
- Medisch Centrum Haaglanden, Postbus 432, 2501 CK Den Haag, The Netherlands.
| | - A A M Zandbergen
- Ikazia Ziekenhuizen, Postbus 5009, 3008 AA Rotterdam, The Netherlands.
| | - P J Koudstaal
- Erasmus Medisch Centrum, Postbus 2040, 3000 CA Rotterdam, The Netherlands.
| | - D W J Dippel
- Erasmus Medisch Centrum, Postbus 2040, 3000 CA Rotterdam, The Netherlands.
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Darko J, Kiciak A, Badu S, Grigorov G, Fleck A, Osei E. SU-F-T-272: Patient Specific Quality Assurance of Prostate VMAT Plans with Portal Dosimetry. Med Phys 2016. [DOI: 10.1118/1.4956412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Grigorov G, Darko J, Kitor M, Redekop R, Osei E. SU-E-T-100: An Approach to Improving the Dynamic Delivery Accuracy for Breast IMRT. Med Phys 2015. [DOI: 10.1118/1.4924461] [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: 11/07/2022] Open
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Jiang R, Zhan L, Gopaul D, Osei E. Poster - Thur Eve - 67: Clinical results of deep inspiration breath hold radiation treatment for the left breast patients. Med Phys 2012; 39:4637. [DOI: 10.1118/1.4740175] [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: 11/07/2022] Open
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14
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Zhan L, Fleck A, Jiang R, Osei E. SU-E-T-729: A Superficial Information Management and Calculation System. Med Phys 2011. [DOI: 10.1118/1.3612691] [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: 11/07/2022] Open
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15
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Jiang R, Zhan L, Gopaul D, Osei E. SU-E-T-615: Clinical Implementation of Deep Inspiration Breath-Hold for Left Breast Cancers Treatment. Med Phys 2011. [DOI: 10.1118/1.3612578] [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: 11/07/2022] Open
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Jiang R, Osei E, Fleck A, Gopaul D, Barnett R. Poster - Thur Eve - 35: Lung SBRT: 4DCT Based Treatment Planning in Presence of Respiratory Motion. Med Phys 2010. [DOI: 10.1118/1.3476140] [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: 11/07/2022] Open
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Jiang R, Osei E, Fleck A, Gopaul D, Barnett R. Poster - Thur Eve - 36: Lung SBRT: Dosimetric Evaluation of 4DCT Based Treatment Planning in Presence of Respiratory Motion. Med Phys 2010. [DOI: 10.1118/1.3476141] [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: 11/07/2022] Open
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18
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Jiang R, Gopaul D, Osei E, Barnett R. Poster - Wed Eve-33: Respiratory Internal Target Volume Assessment Using a Modified Slow CT Scan and CBCT. Med Phys 2009. [DOI: 10.1118/1.3244137] [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: 11/07/2022] Open
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Jiang R, Gopaul D, Osei E, Barnett R. Poster - Wed Eve-32: Internal Target Volume Dose Coverage Measurement for Respiratory Tumor Motion. Med Phys 2009. [DOI: 10.1118/1.3244136] [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: 11/07/2022] Open
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Wierzbicki M, Schaly B, Osei E, Barnett R. Sci-Thurs PM: Delivery-11: Image guidance for prostate IMRT using low dose cone beam CT. Med Phys 2008; 35:3401. [PMID: 28512829 DOI: 10.1118/1.2965918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Linac-mounted cone beam computed tomography (CBCT) using Varian's On Board Imager (OBI) currently delivers significant imaging dose and lacks automatic methods for clinical target volume (CTV) registration. In this work, we address these two issues to enable frequent treatment corrections during a course of prostate intensity modulated radiation therapy (IMRT). The process starts by acquiring a low dose (low mAs) CBCT image after patient setup. The image is then used in one of two automatic image guidance strategies. The "global" technique provides the couch corrections necessary to improve patient setup by registering the CBCT to the planning CT. The "local" method involves non-rigid registration of the planning CT to the CBCT followed by automatic treatment re-optimization using the deformed planning CT and contours. Thus, the global method attempts to correct patient setup to match the planned treatment, while the local method corrects the treatment to match the patient setup. Both techniques were evaluated using images of an anthropomorphic male pelvis phantom. Global image guidance resulted in a registration error of 3.6 ± 1.3 mm (imaging dose independent) and high treatment doses to the bladder and rectum for large magnitude motion. The local technique always resulted in clinically acceptable treatment doses due to a reduced registration error of 2.3 ± 0.8 mm, obtained at 15% of the OBI's default dose (125 kVp, 2 mAs per projection). These preliminary results show that our automatic local image guidance technique reduces imaging dose and is sufficiently accurate and robust for application in prostate IMRT.
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Affiliation(s)
- M Wierzbicki
- Grand River Regional Cancer Center, Kitchener, ON
| | - B Schaly
- Grand River Regional Cancer Center, Kitchener, ON
| | - E Osei
- Grand River Regional Cancer Center, Kitchener, ON.,Department of Physics & Astronomy, University of Waterloo, Waterloo, ON
| | - R Barnett
- Grand River Regional Cancer Center, Kitchener, ON.,Department of Physics & Astronomy, University of Waterloo, Waterloo, ON
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Jiang R, Barnett R, Osei E. Poster - Thurs Eve-14: Linking IGRT data with dose calculation for prostate IMRT planning. Med Phys 2008; 35:3404. [DOI: 10.1118/1.2965933] [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: 11/07/2022] Open
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Jiang R, Osei E, Barnett R. SU-GG-J-101: IGRT Prostate: Analysis of the Effect of Body Size On Setup Error. Med Phys 2008. [DOI: 10.1118/1.2961651] [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: 11/07/2022] Open
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Osei E, Fan C, Jeevasagayam G, Alexander A, Seguin M, Darko J. Po-Thur Eve General-12: ProLoc: An image-guided localization software for target positioning. Med Phys 2006. [DOI: 10.1118/1.2244639] [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: 11/07/2022] Open
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Osei E, Bradley B, Fleck A, Darko J. Po-Thur Eve General-34: Normalized data for the estimation of fetal radiation dose from radiotherapy of the breast. Med Phys 2006. [DOI: 10.1118/1.2244661] [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: 11/07/2022] Open
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Darko J, Joshi C, Osei E, Halsall T, Salomons G, Kerr A. Po-Thur Eve General-07: Dosimetry of Small Lung Lesions with EGSnrc Monte Carlo and Treatment Planning Systems. Med Phys 2006. [DOI: 10.1118/1.2244634] [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: 11/07/2022] Open
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Darko J, Joshi C, Osei E, Halsall T, Dai J, Salomons G, Kerr A. SU-FF-T-198: Dosimetry of Small Lung Lesions with EGSnrc Monte Carlo and Treatment Planning Systems. Med Phys 2006. [DOI: 10.1118/1.2241121] [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: 11/07/2022] Open
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Osei E, Bradley B, Fleck A, Darko J. SU-FF-T-343: Normalized Data for the Estimation of Fetal Radiation Dose From Radiotherapy of the Breast. Med Phys 2006. [DOI: 10.1118/1.2241264] [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: 11/07/2022] Open
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Akmal S, Tsoi E, Howard R, Osei E, Nicolaides KH. Investigation of occiput posterior delivery by intrapartum sonography. Ultrasound Obstet Gynecol 2004; 24:425-428. [PMID: 15343598 DOI: 10.1002/uog.1064] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To investigate if occiput posterior delivery is the consequence of persistence of an initial occiput posterior position or malrotation from an initial occiput anterior or transverse position. METHODS This was a cross-sectional study involving transabdominal sonography to determine fetal occipital position in 918 singleton pregnancies with cephalic presentation in active labor at 37-42 weeks of gestation. The relationship between occipital position in labor and at delivery was examined. RESULTS The occiput was posterior in 33.0% (149/452), 33.9% (101/298) and 19.0% (32/168) of fetuses at the respective cervical dilatations of 3-5, 6-9 and 10 cm and this persisted at delivery in 21.5% (32/149), 31.7% (32/101) and 43.8% (14/32) of cases. In 70% (32/46), 91% (32/35) and 100% (14/14) of occiput posterior deliveries there was persistence from this position at 3-5, 6-9 and 10 cm of cervical dilation. CONCLUSIONS The majority of occiput posterior positions during labor rotate to the anterior position even at 10 cm of cervical dilatation. However, the vast majority of occiput posterior positions at delivery are a consequence of persistence of this position during labor rather than malrotation from an initial occiput anterior or transverse position.
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Affiliation(s)
- S Akmal
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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29
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Ramanathan G, Yu C, Osei E, Nicolaides KH. Ultrasound examination at 37 weeks' gestation in the prediction of pregnancy outcome: the value of cervical assessment. Ultrasound Obstet Gynecol 2003; 22:598-603. [PMID: 14689532 DOI: 10.1002/uog.913] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To examine the potential value of routine measurement of cervical length in singleton low-risk pregnancies at 37 weeks of gestation in the prediction of onset and outcome of labor. METHODS Cervical length was measured by transvaginal sonography at 37 weeks in 1571 singleton low-risk pregnancies. Outcome measures were gestation at spontaneous onset of labor, post-term delivery, duration of labor and mode of delivery. RESULTS The median cervical length at 37 weeks was 30 mm and there was a significant association between cervical length and gestation at delivery, which increased from a mean of 38 weeks for cervical length of 10 mm to 41 weeks for cervical length of 35 mm. The incidence of delivery after 40 weeks and 10 days was 296 (18.8%) and the incidence increased with cervical length at 37 weeks from 0% to 6%, 35% and 68% for respective cervical lengths of < 20, 21-30, 31-40 and 41-50 mm. In the pregnancies with spontaneous onset of labor the incidence of Cesarean section for failure to progress increased from 3.6% to 6.0%, 6.4% and 11.8% for cervical lengths of < 20, 21-30, 31-40 and 41-50 mm, respectively. In the pregnancies requiring induction for post-term the incidence of Cesarean section for failed induction or failure to progress increased from 7.5% to 20.1% to 25.0% for cervical lengths of 21-30, 31-40 and 41-50 mm, respectively. CONCLUSION Measurement of cervical length at 37 weeks can define the likelihood of spontaneous delivery before 40 weeks and 10 days and the risk of Cesarean section in those requiring induction for prolonged pregnancy.
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Affiliation(s)
- G Ramanathan
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical School, London, UK
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Osei E, Gassman PW, Hauck LM, Jones R, Beran L, Dyke PT, Goss DW, Flowers JD, McFarland AMS, Saleh A. Environmental benefits and economic costs of manure incorporation on dairy waste application fields. J Environ Manage 2003; 68:1-11. [PMID: 12767858 DOI: 10.1016/s0301-4797(02)00226-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Model simulations performed representing dairies in a 93000 ha watershed in north central Texas suggest that manure incorporation results in reduced phosphorus (P) losses at relatively small to moderate cost to producers. Simulated manure incorporation with a tandem disk on fields double-cropped with sorghum/winter wheat resulted in up to 33, 45, and 37% reductions in per hectare sediment-bound, soluble, and total P losses in edge-of-field runoff, relative to simulated surface manure applications. The effects of incorporation were evaluated at three different manure application rates. On aggregate across all three manure application rates, significant declines in P losses were obtained with incorporation except for sediment-bound P losses under the N-based manure application rate scenario. We found that the practice of incorporating manure shortly after it has been broadcast on the soil surface could help reduce P losses in such situations where P-based rates alone prove inadequate. The cost the producer incurs when manure is incorporated is on average about 1% of net returns when manure is applied at the N rate and 2-3% when it is applied at alternative P-based rates. In practice the costs could be lower because producers may substitute the manure incorporation operation for a tandem disk operation performed prior to manure application. As more and more dairy producers switch to the use of sorghum and corn silage in dairy rations and consequent on-farm production of these forages, the practice of manure incorporation may help to reduce phosphorus losses resulting from dairy manure applications to fields with these forage crops.
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Affiliation(s)
- E Osei
- Texas Institute for Applied Environmental Research, Tarleton State University, Stephenville, TX 76402, USA.
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Papaioannou S, Davies J, Grant I, Osei E. Folate deficiency in pregnancy presenting as acute megaloblastic crisis. J OBSTET GYNAECOL 2000; 20:190. [PMID: 15512517 DOI: 10.1080/01443610063048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Osei E, Tharmaratnam S, Opemuyi I, Cochrane G. Laser endometrial ablation with the neodynium: yttrium-aluminium garnet (Nd-YAG) laser: a review of ninety consecutive patients. Acta Obstet Gynecol Scand 1995; 74:619-23. [PMID: 7660768 DOI: 10.3109/00016349509013474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [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: 01/26/2023]
Abstract
OBJECTIVE To assess the effectiveness of laser endometrial ablation in women with dysfunctional bleeding. DESIGN A retrospective analysis of 90 patients. SETTING Department of Gynaecology, King George Hospital, Barley Lane, Goodmayes, Essex IG3 8YB, U:K. SUBJECTS Ninety patients with dysfunctional uterine bleeding who were hysteroscopically suitable for laser endometrial ablation. INTERVENTIONS Endometrial laser ablations using the neodynium-yttrium-garnet laser at 70 watts power output. MAIN OUTCOME MEASURES Patient satisfaction/dissatisfaction at 6 months follow-up and response to repeat ablation. RESULTS A total of 117 procedures were carried out on the 90 patients. There was one suspected perforation which was not confirmed at subsequent hysterectomy and one primary hemorrhage which required tamponade with Foley catheter. There were three cases of fluid overload with no clinical evidence of fluid over-load syndrome. All five major complications occurred in the first six months or 'learning phase' of the study. During this period, there were proportionately more treatment failures after one attempt (52.8% versus 42.6%) than the second six months of the study. Overall, 53.3% of the patients were satisfied with the initial ablation and 73.3% were satisfied after repeat ablations. CONCLUSION Endometrial laser ablation is a major advance in the management of dysfunctional uterine bleeding, especially in patients who would otherwise have had a hysterectomy.
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Affiliation(s)
- E Osei
- King George Hospital, Goodmayes, Essex, United Kingdom
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