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Amrhein TJ, Williams JW, Gray L, Malinzak MD, Cantrell S, Deline CR, Carr CM, Kim DK, Goldstein KM, Kranz PG. Efficacy of Epidural Blood Patching or Surgery in Spontaneous Intracranial Hypotension: A Systematic Review and Evidence Map. AJNR Am J Neuroradiol 2023; 44:730-739. [PMID: 37202114 PMCID: PMC10249694 DOI: 10.3174/ajnr.a7880] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/21/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Spontaneous intracranial hypotension is an important cause of treatable secondary headaches. Evidence on the efficacy of epidural blood patching and surgery for spontaneous intracranial hypotension has not been synthesized. PURPOSE Our aim was to identify evidence clusters and knowledge gaps in the efficacy of treatments for spontaneous intracranial hypotension to prioritize future research. DATA SOURCES We searched published English language articles on MEDLINE (Ovid), the Web of Science (Clarivate), and EMBASE (Elsevier) from inception until October 29, 2021. STUDY SELECTION We reviewed experimental, observational, and systematic review studies assessing the efficacy of epidural blood patching or surgery in spontaneous intracranial hypotension. DATA ANALYSIS One author performed data extraction, and a second verified it. Disagreements were resolved by consensus or adjudicated by a third author. DATA SYNTHESIS One hundred thirty-nine studies were included (median, 14 participants; range, 3-298 participants). Most articles were published in the past decade. Most assessed epidural blood patching outcomes. No studies met level 1 evidence. Most were retrospective cohort or case series (92.1%, n = 128). A few compared the efficacy of different treatments (10.8%, n = 15). Most used objective methods for the diagnosis of spontaneous intracranial hypotension (62.3%, n = 86); however, 37.7% (n = 52) did not clearly meet the International Classification of Headache Disorders-3 criteria. CSF leak type was unclear in 77.7% (n = 108). Nearly all reported patient symptoms using unvalidated measures (84.9%, n = 118). Outcomes were rarely collected at uniform prespecified time points. LIMITATIONS The investigation did not include transvenous embolization of CSF-to-venous fistulas. CONCLUSIONS Evidence gaps demonstrate a need for prospective study designs, clinical trials, and comparative studies. We recommend using the International Classification of Headache Disorders-3 diagnostic criteria, explicit reporting of CSF leak subtype, inclusion of key procedural details, and using objective validated outcome measures collected at uniform time points.
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Affiliation(s)
- T J Amrhein
- From the Department of Radiology (T.J.A., L.G., M.D.M., P.G.K.), Duke University Medical Center, Durham, North Carolina
| | - J W Williams
- Division of General Internal Medicine (J.W.W., K.M.G.)
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (J.W.W., K.M.G.), Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - L Gray
- From the Department of Radiology (T.J.A., L.G., M.D.M., P.G.K.), Duke University Medical Center, Durham, North Carolina
| | - M D Malinzak
- From the Department of Radiology (T.J.A., L.G., M.D.M., P.G.K.), Duke University Medical Center, Durham, North Carolina
| | - S Cantrell
- Duke University Medical Center Library (S.C.), Duke University School of Medicine, Durham, North Carolina
| | - C R Deline
- Spinal CSF Leak Foundation (C.R.D.), Spokane, Washington
| | - C M Carr
- Department of Radiology (C.M.C., D.K.K.), Mayo Clinic, Rochester, Minnesota
| | - D K Kim
- Department of Radiology (C.M.C., D.K.K.), Mayo Clinic, Rochester, Minnesota
| | - K M Goldstein
- Division of General Internal Medicine (J.W.W., K.M.G.)
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (J.W.W., K.M.G.), Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - P G Kranz
- From the Department of Radiology (T.J.A., L.G., M.D.M., P.G.K.), Duke University Medical Center, Durham, North Carolina
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Raiho AM, Paciorek CJ, Dawson A, Jackson ST, Mladenoff DJ, Williams JW, McLachlan JS. 8000-year doubling of Midwestern forest biomass driven by population- and biome-scale processes. Science 2022. [DOI: 10.1126/science.abk3126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Changes in woody biomass over centuries to millennia are poorly known, leaving unclear the magnitude of terrestrial carbon fluxes before industrial-era disturbance. Here, we statistically reconstructed changes in woody biomass across the upper Midwestern region of the United States over the past 10,000 years using a Bayesian model calibrated to preindustrial forest biomass estimates and fossil pollen records. After an initial postglacial decline, woody biomass nearly doubled during the past 8000 years, sequestering 1800 teragrams. This steady accumulation of carbon was driven by two separate ecological responses to regionally changing climate: the spread of forested biomes and the population expansion of high-biomass tree species within forests. What took millennia to accumulate took less than two centuries to remove: Industrial-era logging and agriculture have erased this carbon accumulation.
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Affiliation(s)
- A. M. Raiho
- Department of Biological Sciences, University of Notre Dame, South Bend, IN, USA
- Earth System Science Interdisciplinary Center, University of Maryland, College Park, College Park, MD, USA
| | - C. J. Paciorek
- Department of Statistics, University of California, Berkeley, Berkeley, CA, USA
| | - A. Dawson
- Department of General Education, Mount Royal University, Calgary, Alberta, Canada
- Department of Biological Sciences, University of Calgary, Calgary, Alberta, Canada
| | - S. T. Jackson
- US Geological Survey, Southwest and South Central Climate Adaptation Centers, Tucson, AZ, USA
- Department of Geosciences, University of Arizona, Tucson, AZ, USA
| | - D. J. Mladenoff
- Department of Forest and Wildlife Ecology, University of Wisconsin–Madison, Madison, WI, USA
| | - J. W. Williams
- Department of Geography, University of Wisconsin–Madison, Madison, WI, USA
- Center for Climatic Research, University of Wisconsin–Madison, Madison, WI, USA
| | - J. S. McLachlan
- Department of Biological Sciences, University of Notre Dame, South Bend, IN, USA
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Din USU, Brook MS, Selby A, Quinlan J, Boereboom C, Abdulla H, Franchi M, Narici MV, Phillips BE, Williams JW, Rathmacher JA, Wilkinson DJ, Atherton PJ, Smith K. A double-blind placebo controlled trial into the impacts of HMB supplementation and exercise on free-living muscle protein synthesis, muscle mass and function, in older adults. Clin Nutr 2018; 38:2071-2078. [PMID: 30360984 PMCID: PMC6876270 DOI: 10.1016/j.clnu.2018.09.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/11/2018] [Accepted: 09/24/2018] [Indexed: 01/06/2023]
Abstract
Age-related sarcopenia and dynapenia are associated with frailty and metabolic diseases. Resistance exercise training (RET) adjuvant to evidence-based nutritional intervention(s) have been shown as mitigating strategies. Given that β-hydroxy-β-methyl-butyrate (HMB) supplementation during RET improves lean body mass in younger humans, and that we have shown that HMB acutely stimulates muscle protein synthesis (MPS) and inhibits breakdown; we hypothesized that chronic supplementation of HMB free acid (HMB-FA) would enhance MPS and muscle mass/function in response to RET in older people. We recruited 16 healthy older men (Placebo (PLA): 68.5 ± 1.0 y, HMB-FA: 67.8 ± 1.15 y) for a randomised double-blind-placebo controlled trial (HMB-FA 3 × 1 g/day vs. PLA) involving a 6-week unilateral progressive RET regime (6 × 8 repetitions, 75% 1-RM, 3 · wk−1). Deuterium oxide (D2O) dosing was performed over the first two weeks (0–2 wk) and last two weeks (4–6 wk) with bilateral vastus lateralis (VL) biopsies at 0–2 and 4–6 wk (each time 75 ± 2 min after a single bout of resistance exercise (RE)) for quantification of early and later MPS responses and post-RE myogenic gene expression. Thigh lean mass (TLM) was measured by DXA, VL thickness and architecture (fibre length and pennation angle) by ultrasound at 0/3/6 wk, and strength by knee extensor 1-RM testing and MVC by isokinetic dynamometry (approx. every 10 days). RET induced strength increases (1-RM) in the exercised leg of both groups (398 ± 22N to 499 ± 30N HMB-FA vs. 396 ± 29N to 510 ± 43N PLA (both P < 0.05)). In addition, maximal voluntary contraction (MVC) also increased (179 ± 12 Nm to 203 ± 12 Nm HMB-FA vs. 185 ± 10 Nm to 217 ± 11 Nm PLA (both P < 0.05); with no group differences. VL muscle thickness increased significantly in the exercised leg in both groups, with no group differences. TLM (by DXA) rose to significance only in the HMB-FA group (by 5.8%–5734 ± 245 g p = 0.015 vs. 3.0% to 5644 ± 323 g P = 0.06 in PLA). MPS remained unchanged in the untrained legs (UT) 0–2 weeks being 1.06 ± 0.08%.d−1 (HMB-FA) and 1.14 ± 0.09%.d−1 (PLA), the trained legs (T) exhibited increased MPS in the HMB-FA group only at 0–2-weeks (1.39 ± 0.10%.d−1, P < 0.05) compared with UT: but was not different at 4–6-weeks: 1.26 ± 0.05%.d−1. However, there were no significant differences in MPS between the HMB-FA and PLA groups at any given time point and no significant treatment interaction observed. We also observed significant inductions of c-Myc gene expression following each acute RE bout, with no group differences. Further, there were no changes in any other muscle atrophy/hypertrophy or myogenic transcription factor genes we measured. RET with adjuvant HMB-FA supplements in free-living healthy older men did not enhance muscle strength or mass greater than that of RET alone (PLA). That said, only HMB-FA increased TLM, supported by early increases in chronic MPS. As such, chronic HMB-FA supplementation may result in long term benefits in older males, however longer and larger studies may be needed to fully determine the potential effects of HMB-FA supplementation; translating to any functional benefit.
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Affiliation(s)
- U S U Din
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Clinical, Metabolic and Molecular Physiology, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
| | - M S Brook
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Clinical, Metabolic and Molecular Physiology, University of Nottingham, Royal Derby Hospital Centre, Derby, UK; Nottingham NIHR BRC, UK
| | - A Selby
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Clinical, Metabolic and Molecular Physiology, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
| | - J Quinlan
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Clinical, Metabolic and Molecular Physiology, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
| | - C Boereboom
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Clinical, Metabolic and Molecular Physiology, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
| | - H Abdulla
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Clinical, Metabolic and Molecular Physiology, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
| | - M Franchi
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Clinical, Metabolic and Molecular Physiology, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
| | - M V Narici
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Clinical, Metabolic and Molecular Physiology, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
| | - B E Phillips
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Clinical, Metabolic and Molecular Physiology, University of Nottingham, Royal Derby Hospital Centre, Derby, UK; Nottingham NIHR BRC, UK
| | - J W Williams
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Clinical, Metabolic and Molecular Physiology, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
| | - J A Rathmacher
- Metabolic Technologies, Inc, Iowa State University Research Park, 2711 S. Loop Drive, Ste 4400, Ames, IA, 50010, USA
| | - D J Wilkinson
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Clinical, Metabolic and Molecular Physiology, University of Nottingham, Royal Derby Hospital Centre, Derby, UK; Nottingham NIHR BRC, UK
| | - P J Atherton
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Clinical, Metabolic and Molecular Physiology, University of Nottingham, Royal Derby Hospital Centre, Derby, UK; Nottingham NIHR BRC, UK
| | - K Smith
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Clinical, Metabolic and Molecular Physiology, University of Nottingham, Royal Derby Hospital Centre, Derby, UK; Nottingham NIHR BRC, UK.
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Rowland B, Abraham C, Carter R, Abimanyi-Ochom J, Kelly AB, Kremer P, Williams JW, Smith R, Hall JK, Wagner D, Renner H, Hosseini T, Osborn A, Mohebbi M, Toumbourou JW. Trial protocol: a clustered, randomised, longitudinal, type 2 translational trial of alcohol consumption and alcohol-related harm among adolescents in Australia. BMC Public Health 2018; 18:559. [PMID: 29703187 PMCID: PMC5921968 DOI: 10.1186/s12889-018-5452-3] [Citation(s) in RCA: 4] [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: 11/15/2017] [Accepted: 04/12/2018] [Indexed: 11/19/2022] Open
Abstract
Background This cluster randomised control trial is designed to evaluate whether the Communities That Care intervention (CTC) is effective in reducing the proportion of secondary school age adolescents who use alcohol before the Australian legal purchasing age of 18 years. Secondary outcomes are other substance use and antisocial behaviours. Long term economic benefits of reduced alcohol use by adolescents for the community will also be assessed. Methods Fourteen communities and 14 other non-contiguous communities will be matched on socioeconomic status (SES), location, and size. One of each pair will be randomly allocated to the intervention in three Australian states (Victoria, Queensland and Western Australia). A longitudinal survey will recruit grade 8 and 10 students (M = 15 years old, N = 3500) in 2017 and conduct follow-up surveys in 2019 and 2021 (M = 19 years old). Municipal youth populations will also be monitored for trends in alcohol-harms using hospital and police administrative data. Discussion Community-led interventions that systematically and strategically implement evidence-based programs have been shown to be effective in producing population-level behaviour change, including reduced alcohol and drug use. We expect that the study will be associated with significant effects on alcohol use amongst adolescents because interventions adopted within communities will be based on evidence-based practices and target specific problems identified from surveys conducted within each community. Trial registration The trial was retrospectively registered in September, 2017 (ACTRN12616001276448), as communities were selected prior to trial registration; however, participants were recruited after registration. Findings will be disseminated in peer-review journals and community fora.
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Affiliation(s)
- B Rowland
- Deakin University, Geelong, Victoria, Australia. .,School of Psychology, Centre for Social and Early Emotional Development, Faculty of Health, Geelong, Australia.
| | - C Abraham
- Institute of Health Research, University of Exeter Medical School St Luke's Campus, Exeter, EX1 2LU, UK
| | - R Carter
- Deakin University, Burwood, Victoria, Australia.,School of Health and Social Development, Faculty of Health, Geelong, Australia
| | - J Abimanyi-Ochom
- Deakin University, Burwood, Victoria, Australia.,School of Health and Social Development, Faculty of Health, Geelong, Australia
| | - A B Kelly
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, Australia
| | - P Kremer
- Deakin University, Geelong, Victoria, Australia.,School of Exercise and Nutrition Sciences, Faculty of Health, Geelong, Australia
| | - J W Williams
- Deakin University, Burwood, Victoria, Australia.,School of Health and Social Development, Faculty of Health, Geelong, Australia
| | - R Smith
- Deakin University, Geelong, Victoria, Australia.,School of Exercise and Nutrition Sciences, Faculty of Health, Geelong, Australia
| | - J K Hall
- Deakin University, Geelong, Victoria, Australia.,School of Psychology, Centre for Social and Early Emotional Development, Faculty of Health, Geelong, Australia
| | - D Wagner
- Murdoch Children Research Institute, The Royal Children's Hospital, Road Parkville Victoria, Flemington, Australia
| | - H Renner
- Deakin University, Geelong, Victoria, Australia.,School of Psychology, Centre for Social and Early Emotional Development, Faculty of Health, Geelong, Australia
| | - T Hosseini
- Deakin University, Geelong, Victoria, Australia.,School of Psychology, Centre for Social and Early Emotional Development, Faculty of Health, Geelong, Australia
| | - A Osborn
- Deakin University, Geelong, Victoria, Australia.,School of Psychology, Centre for Social and Early Emotional Development, Faculty of Health, Geelong, Australia
| | - M Mohebbi
- Deakin University, Geelong, Victoria, Australia.,Biostatistics unit, Faculty of Health, Melbourne, Australia
| | - J W Toumbourou
- Deakin University, Geelong, Victoria, Australia.,School of Psychology, Centre for Social and Early Emotional Development, Faculty of Health, Geelong, Australia
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Williams JW, Craig CK, Emerman MA, Holmes JH, Carter JE. 43 Utilization of a Burn Sepsis Algorithm: Should we Abandon the Consensus Criteria? J Burn Care Res 2018. [DOI: 10.1093/jbcr/iry006.047] [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] [Indexed: 11/12/2022]
Affiliation(s)
| | - C K Craig
- Wake Forest Baptist Health, Winston Salem, NC
| | - M A Emerman
- Wake Forest Baptist Health, Winston Salem, NC
| | - J H Holmes
- Wake Forest Baptist Health, Winston Salem, NC
| | - J E Carter
- Wake Forest Baptist Health, Winston Salem, NC
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Turecamo SE, Walji TA, Broekelmann TJ, Williams JW, Ivanov S, Wee NK, Procknow JD, McManus MR, Randolph GJ, Scheller EL, Mecham RP, Craft CS. Contribution of metabolic disease to bone fragility in MAGP1-deficient mice. Matrix Biol 2018. [PMID: 29519758 DOI: 10.1016/j.matbio.2018.02.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Microfibril-associated glycoprotein-1 (MAGP1) is an extracellular matrix protein that interacts with fibrillin and is involved in regulating the bioavailability of signaling molecules such as TGFβ. Mice with germline MAGP1 deficiency (Mfap2-/-) develop increased adiposity, hyperglycemia, insulin resistance, bone marrow adipose tissue expansion, reduced cancellous bone mass, cortical bone thinning and bone fragility. The goal of this study was to assess whether the Mfap2-/- bone phenotypes were due to loss of MAGP1 locally or secondary to a change in whole body physiology (metabolic dysfunction). To do this, mice with conditional deletion of MAGP1 in the limb skeleton were generated by crossing MAGP1-flox mice (Mfap2lox/lox) with Prx1-Cre mice. Mfap2Prx-/- mice did not show any changes in peripheral adiposity, hyperglycemia or insulin sensitivity, but did have increased bone length and cancellous bone loss that was comparable to the germline Mfap2-/- knockout. Unlike the germline knockout, marrow adiposity, cortical bone thickness and bone strength in Mfap2Prx-/- mice were normal. These findings implicate systemic metabolic dysfunction in the development of bone fragility in germline Mfap2-/- mice. An unexpected finding of this study was the detection of MAGP1 protein in the Mfap2Prx-/- hematopoietic bone marrow, despite the absence of MAGP1 protein in osseous bone matrix and absent Mfap2 transcript expression at both sites. This suggests MAGP1 from a secondary site may accumulate in the bone marrow, but not be incorporated into the bone matrix, during times of regional MAGP1 depletion.
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Affiliation(s)
- S E Turecamo
- Medicine, Division of Bone and Mineral Diseases, Washington University School of Medicine, Saint Louis, MO 63110, USA.
| | - T A Walji
- Medicine, Division of Bone and Mineral Diseases, Washington University School of Medicine, Saint Louis, MO 63110, USA; Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
| | - T J Broekelmann
- Cell Biology and Physiology, Washington University School of Medicine, Saint Louis, MO 63110, USA.
| | - J W Williams
- Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, USA.
| | - S Ivanov
- INSERM U1065, Mediterranean Center of Molecular Medicine, University of Nice Sophia-Antipolis, Faculty of Medicine, Nice, France.
| | - N K Wee
- Medicine, Division of Bone and Mineral Diseases, Washington University School of Medicine, Saint Louis, MO 63110, USA; Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, CT 06030, USA.
| | - J D Procknow
- Medicine, Division of Bone and Mineral Diseases, Washington University School of Medicine, Saint Louis, MO 63110, USA.
| | - M R McManus
- Medicine, Division of Bone and Mineral Diseases, Washington University School of Medicine, Saint Louis, MO 63110, USA.
| | - G J Randolph
- Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, USA.
| | - E L Scheller
- Medicine, Division of Bone and Mineral Diseases, Washington University School of Medicine, Saint Louis, MO 63110, USA; Cell Biology and Physiology, Washington University School of Medicine, Saint Louis, MO 63110, USA.
| | - R P Mecham
- Cell Biology and Physiology, Washington University School of Medicine, Saint Louis, MO 63110, USA.
| | - C S Craft
- Medicine, Division of Bone and Mineral Diseases, Washington University School of Medicine, Saint Louis, MO 63110, USA; Cell Biology and Physiology, Washington University School of Medicine, Saint Louis, MO 63110, USA.
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Shepherd-Banigan M, Goldstein KM, Coeytaux RR, McDuffie JR, Goode AP, Kosinski AS, Van Noord MG, Befus D, Adam S, Masilamani V, Nagi A, Williams JW. Improving vasomotor symptoms; psychological symptoms; and health-related quality of life in peri- or post-menopausal women through yoga: An umbrella systematic review and meta-analysis. Complement Ther Med 2017; 34:156-164. [PMID: 28917368 DOI: 10.1016/j.ctim.2017.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/05/2017] [Accepted: 08/17/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Vasomotor symptoms (VMS), commonly reported during menopausal transition, negatively affect psychological health and health-related quality of life (HRQoL). While hormone therapy is an effective treatment, its use is limited by concerns about possible harms. Thus, many women with VMS seek nonhormonal, nonpharmacologic treatment options. However, evidence to guide clinical recommendations is inconclusive. This study reviewed the effectiveness of yoga, tai chi and qigong on vasomotor, psychological symptoms, and HRQoL in peri- or post-menopausal women. DESIGN MEDLINE, Cochrane Database of Systematic Reviews, EMBASE, CINAHL and the Allied and Complementary Medicine Database were searched. Researchers identified systematic reviews (SR) or RCTs that evaluated yoga, tai chi, or qigong for vasomotor, psychological symptoms, and health-related quality of life (HRQoL) in peri- or post-menopausal women. Data were abstracted on study design, participants, interventions and outcomes. Risk of bias (ROB) was assessed and updated meta-analyses were performed. RESULTS We identified one high-quality SR (5 RCTs, 582 participants) and 3 new RCTs (345 participants) published after the SR evaluating yoga for vasomotor, psychological symptoms, and HRQoL; no studies evaluated tai chi or qigong. Updated meta-analyses indicate that, compared to controls, yoga reduced VMS (5 trials, standardized mean difference (SMD) -0.27, 95% CI -0.49 to -0.05) and psychological symptoms (6 trials, SDM -0.32; 95% CI -0.47 to -0.17). Effects on quality of life were reported infrequently. Key limitations are that adverse effects were rarely reported and outcome measures lacked standardization. CONCLUSIONS Results from this meta-analysis suggest that yoga may be a useful therapy to manage bothersome vasomotor and psychological symptoms.
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Affiliation(s)
- M Shepherd-Banigan
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA.
| | - K M Goldstein
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center 6301 Herndon Road, Durham, NC, USA
| | - R R Coeytaux
- Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705, USA
| | - J R McDuffie
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center 6301 Herndon Road, Durham, NC, USA
| | - A P Goode
- Department of Physical Therapy, Duke University Medical Center 2200 W. Main Street Durham, NC 27705, USA
| | - A S Kosinski
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, 8 Duke University Medical Center, Durham, MC 27703, USA
| | - M G Van Noord
- Duke University Medical Center Library, Durham, NC 27708, USA
| | - D Befus
- Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, USA
| | - S Adam
- Department of Medicine, Division of Hematology Oncology, Duke University Medical Center, 8 Duke University Medical Center, Durham, NC 27703, USA
| | - V Masilamani
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA
| | - A Nagi
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA
| | - J W Williams
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705, USA; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center 6301 Herndon Road, Durham, NC, USA
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Goldstein KM, Shepherd-Banigan M, Coeytaux RR, McDuffie JR, Adam S, Befus D, Goode AP, Kosinski AS, Masilamani V, Williams JW. Use of mindfulness, meditation and relaxation to treat vasomotor symptoms. Climacteric 2017; 20:178-182. [DOI: 10.1080/13697137.2017.1283685] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- K. M. Goldstein
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA
| | - M. Shepherd-Banigan
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | | | - J. R. McDuffie
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA
| | - S. Adam
- Department of Medicine, Division of Hematology Oncology, Duke University Medical Center, Durham, NC, USA
| | - D. Befus
- Duke University School of Nursing, Durham, NC, USA
| | - A. P. Goode
- Department of Physical Therapy, Duke University Medical Center, Durham, NC, USA
| | - A. S. Kosinski
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - V. Masilamani
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - J. W. Williams
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA
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Simon L, Avery L, Braden TD, Williams CS, Okumu LA, Williams JW, Goyal HO. Exposure of neonatal rats to anti-androgens induces penile mal-developments and infertility comparable to those induced by oestrogens. ACTA ACUST UNITED AC 2011; 35:364-76. [PMID: 22150386 DOI: 10.1111/j.1365-2605.2011.01232.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
We previously reported that oestrogen exposure in neonatal rats induced permanent infertility and malformed penis characterized by fat accumulation, which replaced most of the smooth muscle cells and cavernous spaces in the body of the penis, structures essential for erection. The objective of this study was to determine if reduced androgen production/action in the neonatal period, in the absence of exogenous oestrogen exposure, induces penile deformities similar to those caused by oestrogen. Male rats were treated from postnatal days 1-6 with GnRH antagonist antide (A, 10 mg/kg) or androgen receptor (AR) antagonist flutamide (F, 50 mg/kg) or F + A, with or without AR agonist dihydrotestosterone (DHT, 20 mg/kg). For comparison, pups received diethylstilbestrol (DES, 0.1 mg/kg), with or without DHT. Tissues were collected at ages 7 and 12 days and at adulthood. Flutamide alone decreased penile length and weight significantly (p < 0.05), but it caused neither fat accumulation, nor affected fertility (80% vs. 87% in controls). Antide alone reduced penile length and weight significantly, and induced fat accumulation in 4/11 rats and infertility in 13/14 rats. Conversely, all 11 F + A-treated rats, similar to all nine DES-treated rats, had fat accumulation and loss of smooth muscle cells and cavernous spaces in the body of the penis and were infertile. In addition, reductions in penile length and weight were higher than in rats treated with F or A alone. DHT co-administration mitigated penile deformities in the DES group, but did not in the F + A group. Testicular testosterone was reduced by 70-95% at 7 or 12 days of age in all treated groups, except in the F group, which had threefold higher testosterone than controls. Collectively, data unequivocally show that reduced androgen production/action in the neonatal period, in the absence of oestrogen exposure, induces permanent infertility and malformed penis similar to that caused by oestrogen.
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Affiliation(s)
- L Simon
- Department of Biomedical Sciences, Tuskegee University, Tuskegee, AL, USA
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11
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Brożek JL, Akl EA, Compalati E, Kreis J, Terracciano L, Fiocchi A, Ueffing E, Andrews J, Alonso-Coello P, Meerpohl JJ, Lang DM, Jaeschke R, Williams JW, Phillips B, Lethaby A, Bossuyt P, Glasziou P, Helfand M, Watine J, Afilalo M, Welch V, Montedori A, Abraha I, Horvath AR, Bousquet J, Guyatt GH, Schünemann HJ. Grading quality of evidence and strength of recommendations in clinical practice guidelines part 3 of 3. The GRADE approach to developing recommendations. Allergy 2011; 66:588-95. [PMID: 21241318 DOI: 10.1111/j.1398-9995.2010.02530.x] [Citation(s) in RCA: 173] [Impact Index Per Article: 13.3] [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: 11/27/2022]
Abstract
This is the third and last article in the series about the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to grading the quality of evidence and the strength of recommendations in clinical practice guidelines and its application in the field of allergy. We describe the factors that influence the strength of recommendations about the use of diagnostic, preventive and therapeutic interventions: the balance of desirable and undesirable consequences, the quality of a body of evidence related to a decision, patients' values and preferences, and considerations of resource use. We provide examples from two recently developed guidelines in the field of allergy that applied the GRADE approach. The main advantages of this approach are the focus on patient important outcomes, explicit consideration of patients' values and preferences, the systematic approach to collecting the evidence, the clear separation of the concepts of quality of evidence and strength of recommendations, and transparent reporting of the decision process. The focus on transparency facilitates understanding and implementation and should empower patients, clinicians and other health care professionals to make informed choices.
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Affiliation(s)
- J L Brożek
- Department of Clinical Epidemiology & Biostatistics and Medicine, McMaster University, Hamilton, ON, Canada
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12
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Williams JW, Shang SW, Sacks MD. Quantitative Studies of the Effect of Adhesion on the Mechanical and Physical Properties of Polymer Composites. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-119-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AbstractYoung's modulus, tensile strength and the storage shear modulus experiments were performed on silica-filled ethylene-vinyl acetate composites and the results were correlated with polymer-filler interaction energy. The polymer-filler interaction energy was determined by wetting and infrared spectroscopy experiments. The interaction energy was characterized by the work of adhesion. The results indicate there is a strong correlation between modulus and tensile strength and the work of adhesion. There was an exponential relationship of modulus and tensile strength with the reciprocal of the work of adhesion.
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13
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Deonier RC, Williams JW. Sedimentation equilibrium of polydisperse nonideal solutes: a comparison of three approximations. Proc Natl Acad Sci U S A 2010; 64:828-34. [PMID: 16591803 PMCID: PMC223309 DOI: 10.1073/pnas.64.3.828] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In the evaluation of sedimentation equilibrium data for polydisperse nonideal solutions, extrapolation procedures are required for the determination of the true solute weight-average molecular weight and of the light-scattering second virial coefficient. In an attempt to decide just which concentration-dependent parameter should be used in making these extrapolations, Van Holde and Williams, J. Polym. Sci., 11, 243 (1953), and Fujita, J. Phys. Chem., 63, 1326 (1959), and ibid., 73, 1759(1969), have derived relations between apparent and true weight-average molecular weights which, starting from approximate forms of the same differential equations, appear to give different working expressions. The present analysis of these results will demonstrate new and perhaps unexpected relations between them.Further, these approximations are discussed in terms of certain of the available experimental data, the purpose being to clarify the conditions under which the behavior of a polydisperse nonideal solution in the ultracentrifuge may be treated as if a nonideal two-component system were involved.
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Affiliation(s)
- R C Deonier
- DEPARTMENT OF CHEMISTRY, UNIVERSITY OF WISCONSIN, MADISON
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14
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Abstract
Purified diphtheria antitoxic horse pseudoglobulin has been prepared which is homogeneous by sedimentation, diffusion, and electrophoresis. Immunologically, however, the preparation contains only 43.5 per cent antitoxin specifically precipitable by toxin. The inactive pseudoglobulin remaining after specific precipitation was found to have the same physical and chemical properties as the original antitoxic pseudoglobulin. Although the molecular weight of antitoxin is the same as that of the normal horse serum globulins, the electrophoretic mobility does differ from those normally present. The molecular weight of diphtheria toxin is 70,000 and of antitoxin is 150,000. From ultracentrifuge studies on the two reactants and on mixtures of toxin and antitoxin in the soluble inhibition zones, the average molecular composition of the specific floccules at certain reference points throughout the equivalence zone and the maximum "valence" of toxin and antitoxin with respect to each other have been calculated. The significance of the results has been discussed in relation to antigen-antibody reactions in general and a possible explanation for the exceptional behavior of the toxin-antitoxin reaction in the region of excess antitoxin has been suggested.
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Affiliation(s)
- A M Pappenheimer
- Antitoxin and Vaccine Laboratory of the Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, and the Department of Physical Chemistry, University of Wisconsin, Madison
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15
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Heilman RL, Devarapalli Y, Chakkera HA, Mekeel KL, Moss AA, Mulligan DC, Mazur MJ, Hamawi K, Williams JW, Reddy KS. Impact of subclinical inflammation on the development of interstitial fibrosis and tubular atrophy in kidney transplant recipients. Am J Transplant 2010; 10:563-70. [PMID: 20121731 DOI: 10.1111/j.1600-6143.2009.02966.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Our aim was to study the impact of subclinical inflammation on the development of interstitial fibrosis and tubular atrophy (IF/TA) on a 1-year protocol biopsy in patients on rapid steroid withdrawal (RSW). A total of 256 patients were classified based on protocol biopsy findings at months 1 or 4. Group 1 is 172 patients with no inflammation, group 2 is 50 patients with subclinical inflammation (SCI), group 3 is 19 patients with subclinical acute rejection (SAR) and group 4 is 15 patients with clinical acute rejection (CAR). On the 1-year biopsy, more patients in group 2 (SCI) (34%, p = 0.004) and group 3 (SAR) (53%, p = 0.0002), had an IF/TA score > 2 compared to group 1 (control) (15%). IF/TA was not increased in group 4 (CAR) (20%). The percent with IF/TA score > 2 and interstitial inflammation (Banff i score > 0) was higher in group 2 (16%, p = 0.004) and group 3 (37%, p < 0.0001) compared to group 1 (3%). In a multivariate analysis, patients in groups 2 or 3 had a higher risk of IF/TA score > 2 on the 1-year biopsy (OR 6.62, 95% CI 2.68-16.3). We conclude that SCI and SAR increase the risk of developing IF/TA in patient on RSW.
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Affiliation(s)
- R L Heilman
- Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ.
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16
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Pasha SF, Leighton JA, Williams JW, De Petris G, Harold K, Shiff AA. Capsule retention in a patient with eosinophilic gastroenteritis mimicking diaphragm disease of the small bowel. Endoscopy 2010; 41 Suppl 2:E290-1. [PMID: 19899044 DOI: 10.1055/s-0029-1215125] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- S F Pasha
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Scottsdale, Arizona, USA.
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17
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Goyal HO, Braden TD, Williams CS, Williams JW. Estrogen-induced developmental disorders of the rat penis involve both estrogen receptor (ESR)- and androgen receptor (AR)-mediated pathways. Biol Reprod 2009; 81:507-16. [PMID: 19420389 DOI: 10.1095/biolreprod.108.071951] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
This study tested the hypothesis that the estrogen receptor (ESR) pathway, androgen receptor (AR) pathway, or both mediate estrogen-induced developmental penile disorders. Rat pups received diethylstilbestrol (DES), with or without the ESR antagonist ICI 182,780 (ICI) or the AR agonist dihydrotestosterone (DHT) or testosterone (T), from Postnatal Days 1 to 6. Testicular T concentration, penile morphology and morphometry, and/or fertility was determined at age 7, 28, or 150 days. DES treatment alone caused 90% reduction in the neonatal intratesticular T surge; this reduction was prevented by ICI coadministration, but not by DHT or T coadministration. Unlike the T surge, coadministration of ICI and coadministration of DHT or T mitigated penile deformities and loss of fertility. Generally, ICI, DHT, or T treatment alone did not alter penile morphology; however, fertility was 20% that of controls in ICI-treated rats vs. 70%-90% in DHT- or T-treated rats. The lower fertility in the rats treated with ICI alone could be due to altered sexual behavior, as these males did not deposit vaginal plugs. In conclusion, observations that both an ESR antagonist and AR agonists prevent penile deformities and infertility suggest that both pathways are involved in estrogen-induced penile disorders. Observations that coadministration of ICI, but not DHT or T, prevents the DES-induced reduction in the neonatal T surge suggest that, although ICI exerts its mitigating effect both at the level of Leydig cells and penile stromal cells, DHT and T do so only at the level of stromal cells.
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Affiliation(s)
- H O Goyal
- Department of Biomedical Sciences and Biology/CBR/RCMI, College of Veterinary Medicine, Tuskegee University, Tuskegee, AL 36088, USA.
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18
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Brozek JL, Akl EA, Alonso-Coello P, Lang D, Jaeschke R, Williams JW, Phillips B, Lelgemann M, Lethaby A, Bousquet J, Guyatt GH, Schünemann HJ. Grading quality of evidence and strength of recommendations in clinical practice guidelines. Part 1 of 3. An overview of the GRADE approach and grading quality of evidence about interventions. Allergy 2009; 64:669-77. [PMID: 19210357 DOI: 10.1111/j.1398-9995.2009.01973.x] [Citation(s) in RCA: 472] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach provides guidance to grading the quality of underlying evidence and the strength of recommendations in health care. The GRADE system's conceptual underpinnings allow for a detailed stepwise process that defines what role the quality of the available evidence plays in the development of health care recommendations. The merit of GRADE is not that it eliminates judgments or disagreements about evidence and recommendations, but rather that it makes them transparent. This first article in a three-part series describes the GRADE framework in relation to grading the quality of evidence about interventions based on examples from the field of allergy and asthma. In the GRADE system, the quality of evidence reflects the extent to which a guideline panel's confidence in an estimate of the effect is adequate to support a particular recommendation. The system classifies quality of evidence as high, moderate, low, or very low according to factors that include the study methodology, consistency and precision of the results, and directness of the evidence.
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Affiliation(s)
- J L Brozek
- Department of Epidemiology, Italian National Cancer Institute Regina Elena, Rome, Italy
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19
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Goyal HO, Braden TD, Cooke PS, Szewczykowski MA, Williams CS, Dalvi P, Williams JW. Estrogen receptor alpha mediates estrogen-inducible abnormalities in the developing penis. Reproduction 2007; 133:1057-67. [PMID: 17616734 DOI: 10.1530/rep-06-0326] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Previously, we reported an association between estrogen receptor-alpha (ERalpha) upregulation and detrimental effects of neonatal diethylstilbestrol (DES) exposure in the rat penis. The objective of this study was to employ the ERalpha knockout (ERalphaKO) mouse model to test the hypothesis that ERalpha mediates DES effects in the developing penis. ERalphaKO and wild-type C57BL/6 mice received oil or DES at a dose of 0.2 microg/pup per day (0.1 mg/kg) on alternate days from postnatal days 2 to 12. Fertility was tested at 80-240 days of age and tissues were examined at 96-255 days of age. DES caused malformation of the os penis, significant reductions in penile length, diameter, and weight, accumulation of fat cells in the corpora cavernosa penis, and significant reductions in weight of the bulbospongiosus and levator ani muscles in wild-type mice. Conversely, ERalphaKO mice treated with DES developed none of the above abnormalities. While nine out of ten male mice sired pups in the wild-type/control group, none did in the wild-type/DES group. ERalphaKO mice, despite normal penile development, are inherently infertile. Both plasma and intratesticular testosterone levels were unaltered in the DES-treated wild-type or DES-treated ERalphaKO mice when compared with controls, although testosterone concentration was much higher in the ERalphaKO mice. Hence, the resistance of ERalphaKO mice to developing penile abnormalities provides unequivocal evidence of an obligatory role for ERalpha in mediating the harmful effects of neonatal DES exposure in the developing penis.
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Affiliation(s)
- H O Goyal
- Department of Biomedical Sciences, Tuskegee University, Tuskegee, AL 36088, USA.
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20
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Abstract
In this review, we report permanent dysmorphogenesis of the penis and loss of fertility in adult rats treated neonatally with estrogen. Specifically, we report replacement of smooth muscle cells and cavernous spaces by fat cells in the corpus cavernosum penis, but not in the adjoining corpus spongiosum. Induction of these novel, region-specific phenotypes is dose-dependent, requires a critical window of exposure and associated with decreased testosterone and up-regulation of estrogen receptor α (ERα). The resistance of ERα knockout mice to develop these abnormalities implies an unequivocal role for ERα in mediating maldevelopment of the penis. Additionally, the prevention of estrogen-inducible penile abnormalities by ER antagonist ICI 182 780 implies that a functional ER-mediated pathway is essential for inducing penile abnormalities. Likewise, the ability of testosterone or dihydrotestosterone to negate these abnormalities suggests a role for an androgen receptor (AR)-mediated pathway. Taken together, these observations led us to hypothesize that neonatal estrogen exposure, via an ER-mediated pathway (direct action) or an AR-mediated pathway (indirect action through decreased testosterone) or both pathways, up-regulates ERα expression in stromal cells of the penis, which are then reprogrammed such that their differentiation into smooth muscle cells is inhibited and their differentiation into adipocytes is stimulated.
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Affiliation(s)
- H O Goyal
- Department of Biomedical Sciences, College of Veterinary Medicine, Nursing and Allied Health, Tuskegee University, Tuskegee, AL 36088, USA.
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21
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Abstract
Polyomavirus-associated nephropathy (PVAN) is a major complication of kidney transplantation. Many centers respond to PVAN by reducing immunosuppression. Concern over precipitating rejection, as well as situations in which some PVAN-afflicted individuals have multi-organ transplants, can make reduction of immunosuppression undesirable. In these cases, effective antiviral strategies would be useful. This article describes clinical observations and experiences with 3 different antiviral protocols. Two protocols address antiviral treatment of nephropathy (cidofovir in one, and leflunomide in the other). The third protocol examines fluoroquinolone control of polyoma urinary excretion. Patients responded to all 3 strategies. These promising approaches deserve further evaluation with prospective controlled studies.
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Affiliation(s)
- M A Josephson
- Department of Medicine, University of Chicago, Illinois 60637, USA.
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22
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Affiliation(s)
- A Frumkin
- Laboratory of Physical Chemistry, University of Wisconsin
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23
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Williams JW, Petermann ML, Colovos GC, Goodloe MB, Oncley JL, Armstrong SH. CHEMICAL, CLINICAL, AND IMMUNOLOGICAL STUDIES ON THE PRODUCTS OF HUMAN PLASMA FRACTIONATION. II. ELECTROPHORETIC AND ULTRACENTRIFUGAL STUDIES OF SOLUTIONS OF HUMAN SERUM ALBUMIN AND IMMUNE SERUM GLOBULINS. J Clin Invest 2006; 23:433-6. [PMID: 16695120 PMCID: PMC435358 DOI: 10.1172/jci101509] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- J W Williams
- Department of Chemistry, University of Wisconsin, Madison
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Kaplan I, Williams JW. Spore Formation among the Anaerobic Bacteria: I. The Formation of Spores by Clostridium sporogenes in Nutrient Agar Media. J Bacteriol 2006; 42:265-82. [PMID: 16560453 PMCID: PMC374757 DOI: 10.1128/jb.42.2.265-282.1941] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- I Kaplan
- Massachusetts Institute of Technology, Cambridge, Massachusetts
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25
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Abstract
We previously reported that the immunosuppressive malononitrileamides leflunomide and FK778 exert antiviral activity against cytomegalovirus (CMV). In the current investigation, we tested the hypothesis that leflunomide exerts concurrent antiviral activity and immune suppression in CMV-infected cardiac allograft recipients. Lewis rats were transplanted with Brown Norway hearts and then inoculated with rat CMV. Plaque assay demonstrated that leflunomide (30 mg/kg/day) reduced viral loads by 4-6 logs, and that the reduction in viral load was unaffected by administration of uridine. Leflunomide was as effective as cyclosporine A (CsA) or tacrolimus in preservation of allograft integrity through day 28. These studies directly demonstrate the bifunctionality of leflunomide as concurrently immunosuppressive and antiviral, enhancing the promise of this agent as a clinical option for treatment of transplant recipients.
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Affiliation(s)
- A S Chong
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
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26
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Goyal HO, Braden TD, Williams CS, Dalvi P, Mansour M, Williams JW. Estrogen-induced abnormal accumulation of fat cells in the rat penis and associated loss of fertility depends upon estrogen exposure during critical period of penile development. Toxicol Sci 2005; 87:242-54. [PMID: 15976194 DOI: 10.1093/toxsci/kfi233] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We previously reported that diethylstilbestrol (DES) or estradiol valerate (EV) exposure at a dose of 0.10-0.12 mg/kg, or higher, per day, on alternate days, from postnatal days 2-12, resulted in abnormal penis development and infertility (H. O. Goyal et al., 2005, J. Androl. 26, 32-43). The objective of this study was to identify a critical developmental period(s) during which EV exposure results in the observed penile abnormalities. Male pups received EV at a dose of 0.10-0.12 mg/kg on postnatal day(s) 1, 1-3, 4-6, 1-6, 7-12, 13-18, 19-24, or 25-30. Fertility was tested at 102-115 days of age and tissues were examined at 117-137 days. Both penile morphology and fertility were unaltered in rats treated with EV after 12 days of age. Conversely, except in rats treated on postnatal day 1 only, none of the males treated prior to 12 days of age sired pups, and all had abnormal penises, including varying degrees of abnormal accumulation of fat cells and loss of cavernous spaces and smooth muscle cells in the corpora cavernosa penis, which were maximal in the 1-6-day group. Also, the preputial sheath was partially released or its release was delayed, and the weight of the bulbospongiosus muscle was significantly reduced. Plasma testosterone (T) in the 1-6- and 4-6-day groups and intratesticular T in the 4-6-day group were significantly lower. The testosterone surge, characteristic of controls in the first week of life, was suppressed in the 1-3-day group. Estrogen receptor alpha mRNA expression was enhanced in the body of the penis in the 1-3-day group, but not in the 13-18-day group. Hence, EV exposure prior to 12 days of age (as short as 1-3 days postnatal), but not after 12 days of age, results in long-term abnormal penile morphology, characterized by abnormal accumulation of fat cells in the corpora cavernosa penis and, consequently, loss of fertility.
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Affiliation(s)
- H O Goyal
- Department of Biomedical Sciences, Tuskegee University, Tuskegee, Alabama, USA.
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27
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Avery RK, Bolwell BJ, Yen-Lieberman B, Lurain N, Waldman WJ, Longworth DL, Taege AJ, Mossad SB, Kohn D, Long JR, Curtis J, Kalaycio M, Pohlman B, Williams JW. Use of leflunomide in an allogeneic bone marrow transplant recipient with refractory cytomegalovirus infection. Bone Marrow Transplant 2005; 34:1071-5. [PMID: 15489872 DOI: 10.1038/sj.bmt.1704694] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [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: 11/09/2022]
Abstract
Ganciclovir-resistant cytomegalovirus (CMV) infection is an emerging problem in transplant recipients. Foscarnet resistance and cidofovir resistance have also been described, but no previous reports have suggested treatment regimens for patients with CMV refractory to all three of these drugs. Leflunomide, an immunosuppressive drug used in rheumatoid arthritis and in rejection in solid-organ transplantation, has been reported to have novel anti-CMV activity. However, its clinical utility in CMV treatment has not been described previously. We report an allogeneic bone marrow transplant recipient who developed CMV infection refractory to sequential therapy with ganciclovir, foscarnet, and cidofovir. The patient was ultimately treated with a combination of leflunomide and foscarnet. Both phenotypic and genotypic virologic analysis was performed on sequential CMV isolates. The patient's high CMV-DNA viral load became undetectable on leflunomide and foscarnet, but the patient, who had severe graft-versus-host disease (GVHD) of the liver, expired with progressive liver failure and other complications. We concluded that leflunomide is a new immunosuppressive agent with anti-CMV activity, which may be useful in the treatment of multiresistant CMV. However, the toxicity profile of leflunomide in patients with underlying GVHD remains to be defined.
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Affiliation(s)
- R K Avery
- Department of Infectious Disease, Cleveland Clinic Foundation, Desk S-32, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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28
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Goyal HO, Braden TD, Williams CS, Dalvi P, Mansour MM, Mansour M, Williams JW, Bartol FF, Wiley AA, Birch L, Prins GS. Abnormal Morphology of the Penis in Male Rats Exposed Neonatally to Diethylstilbestrol Is Associated with Altered Profile of Estrogen Receptor-α Protein, but Not of Androgen Receptor Protein: A Developmental and Immunocytochemical Study1. Biol Reprod 2004; 70:1504-17. [PMID: 14749301 DOI: 10.1095/biolreprod.103.026328] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objectives of the study were to determine developmental changes in morphology and expression of androgen receptor (AR) and estrogen receptor (ER)alpha in the body of the rat penis exposed neonatally to diethylstilbestrol (DES). Male pups received DES at a dose of 10 microg per rat on alternate days from Postnatal Day 2 to Postnatal Day 12. Controls received olive oil vehicle only. Tissue samples were collected on Days 18 (prepuberty), 41 (puberty), and 120 (adult) of age. DES-induced abnormalities were evident at 18 days of age and included smaller, lighter, and thinner penis, loss of cavernous spaces and associated smooth muscle cells, and increased deposition of fat cells in the corpora cavernosa penis. Fat cells virtually filled the entire area of the corpora cavernosa at puberty and adulthood. Plasma testosterone (T) was reduced to an undetectable level, while LH was unaltered in all treated groups. AR-positive cells were ubiquitous and their profile (incidence and staining intensity) did not differ between control and treated rats of the respective age groups. Conversely, ERalpha-positive cells were limited to the stroma of corpus spongiosus in all age groups of both control and treated rats, but the expression in treated rats at 18 days was up-regulated in stromal cells of corpora cavernosa, coincident with the presence of morphological abnormalities. Hence, this study reports for the first time DES-induced developmental, morphological abnormalities in the body of the penis and suggests that these abnormalities may have resulted from decreased T and/or overexpression of ERalpha.
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Affiliation(s)
- H O Goyal
- Department of Biomedical Sciences, Tuskegee University, Tuskegee, Alabama 36088, USA.
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Goyal HO, Braden TD, Williams CS, Dalvi P, Williams JW, Srivastava KK. Exposure of neonatal male rats to estrogen induces abnormal morphology of the penis and loss of fertility. Reprod Toxicol 2004; 18:265-74. [PMID: 15019723 DOI: 10.1016/j.reprotox.2003.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2003] [Revised: 09/10/2003] [Accepted: 10/30/2003] [Indexed: 10/26/2022]
Abstract
The research objectives are to determine whether estrogen-induced infertility is associated with abnormal morphology of the penis and if morphological alterations can be reversed by testosterone (T). Male pups received diethylstilbestrol (DES) on alternate days from postnatal days 2 to 12. They received T or empty implants at 180 days, were tested for fertility at 188 days, and terminated at 200 days. While 5/7 control males sired pups, only 1/6 did in the DES group, and 0/8 in the DES plus T group. In addition to reductions in penile length and weight, the novel structural change induced by DES, and not reversed by T, was a replacement of cavernous spaces by fat cells in the penis body. Hence, T substitution for 8 days at adulthood did not reverse infertility in rats treated neonatally with DES and provided evidence that infertility probably resulted from absence of cavernous spaces and/or accumulation of fat cells in the penis body.
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Affiliation(s)
- H O Goyal
- Department of Biomedical Sciences, School of Veterinary Medicine, Tuskegee University, Tuskegee, AL 36088, USA.
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Abstract
We retrospectively reviewed 18 patients with endoscopically discovered Candida esophagitis to more fully characterize this entity and identify predisposing conditions. Candida esophagitis was defined by the presence of fungal mycelia on brush cytology. Only two patients had an associated malignancy. Other possible predisposing risk factors were acid suppressive therapy (14 patients), prior gastric surgery (five), mucosal barrier injury (four), inhaled steroid use (four), oral steroid use (three), esophageal motility disorders (three), rheumatologic disorders (three), prior antibiotic use (two) and diabetes mellitus (two). The majority of patients had more than one proposed risk factor. Ten (56%) were treated with antifungal therapy. Thus, Candida esophagitis was infrequently seen in patients with associated malignancy. Prospective evaluation of predisposing conditions and treatment is recommended.
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Affiliation(s)
- J A Underwood
- Division of Gastroenterology, Mayo Clinic Scottsdale, Arizona, USA
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Williams JW, Zimmet PZ, Shaw JE, de Courten MP, Cameron AJ, Chitson P, Tuomilehto J, Alberti KGMM. Gender differences in the prevalence of impaired fasting glycaemia and impaired glucose tolerance in Mauritius. Does sex matter? Diabet Med 2003; 20:915-20. [PMID: 14632717 DOI: 10.1046/j.1464-5491.2003.01059.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.8] [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: 11/20/2022]
Abstract
OBJECTIVE To examine gender differences in the characteristics and prevalence of various categories of glucose tolerance in a population study in Mauritius. RESEARCH DESIGN AND METHODS In 1998, a community-based cross-sectional survey was conducted in Mauritius. Categories of glucose metabolism were determined in 5388 adults, with an oral glucose tolerance test given to those who did not have previously diagnosed diabetes (n=4036). Other cardiovascular risk factors were assessed among those without known diabetes. RESULTS For men and women the prevalence of diabetes (22.0 vs. 21.8%, respectively) and the prevalence of coexisting impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) (3.2 vs. 2.9%) were similar. However, men were twice as likely as women to have isolated IFG [5.1% (4.2-6.0) vs. 2.9% (2.3-3.5)], despite being younger, thinner and with lower plasma insulin but higher lipids. Conversely, the prevalence of isolated IGT was lower in men [9.0% (7.9-10.2) vs. 13.9% (12.6-15.1)]. Among non-diabetic individuals, fasting glucose was higher in men than women, whereas 2-h glucose was higher in women. In people without diabetes, women had significantly higher body mass index, beta cell function (HOMA-B), fasting and 2-h insulin than men and significantly lower waist-hip ratios, waist circumference, insulin sensitivity (HOMA-S) and triglycerides. CONCLUSION In Mauritius, the distribution of impaired glucose metabolism differs by sex. The observation that IFG is more prevalent in men and IGT more prevalent in women raises important questions about their underlying aetiology and the ability of the current glucose thresholds to equally identify men and women at high-risk of developing diabetes. IFG should be seen as a complimentary category of abnormal glucose tolerance, rather than a replacement for IGT.
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Affiliation(s)
- J W Williams
- International Diabetes Institute, Melbourne, Australia
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Abstract
Clinically significant involvement of the esophagus is uncommon in patients who have lichen planus, a common disorder of squamous epithelium. In three patients who had oral, cutaneous, and esophageal lichen planus, endoscopic intralesional esophageal injection of corticosteroids (in all three patients) and oral tacrolimus (FH506) (in two patients) resulted in improvement in dysphagia, a less frequent need for dilation, and improvement in esophageal inflammation.
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Affiliation(s)
- R F Keate
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ 85259, USA.
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Abstract
BACKGROUND For adults seeking care in ambulatory medical practices, sinusitis is the most common diagnosis treated with antibiotics. OBJECTIVES We examined whether antibiotics are indicated for acute sinusitis, and if so, which antibiotic classes are most effective. SEARCH STRATEGY Relevant studies were identified from searches of MEDLINE and EMBASE in December 2001, contacts with pharmaceutical companies and bibliographies of included studies. SELECTION CRITERIA Randomized trials were eligible that compared antibiotic to control or antibiotics from different classes, for acute maxillary sinusitis. Additional criteria for inclusion were diagnostic confirmation by radiograph or sinus aspiration, outcomes that included clinical cure or improvement, and a sample size of 30 or more adults. Of 2058 potentially relevant studies, two or more reviewers identified 49 studies meeting selection criteria. DATA COLLECTION AND ANALYSIS Data were extracted independently by two persons and synthesized descriptively. Some data were analyzed quantitatively using a random effects model. Primary outcomes were: a) clinical cure, and b) clinical cure or improvement. Secondary outcomes were radiographic improvement, relapse rates, and dropouts due to adverse effects. MAIN RESULTS Forty-nine trials, involving 13,660 participants, evaluated antibiotic treatment for acute maxillary sinusitis. Major comparisons were antibiotic versus control (n of 5); newer, non-penicillin antibiotic versus penicillin class (n of 10); and amoxicillin-clavulanate versus other extended spectrum antibiotics (n of 17), where n is the number of trials. Most trials were conducted in otolaryngology settings. Only 8 trials described adequate allocation and concealment procedures; 20 were double-blind. Compared to control, penicillin improved clinical cures [relative risk (RR) 1.72; 95% CI 1.00 to 2.96]. Treatment with amoxicillin did not significantly improve cure rates (RR 2.06; 95% CI 0.65 to 6.53) but there was significant variability between studies. Radiographic outcomes were improved by antibiotic treatment. Comparisons between classes of antibiotics showed no significant differences: newer non-penicillins versus penicillins (RR for cure 1.07; 95% CI 0.99 to 1.17); newer non-penicillins versus amoxicillin-clavulanate (RR for cure 1.03; 95% CI 0.96 to 1.11). Compared to amoxicillin-clavulanate, dropouts due to adverse effects were significantly lower for cephalosporin antibiotics (RR 0.47; 95% CI 0.30 to 0.73). Relapse rates within one month of successful therapy were 7.7%. REVIEWER'S CONCLUSIONS For acute maxillary sinusitis confirmed radiographically or by aspiration, current evidence is limited but supports the use of penicillin or amoxicillin for 7 to 14 days. Clinicians should weigh the moderate benefits of antibiotic treatment against the potential for adverse effects.
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Affiliation(s)
- J W Williams
- Medicine, Durham Veterans Affairs Medical Center/ Duke University Medical Center, 508 Fulton Street, HSRD (152), Durham, NC 27705, USA.
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McCrory DC, Williams JW, Dolor RJ, Gray RN, Kolimaga JT, Reed S, Sundy J, Witsell DL. Management of allergic rhinitis in the working-age population. Evid Rep Technol Assess (Summ) 2003:1-4. [PMID: 12674744 PMCID: PMC4781251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
MESH Headings
- Adult
- Drug Therapy, Combination
- Environmental Health
- Ethnicity
- Evidence-Based Medicine
- Female
- Health Care Costs
- Humans
- Immunotherapy
- Male
- Medicine
- Middle Aged
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/drug therapy
- Rhinitis, Allergic, Perennial/economics
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/economics
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/therapy
- Specialization
- United States/epidemiology
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Williams JW, Van Holde KE, Baldwin RL, Fujita H. Part III. Fundamental Theory Of Sedimentation Processes In The Ultracentrifuge. Chem Rev 2002. [DOI: 10.1021/cr50022a007] [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: 11/29/2022]
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Adams ET, Williams JW. Sedimentation Equilibrium in Reacting Systems. II. Extensions of the Theory to Several Types of Association Phenomena. J Am Chem Soc 2002. [DOI: 10.1021/ja01071a011] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Williams JW. Introduction to the Symposium. Chem Rev 2002. [DOI: 10.1021/cr60078a001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Osterhoudt HW, Williams JW. Sedimentation Equilibria in Polydisperse Pseudo-Ideal Solutions and at Low Centrifugal Fields. ACTA ACUST UNITED AC 2002. [DOI: 10.1021/j100887a062] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wales M, Williams JW, Thompson JO, Ewart RH. Sedimentation Equilibria of Polydisperse Non-Ideal Solutes. Experiment. ACTA ACUST UNITED AC 2002; 52:983-98. [DOI: 10.1021/j150462a009] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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