1
|
Emery A, Moore S, Crowe J, Murray J, Peacock O, Thompson D, Betts F, Rapps S, Ross L, Rothschild-Rodriguez D, Arana Echarri A, Davies R, Lewis R, Augustine DX, Whiteway A, Afzal Z, Heaney J, Drayson MT, Turner JE, Campbell JP. The effects of short-term, progressive exercise training on disease activity in smouldering multiple myeloma and monoclonal gammopathy of undetermined significance: a single-arm pilot study. BMC Cancer 2024; 24:174. [PMID: 38317104 PMCID: PMC10840198 DOI: 10.1186/s12885-024-11817-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/01/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND High levels of physical activity are associated with reduced risk of the blood cancer multiple myeloma (MM). MM is preceded by the asymptomatic stages of monoclonal gammopathy of undetermined significance (MGUS) and smouldering multiple myeloma (SMM) which are clinically managed by watchful waiting. A case study (N = 1) of a former elite athlete aged 44 years previously indicated that a multi-modal exercise programme reversed SMM disease activity. To build from this prior case study, the present pilot study firstly examined if short-term exercise training was feasible and safe for a group of MGUS and SMM patients, and secondly investigated the effects on MGUS/SMM disease activity. METHODS In this single-arm pilot study, N = 20 participants diagnosed with MGUS or SMM were allocated to receive a 16-week progressive exercise programme. Primary outcome measures were feasibility and safety. Secondary outcomes were pre- to post-exercise training changes to blood biomarkers of MGUS and SMM disease activity- monoclonal (M)-protein and free light chains (FLC)- plus cardiorespiratory and functional fitness, body composition, quality of life, blood immunophenotype, and blood biomarkers of inflammation. RESULTS Fifteen (3 MGUS and 12 SMM) participants completed the exercise programme. Adherence was 91 ± 11%. Compliance was 75 ± 25% overall, with a notable decline in compliance at intensities > 70% V̇O2PEAK. There were no serious adverse events. There were no changes to M-protein (0.0 ± 1.0 g/L, P =.903), involved FLC (+ 1.8 ± 16.8 mg/L, P =.839), or FLC difference (+ 0.2 ± 15.6 mg/L, P =.946) from pre- to post-exercise training. There were pre- to post-exercise training improvements to diastolic blood pressure (- 3 ± 5 mmHg, P =.033), sit-to-stand test performance (+ 5 ± 5 repetitions, P =.002), and energy/fatigue scores (+ 10 ± 15%, P =.026). Other secondary outcomes were unchanged. CONCLUSIONS A 16-week progressive exercise programme was feasible and safe, but did not reverse MGUS/SMM disease activity, contrasting a prior case study showing that five years of exercise training reversed SMM in a 44-year-old former athlete. Longer exercise interventions should be explored in a group of MGUS/SMM patients, with measurements of disease biomarkers, along with rates of disease progression (i.e., MGUS/SMM to MM). REGISTRATION https://www.isrctn.com/ISRCTN65527208 (14/05/2018).
Collapse
Affiliation(s)
- A Emery
- Department for Health, University of Bath, Bath, UK
| | - S Moore
- Department for Haematology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - J Crowe
- Department for Haematology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - J Murray
- Department for Haematology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - O Peacock
- Department for Health, University of Bath, Bath, UK
| | - D Thompson
- Department for Health, University of Bath, Bath, UK
| | - F Betts
- Department for Health, University of Bath, Bath, UK
| | - S Rapps
- Department for Health, University of Bath, Bath, UK
| | - L Ross
- Department for Health, University of Bath, Bath, UK
| | | | | | - R Davies
- Department for Health, University of Bath, Bath, UK
| | - R Lewis
- Department for Physiotherapy, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - D X Augustine
- Department for Health, University of Bath, Bath, UK
- Department for Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - A Whiteway
- Department for Haematology, North Bristol NHS Trust, Bristol, UK
| | - Z Afzal
- Clinical Immunology Service, Institute of Immunity and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jlj Heaney
- Clinical Immunology Service, Institute of Immunity and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - M T Drayson
- Clinical Immunology Service, Institute of Immunity and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - J E Turner
- Department for Health, University of Bath, Bath, UK
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - J P Campbell
- Department for Health, University of Bath, Bath, UK.
- School of Medical and Health Sciences, Edith Cowan University, WA, Joondalup, Australia.
| |
Collapse
|
2
|
Campbell JP, Teigen L, Manski S, Blumhof B, Guglielmo FF, Shivashankar R, Shmidt E. Sarcopenia Is More Prevalent Among Inflammatory Bowel Disease Patients Undergoing Surgery and Predicts Progression to Surgery Among Medically Treated Patients. Inflamm Bowel Dis 2022; 28:1844-1850. [PMID: 35166776 DOI: 10.1093/ibd/izac013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sarcopenia is common in inflammatory bowel disease (IBD); however, estimates of its prevalence and impact on clinical outcomes are variable. This study sought to compare the prevalence of sarcopenia in IBD patients starting new biologics vs patients undergoing IBD surgeries, and its association with common clinical predictors of nutritional status, adverse events, and clinical outcomes. METHODS This was a multicenter retrospective cohort study of IBD patients who had a computed tomography (CT) scan within 6 months prior to new biologic initiation (medical cohort) or IBD surgery (surgery cohort). The lowest sex-specific quartile of the total psoas area index at the L3 level defined sarcopenia. Prevalence and predictors of sarcopenia, performance of common clinical nutritional markers, and association with adverse events and clinical outcomes at 1 year were determined. RESULTS A total of 156 patients were included (48% medical cohort, 52% surgery cohort). Sarcopenia was more common in the surgery cohort (32% vs 16%; P < .02). In the medical cohort, sarcopenia predicted need for surgery at 1 year (odds ratio, 4.75; 95% confidence interval, 1.10-20.57; P = .04). Low albumin and body mass index (BMI) were associated with the presence of sarcopenia; however, 24% of sarcopenic patients had both normal BMI and albumin. CONCLUSIONS Sarcopenia is more prevalent among IBD patients undergoing surgery and predicts the need for surgery in patients starting new biologic therapy. Low albumin and BMI were similar between cohorts, suggesting a unique role for sarcopenia as a relevant clinical marker of lean muscle mass depletion for surgically and medically treated IBD patients.
Collapse
Affiliation(s)
- James P Campbell
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Levi Teigen
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Scott Manski
- Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian Blumhof
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Raina Shivashankar
- Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Eugenia Shmidt
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
3
|
Campbell JP, Kearsley R. Regional analgesia following caesarean section: second thoughts. Anaesthesia 2022; 77:1063. [PMID: 35521645 DOI: 10.1111/anae.15748] [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] [Accepted: 04/23/2022] [Indexed: 11/28/2022]
Affiliation(s)
- J P Campbell
- Imperial College Healthcare NHS Trust, London, UK
| | - R Kearsley
- Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
4
|
Lukin D, Faleck D, Xu R, Zhang Y, Weiss A, Aniwan S, Kadire S, Tran G, Rahal M, Winters A, Chablaney S, Koliani-Pace JL, Meserve J, Campbell JP, Kochhar G, Bohm M, Varma S, Fischer M, Boland B, Singh S, Hirten R, Ungaro R, Lasch K, Shmidt E, Jairath V, Hudesman D, Chang S, Swaminath A, Shen B, Kane S, Loftus EV, Sands BE, Colombel JF, Siegel CA, Sandborn WJ, Dulai PS. Comparative Safety and Effectiveness of Vedolizumab to Tumor Necrosis Factor Antagonist Therapy for Ulcerative Colitis. Clin Gastroenterol Hepatol 2022; 20:126-135. [PMID: 33039584 PMCID: PMC8026779 DOI: 10.1016/j.cgh.2020.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/04/2020] [Accepted: 10/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS We aimed to compare safety and effectiveness of vedolizumab to tumor necrosis factor (TNF)-antagonist therapy in ulcerative colitis in routine practice. METHODS A multicenter, retrospective, observational cohort study (May 2014 to December 2017) of ulcerative colitis patients treated with vedolizumab or TNF-antagonist therapy. Propensity score weighted comparisons for development of serious adverse events and achievement of clinical remission, steroid-free clinical remission, and steroid-free deep remission. A priori determined subgroup comparisons in TNF-antagonist-naïve and -exposed patients, and for vedolizumab against infliximab and subcutaneous TNF-antagonists separately. RESULTS A total of 722 (454 vedolizumab, 268 TNF antagonist) patients were included. Vedolizumab-treated patients were more likely to achieve clinical remission (hazard ratio [HR], 1.651; 95% confidence interval [CI], 1.229-2.217), steroid-free clinical remission (HR, 1.828; 95% CI, 1.135-2.944), and steroid-free deep remission (HR, 2.819; 95% CI, 1.496-5.310) than those treated with TNF antagonists. Results were consistent across subgroup analyses in TNF-antagonist-naïve and -exposed patients, and for vedolizumab vs infliximab and vs subcutaneous TNF-antagonist agents separately. Overall, there were no statistically significant differences in the risk of serious adverse events (HR, 0.899; 95% CI, 0.502-1.612) or serious infections (HR, 1.235; 95% CI, 0.608-2.511) between vedolizumab-treated and TNF-antagonist-treated patients. However, in TNF-antagonist-naïve patients, vedolizumab was less likely to be associated with serious adverse events than TNF antagonists (HR, 0.192; 95% CI, 0.049-0.754). CONCLUSIONS Treatment of ulcerative colitis with vedolizumab is associated with higher rates of remission than treatment with TNF-antagonist therapy in routine practice, and lower rates of serious adverse events in TNF-antagonist-naïve patients.
Collapse
Affiliation(s)
- Dana Lukin
- Montefiore Medical Center, New York, New York
| | - David Faleck
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ronghui Xu
- University of California, San Diego, La Jolla, California
| | - Yiran Zhang
- University of California, San Diego, La Jolla, California
| | - Aaron Weiss
- Montefiore Medical Center, New York, New York
| | | | | | | | | | - Adam Winters
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Joseph Meserve
- University of California, San Diego, La Jolla, California
| | | | | | | | | | | | - Brigid Boland
- University of California, San Diego, La Jolla, California
| | | | - Robert Hirten
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ryan Ungaro
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Karen Lasch
- Takeda Pharmaceuticals, Lexington, Massachusetts
| | | | - Vipul Jairath
- University of Western Ontario, London, Ontario, Canada
| | | | | | | | - Bo Shen
- Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Bruce E. Sands
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | | |
Collapse
|
5
|
Affiliation(s)
- R Kearsley
- Department of Anaesthesia, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - J P Campbell
- Department of Anaesthesia, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
6
|
Graziano EJ, Vaughn BP, Wang Q, Chow LS, Campbell JP. Microscopic Colitis Is Not an Independent Risk Factor for Low Bone Density. Dig Dis Sci 2021; 66:3542-3547. [PMID: 33063187 DOI: 10.1007/s10620-020-06651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/01/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND Microscopic colitis (MC) is a subtype of inflammatory bowel disease (IBD) with overlapping risk factors for low bone density (LBD). While LBD is a known complication of IBD, its association with MC is not well-established. AIMS Assess the prevalence of LBD in MC compared to control populations, and evaluate if MC predicts LBD when controlling for confounders. METHODS Retrospective, observational case control study of adult patients with pathologically confirmed MC from 2005 to 2015. Bone density measurements were abstracted from dual-energy X-ray absorptiometry (DEXA) reports, and bone density was classified using T-score: normal (T ≥ - 1.0), osteopenia (- 1.0 > T > -2.5) or osteoporosis (T ≤ - 2.5). Demographics, disease, medication history and LBD risk factors were obtained from chart review. Prevalence of LBD was compared to national and local controls. A matched control cohort to MC patients without prior diagnosis of LBD was analyzed with logistic regression to assess the relationship of MC to LBD. RESULTS One hundred and eighteen patients with MC were identified. Osteopenia in women with MC was more prevalent compared to national controls (67% vs. 49%, p = 0.0004), and LBD was more prevalent in MC patients compared to local controls (82% vs. 55%, p < 0.0001). In MC patients without prior diagnosis of LBD matched to controls, there was a higher prevalence of osteopenia (53.2% vs. 36.7%, p = 0.04). However, after controlling for confounders, MC was not associated with LBD (OR 0.83, 95% CI 0.22, 3.16, p = 0.8). CONCLUSIONS While LBD was more prevalent in MC patients compared to control populations, with adjustment for key confounders (including BMI, steroids, smoking, vitamin D and calcium use), MC was not an independent predictor of LBD.
Collapse
Affiliation(s)
- Elliot J Graziano
- Department of Internal Medicine, University of Minnesota, 420 Delaware Street SE MMC 284, Minneapolis, MN, 55455, USA.
| | - Byron P Vaughn
- Inflammatory Bowel Disease Program, Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Qi Wang
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Lisa S Chow
- Division of Diabetes, Endocrinology and Metabolism, University of Minnesota, Minneapolis, MN, USA
| | - James P Campbell
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
7
|
Seneviratna D, Campbell JP, Plaat F. A 20-minute decision-delivery interval at caesarean section using general anaesthesia. Anaesthesia 2021; 77:112-113. [PMID: 34555185 DOI: 10.1111/anae.15589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 11/30/2022]
Affiliation(s)
- D Seneviratna
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - J P Campbell
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - F Plaat
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
8
|
Campbell JP, Zierold C, Rode AM, Blocki FA, Vaughn BP. Clinical Performance of a Novel LIAISON Fecal Calprotectin Assay for Differentiation of Inflammatory Bowel Disease From Irritable Bowel Syndrome. J Clin Gastroenterol 2021; 55:239-243. [PMID: 32324678 PMCID: PMC7960147 DOI: 10.1097/mcg.0000000000001359] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Received: 10/02/2019] [Accepted: 03/25/2020] [Indexed: 12/19/2022]
Abstract
GOAL The goal of this study was to assess the clinical performance of an investigational in vitro fecal calprotectin immunoassay for differentiating inflammatory bowel disease (IBD) from irritable bowel syndrome (IBS). BACKGROUND Fecal calprotectin is a stool biomarker that can assist in the detection of intestinal inflammation and is utilized to identify individuals who have a higher chance of having IBD and who require further invasive tests. Current assays exhibit variable performance. MATERIALS AND METHODS This study was a multicenter, cross-sectional analysis of prospectively collected stool samples from patients 4 years of age or older who presented with gastrointestinal (GI) symptoms and underwent colonoscopy for diagnostic confirmation. IBD was diagnosed based on clinical, endoscopic, and histologic findings. IBS was diagnosed based on Rome III Criteria and negative colonoscopy. Stool samples were extracted and tested on the DiaSorin LIAISON XL using the LIAISON Calprotectin Assay. RESULTS A total of 240 patients (67% female) were included in the study. In total, 102 patients had IBD (54% ulcerative colitis), 67 had IBS, and 71 had other GI disorders. Median fecal calprotectin levels were significantly higher in patients with IBD [522 μg/g; 95% confidence interval (CI): 354-970 μg/g] compared with IBS (34.5 μg/g; 95% CI: 19.7-44.2 μg/g, P<0.001) and other GI disorders (28.6 μg/g; 95% CI: 18.7-40.3 μg/g, P<0.001). Receiver operating characteristic curve analysis indicated a fecal calprotectin cutoff of 94 μg/g for distinguishing IBD from other GI disorders with an area under the curve of 0.964 (sensitivity=92.2%, specificity=88.4%). CONCLUSION The automated LIAISON Calprotectin assay brings efficient calprotectin testing to the laboratory with a time to the first result of 35 minutes and is a sensitive marker for distinguishing IBD from IBS with a cutoff of ∼100 μg/g.
Collapse
Affiliation(s)
- James P. Campbell
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota Medical School, Minneapolis
| | | | | | | | - Byron P. Vaughn
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota Medical School, Minneapolis
| |
Collapse
|
9
|
Agarwala R, Millar CM, Campbell JP. Haemostatic disorders in pregnancy. BJA Educ 2021; 20:150-157. [PMID: 33456944 DOI: 10.1016/j.bjae.2020.02.002] [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] [Accepted: 02/04/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- R Agarwala
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - C M Millar
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK.,Centre for Haematology, Imperial College London, London, UK
| | - J P Campbell
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
10
|
Ercan-Fang NG, Mahmoud MA, Cottrell C, Campbell JP, MacDonald DM, Arayssi T, Rockey DC. Best Practices in Resident Research- A National Survey of High Functioning Internal Medicine Residency Programs in Resident Research in USA. Am J Med Sci 2020; 361:23-29. [PMID: 33288205 DOI: 10.1016/j.amjms.2020.08.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/28/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Meaningful participation in research for both faculty and residents is generally viewed to be an essential component of residency training. To better understand best practices in residency research, the authors conducted a survey among Internal Medicine (IM) Residency Programs with experience in research. METHODS Phone interviews were conducted with a convenience sample of Residency Program Directors (PDs). Survey responses were analyzed across the following domains: size and makeup of the residency and research programs, resources for research, role of the PD/research director (RD), profile of trainees doing research, curriculum description, scope of research, role of mentors, career choices and determinants of success. RESULTS Fifteen programs were included in the study. Across these programs, approximately two-thirds of residents were involved in research during their training . Eighty percent of the programs required an application for residents to engage in research. Ninety-two percent of the programs had a RD but only 58% had a formal research curriculum. Clinical research projects were the most common types of research. On average, two-thirds of residents involved in research submitted abstracts to regional and/or national meetings. The factor most frequently associated with resident research success was an effective faculty research mentor. CONCLUSIONS Research success during residency is multifactorial. The authors propose that having a robust structure for research that is led by a residency RD, and the presence of effective mentors and strong administrative support are critical for success.
Collapse
Affiliation(s)
- Nacide G Ercan-Fang
- Department of Medicine, University of Minnesota, Minneapolis, MN; Minneapolis VA Health Care System, Minneapolis, MN.
| | - Mai A Mahmoud
- Weill Cornell Medicine - Qatar, Education City, Al Luqta St, Qatar
| | - Carol Cottrell
- Divisions of Gastroenterology, Hepatology, and Rheumatology, Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL
| | - James P Campbell
- Department of Medicine, University of Minnesota, Minneapolis, MN
| | | | - Thurayya Arayssi
- Weill Cornell Medicine - Qatar, Education City, Al Luqta St, Qatar
| | - Don C Rockey
- Department of Internal Medicine, Medical University of South Carolina, Charleston, SC
| |
Collapse
|
11
|
Negoescu DM, Enns EA, Swanhorst B, Baumgartner B, Campbell JP, Osterman MT, Papamichael K, Cheifetz AS, Vaughn BP. Proactive Vs Reactive Therapeutic Drug Monitoring of Infliximab in Crohn's Disease: A Cost-Effectiveness Analysis in a Simulated Cohort. Inflamm Bowel Dis 2020; 26:103-111. [PMID: 31184366 PMCID: PMC6905301 DOI: 10.1093/ibd/izz113] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Therapeutic drug monitoring (TDM) is increasingly performed for Infliximab (IFX) in patients with Crohn's disease (CD). Reactive TDM is a cost-effective strategy to empiric IFX dose escalation. The cost-effectiveness of proactive TDM is unknown. The aim of this study is to assess the cost-effectiveness of proactive vs reactive TDM in a simulated population of CD patients on IFX. METHODS We developed a stochastic simulation model of CD patients on IFX and evaluated the expected health costs and outcomes of a proactive TDM strategy compared with a reactive strategy. The proactive strategy measured IFX concentration and antibody status every 6 months, or at the time of a flare, and dosed IFX to a therapeutic window. The reactive strategy only did so at the time of a flare. RESULTS The proactive strategy led to fewer flares than the reactive strategy. More patients stayed on IFX in the proactive vs reactive strategy (63.4% vs 58.8% at year 5). From a health sector perspective, a proactive strategy was marginally cost-effective compared with a reactive strategy (incremental cost-effectiveness ratio of $146,494 per quality-adjusted life year), assuming a 40% of the wholesale price of IFX. The results were most sensitive to risk of flaring with a low IFX concentration and the cost of IFX. CONCLUSIONS Assuming 40% of the average wholesale acquisition cost of biologic therapies, proactive TDM for IFX is marginally cost-effective compared with a reactive TDM strategy. As the cost of infliximab decreases, a proactive monitoring strategy is more cost-effective.
Collapse
Affiliation(s)
- Diana M Negoescu
- Department of Industrial and Systems Engineering, University of Minnesota College of Science and Engineering, Minneapolis, MN
| | - Eva A Enns
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN
| | - Brooke Swanhorst
- Department of Industrial and Systems Engineering, University of Minnesota College of Science and Engineering, Minneapolis, MN
| | - Bonnie Baumgartner
- Department of Industrial and Systems Engineering, University of Minnesota College of Science and Engineering, Minneapolis, MN
| | - James P Campbell
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota Medical School, Minneapolis, MN
| | - Mark T Osterman
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Konstantinos Papamichael
- Center for Inflammatory Bowel Disease, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Adam S Cheifetz
- Center for Inflammatory Bowel Disease, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Byron P Vaughn
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota Medical School, Minneapolis, MN
| |
Collapse
|
12
|
Curran M, Campbell JP, Powell E, Chikhlia A, Narendran P. The mobilisation of early mature CD56dim-CD16bright NK cells is blunted following a single bout of vigorous intensity exercise in Type 1 Diabetes. Exerc Immunol Rev 2020; 26:116-131. [PMID: 32139354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Type 1 diabetes (T1D) is a T cell mediated autoimmune disease that targets and destroys insulin-secreting pancreatic beta cells. Although T cell mediated, a number of other immune cells are also critically involved in coordinating the events leading to T1D. Specifically, innate subsets play an important role in the pathogenesis of T1D. NK cells are one of the first cell types to infiltrate the pancreas, causing damage and release of beta cell antigens. Previous work in our group has shown differential mobilisation of highly differentiated CD8+ T cells during vigorous intensity exercise in T1D compared to a control cohort. Here, we aimed to explore exercise-induced mobilisation of other cell types involved in T1D pathogenesis. In this study, we investigated the effects of a single bout of vigorous (80% predicted VO2max) intensity exercise on innate cell mobilisation in T1D and control participants. T1D (N=12, mean age 33.2yrs, predicted VO₂max 32.2 ml.kg.min⁻¹, BMI 25.3 kg.m⁻²) and control (N=12, mean age 29.4yrs, predicted VO2 max 38.5 ml.kg.min⁻¹, BMI 23.7 kg.m⁻² male participants completed a 30-minute bout of cycling at 80% predicted VO₂ max in a fasted state. Peripheral blood was collected at baseline, immediately post-exercise, and 1 hour post-exercise. NK cell subsets mobilised during vigorous intensity exercise in both control and T1D participants. However, mature NK cells, defined as the CD56dimCD16bright subset, displayed a lower percentage increase following vigorous intensity exercise in T1D participants (Control: 185.12%, T1D: 97.06%). This blunted mobilisation was specific to early mature NK cells (KIR+) but not later differentiated NK cells (KIR+CD57+). Myeloid lineage subsets mobilised to a similar extent in both control and T1D participants. In conclusion, vigorous exercise mobilises innate immune cells in people with T1D albeit to a different extent to those without T1D. This mobilisation of innate immune cells provides a mechanistic argument to support exercise in people with T1D where it has the potential to improve surveillance for infection and to modulate the autoimmune response to the beta cell.
Collapse
Affiliation(s)
- M Curran
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Functional and Mechanistic Safety, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge, UK
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - J P Campbell
- Department for Health, University of Bath, Bath, UK
| | - E Powell
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - A Chikhlia
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - P Narendran
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Department of Diabetes, The Queen Elizabeth Hospital, Birmingham, UK
| |
Collapse
|
13
|
Papamichael K, Juncadella A, Wong D, Rakowsky S, Sattler LA, Campbell JP, Vaughn BP, Cheifetz AS. Proactive Therapeutic Drug Monitoring of Adalimumab Is Associated With Better Long-term Outcomes Compared With Standard of Care in Patients With Inflammatory Bowel Disease. J Crohns Colitis 2019; 13:976-981. [PMID: 30689771 PMCID: PMC6939875 DOI: 10.1093/ecco-jcc/jjz018] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/03/2019] [Accepted: 01/19/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Therapeutic drug monitoring [TDM] has proven to be effective for optimising anti-tumour necrosis factor [TNF] therapy in inflammatory bowel disease [IBD]. Nevertheless, the majority of data refer to infliximab and reactive testing or association studies. We aimed to compare the long-term outcome of patients with IBD who received at least one proactive TDM of adalimumab, with standard of care, defined as empirical dose escalation and/or reactive TDM. METHODS This was a multicentre retrospective cohort study. Patients on maintenance adalimumab therapy from June 2006 to December 2015 were eligible. We analysed time to treatment failure from start of adalimumab until the end of follow-up [July 2016]. Treatment failure was defined as drug discontinuation for secondary loss of response or serious adverse event or need for IBD-related surgery. Serum adalimumab concentrations and antibodies to adalimumab were measured using the Prometheus homogeneous mobility shift assay. RESULTS A total of 382 patients with IBD [Crohn's disease, n = 311, 81%] were included and received either at least one proactive TDM [n = 53] or standard of care [empirical dose escalation, n = 279; reactive TDM, n = 50]. Patients were followed for a median of 3.1 years [interquartile range, 1.4-4.8 years]. Multiple Cox regression analyses showed that at least one proactive TDM was independently associated with a reduced risk for treatment failure (hazard ratio [HR]: 0.4; 95% confidence interval [CI]: 0.2-0.9; p = 0.022). CONCLUSIONS This multicentre, retrospective cohort study reflecting real-life clinical practice provides the first evidence that proactive TDM of adalimumab may be associated with a lower risk of treatment failure compared with standard of care in patients with IBD.
Collapse
Affiliation(s)
- Konstantinos Papamichael
- Center for Inflammatory Bowel Diseases, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Anna Juncadella
- Center for Inflammatory Bowel Diseases, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Danny Wong
- Center for Inflammatory Bowel Diseases, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Shana Rakowsky
- Center for Inflammatory Bowel Diseases, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Lindsey A Sattler
- Center for Inflammatory Bowel Diseases, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - James P Campbell
- Department of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Byron P Vaughn
- Department of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Adam S Cheifetz
- Center for Inflammatory Bowel Diseases, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA,Corresponding author: Adam S. Cheifetz, MD, Center for Inflammatory Bowel Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Rabb 425, Boston, MA 02215, USA. . Tel.: [617] 667–2802; fax: [617] 667–5826;
| |
Collapse
|
14
|
Valikodath N, Cole E, Chiang MF, Campbell JP, Chan RVP. Imaging in Retinopathy of Prematurity. Asia Pac J Ophthalmol (Phila) 2019; 8:178-186. [PMID: 31037876 PMCID: PMC7891847 DOI: 10.22608/apo.201963] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/16/2019] [Indexed: 01/29/2023] Open
Abstract
Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness worldwide. Barriers to ROP screening and difficulties with subsequent evaluation and management include poor access to care, lack of physicians trained in ROP, and issues with objective documentation. Digital retinal imaging can help address these barriers and improve our knowledge of the pathophysiology of the disease. Advancements in technology have led to new, non-mydriatic and mydriatic cameras with wider fields of view as well as devices that can simultaneously incorporate fluorescein angiography, optical coherence tomography (OCT), and OCT angiography. Image analysis in ROP is also being employed through smartphones and computer-based software. Telemedicine programs in the United States and worldwide have utilized imaging to extend ROP screening to infants in remote areas and have shown that digital retinal imaging can be reliable, accurate, and cost-effective. In addition, tele-education programs are also using digital retinal images to increase the number of healthcare providers trained in ROP. Although indirect ophthalmoscopy is still an important skill for screening, digital retinal imaging holds promise for more widespread screening and management of ROP.
Collapse
Affiliation(s)
- N Valikodath
- From the Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States; and Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR, United States
| | | | | | | | | |
Collapse
|
15
|
McCrory DJ, Lenahan PM, Nminibapiel DM, Veksler D, Ryan JT, Campbell JP. Total Ionizing Dose Effects on TiN/Ti/HfO 2/TiN Resistive Random-Access Memory Studied via Electrically Detected Magnetic Resonance. IEEE Trans Nucl Sci 2018; 65:10.1109/TNS.2018.2820907. [PMID: 31080273 PMCID: PMC6508598 DOI: 10.1109/tns.2018.2820907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We observe a gamma-irradiation induced change in electrically detected magnetic resonance (EDMR) in TiN/Ti/HfO2/TiN resistive random access memory (RRAM). EDMR measurements exclusively detect electrically active defects which are directly involved in the transport mechanisms within these devices. The EDMR response has an isotropic g-value of 2.001 ± 0.0003. The response increases dramatically with increased gamma-irradiation. We tentatively associate this EDMR response with spin dependent trap assisted tunneling (SDTAT) events at O 2 - centers coupled to hafnium ions. Although our study cannot fully identify the role of these defects in electronic transport, the study does unambiguously identify changes in transport defects caused by the ionizing radiation on defects involved in electronic transport in RRAM devices. This work also contributes more broadly to the RRAM field by providing direct, though incomplete, information about atomic scale defects involved in electronic transport in leading RRAM systems.
Collapse
Affiliation(s)
- D J McCrory
- Pennsylvania State University, University Park, PA 16802 USA
| | - P M Lenahan
- Pennsylvania State University, University Park, PA 16802 USA
| | - D M Nminibapiel
- National Institute of Standards and Technology, Gaithersburg, MD, 20899
| | - D Veksler
- National Institute of Standards and Technology, Gaithersburg, MD, 20899
| | - J T Ryan
- National Institute of Standards and Technology, Gaithersburg, MD, 20899
| | - J P Campbell
- National Institute of Standards and Technology, Gaithersburg, MD, 20899
| |
Collapse
|
16
|
Campbell JP, Burton E, Wymer S, Shaw M, Vaughn BP. Out-of-Pocket Cost Is a Barrier to Therapeutic Drug Monitoring in Inflammatory Bowel Disease. Dig Dis Sci 2017; 62:3336-3343. [PMID: 29052818 PMCID: PMC7366780 DOI: 10.1007/s10620-017-4808-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/12/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Therapeutic drug monitoring (TDM) is increasingly performed to optimize biologic therapy in inflammatory bowel disease (IBD). However, patients and physicians may be reluctant to perform TDM due to concerns related to potential out-of-pocket costs. AIMS The aim of this study was to evaluate patient understanding and attitudes toward TDM in different clinical scenarios with and without potential out-of-pocket costs. METHODS Adult IBD patients at a tertiary gastroenterology clinic were anonymously surveyed from March to September 2016 to assess their understanding of and willingness to undergo TDM in a variety of clinical scenarios, both with and without a potential out-of-pocket cost. Responses were analyzed for associations with changes in attitudes if out-of-pocket costs were involved. RESULTS Of 118 completed surveys, 68.2% of patients were aware of or had previously undergone TDM. Patient willingness to undergo TDM was high both with and without potential out-of-pocket costs (70 and 98%, respectively); however, patients were significantly less willing with out-of-pocket cost (p < 0.01). Higher disease-related quality of life scores, as measured by the short inflammatory bowel disease questionnaire (SIBDQ), was significantly associated with an increased willingness to assume a potential out-of-pocket cost (p = 0.007). CONCLUSIONS Overall, patients understand and are willing to undergo TDM in certain potentially beneficial clinical scenarios, however, are significantly less willing if paying out-of-pocket. A higher SIBDQ score was associated with an increase in willingness to undergo TDM when out-of-pocket cost was involved. Physicians should discuss TDM with their patients in order to make an informed and personalized treatment decision.
Collapse
Affiliation(s)
- James P. Campbell
- Department of Internal Medicine, University of Minnesota, MMC 36, 420 Harvard St. SE, Minneapolis, MN 55455, USA
| | - Erin Burton
- College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Shelly Wymer
- Office of Measurement Services, University of Minnesota, Minneapolis, MN, USA
| | - Michael Shaw
- Division of Gastroenterology, Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Byron P. Vaughn
- Division of Gastroenterology, Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
17
|
|
18
|
Arora R, Campbell JP, Simon G, Sahni N. Does serum procalcitonin aid in the diagnosis of bloodstream infection regardless of whether patients exhibit the systemic inflammatory response syndrome? Infection 2016; 45:291-298. [PMID: 27866368 DOI: 10.1007/s15010-016-0965-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 09/09/2016] [Accepted: 11/12/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Physicians frequently rely on the systemic inflammatory response syndrome (SIRS) criteria to detect bloodstream infections (BSIs). We evaluated the diagnostic performance of procalcitonin (PCT) in detecting BSI in patients with and without SIRS. METHODS We tested the association between BSI, serum PCT levels, contemporaneous SIRS scores and serum lactate using logistic regression in a dataset of 4279 patients. The diagnostic performance of these variables was assessed. RESULTS In multivariate regression analysis, only log(PCT) was independently associated with BSI (p < 0.05). The mean area under the curve (AUC) of PCT in detecting BSI (0.683; 95% CI 0.65-0.71) was significantly higher than serum lactate (0.615; 95% CI 0.58-0.64) and the SIRS score (0.562; 95% CI 0.53-0.58). The AUC of PCT did not differ significantly by SIRS status. PCT of less than 0.1 ng/mL had a negative predictive value (NPV) of 97.4 and NPV of 96.2% for BSI in the SIRS-negative and SIRS-positive patients, respectively. A PCT of greater than 10 ng/mL had a LR of 6.22 for BSI in SIRS-negative patients. The probability of BSI increased exponentially with rising PCT levels regardless of SIRS status. CONCLUSION The performance of PCT for the diagnosis of BSI was not affected by SIRS status. Only PCT was independently associated with BSI, while the SIRS criterion and serum lactate were not. A low PCT value may be used to identify patients at a low risk for having BSI in both settings. An elevated PCT value even in a SIRS negative patient should prompt a careful search for BSI.
Collapse
Affiliation(s)
- Rashi Arora
- Division of General Internal Medicine, Department of Medicine, University of Minnesota, 420 Delaware Street, SE, MMC 741, Minneapolis, MN, 55455, USA
| | - James P Campbell
- Division of General Internal Medicine, Department of Medicine, University of Minnesota, 420 Delaware Street, SE, MMC 741, Minneapolis, MN, 55455, USA
| | - Gyorgy Simon
- Department of Health Informatics, Mayo Clinic, Rochester, MN, USA
| | - Nishant Sahni
- Division of General Internal Medicine, Department of Medicine, University of Minnesota, 420 Delaware Street, SE, MMC 741, Minneapolis, MN, 55455, USA.
| |
Collapse
|
19
|
Anand S, Garg SK, Campbell JP, Singh S, Wadhwa V, Hussein IM, Kumar A, Ahuja V. Oral janus kinase inhibitors for induction of remission in ulcerative colitis. Hippokratia 2016. [DOI: 10.1002/14651858.cd012420] [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: 11/09/2022]
Affiliation(s)
- Sachit Anand
- All India Institute of Medical Sciences; New Delhi India 110029
| | - Sushil K Garg
- University of Minnesota; Department of Medicine; Minneapolis MN USA
| | | | - Siddharth Singh
- University of California San Diego; Division of Gastroenterology; 9500 Gilman Drive La Jolla California USA 92093
| | - Vaibhav Wadhwa
- Fairview Hospital, Cleveland Clinic Foundation; Internal Medicine; Cleveland Ohio USA 44111
| | | | - Atul Kumar
- VA Medical Center - Northport; Gastroenterology and Hepatology; 79 Middleville Road Northport New York USA 11768
| | - Vineet Ahuja
- All India Institute of Medical Sciences; Department of Gastroenterology; Ansari Nagar New Delhi India 110029
| |
Collapse
|
20
|
Abstract
Despite improvements in medical therapies for Crohn’s disease (CD), up to 70% of patients require surgery within 10 years of diagnosis. Surgery is not curative, and almost all patients will experience endoscopic recurrence, and many will go on to clinical recurrence. Identifying patients at high-risk of endoscopic recurrence and standardizing postoperative assessments are essential in preventing clinical recurrence of CD. In this review, we discuss the assessment, monitoring, and treatment of postoperative CD patients. We address the various individual risk factors as well as composite risk factors. Medications used for primary CD treatment can be used in the postoperative setting to prevent endoscopic or clinical recurrence with varying efficacy, although the cost-effectiveness of these approaches are not fully understood. Future directions for postoperative CD management include evaluation of newer biologic agents such as anti-integrin therapy and fecal microbiota transplant for prevention of recurrence. Development of a standard preoperative risk assessment tool to clearly stratify those at high-risk of recurrence is necessary to guide empiric therapy. Lastly, the incorporation of noninvasive testing into disease monitoring will likely lead to early detection of endoscopic recurrence that will allow for tailored treatment to prevent clinical recurrence.
Collapse
Affiliation(s)
- James P Campbell
- Department of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Byron P Vaughn
- Department of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
21
|
Turner JE, Spielmann G, Wadley AJ, Aldred S, Simpson RJ, Campbell JP. Exercise-induced B cell mobilisation: Preliminary evidence for an influx of immature cells into the bloodstream. Physiol Behav 2016; 164:376-82. [PMID: 27321758 DOI: 10.1016/j.physbeh.2016.06.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/13/2016] [Accepted: 06/16/2016] [Indexed: 12/14/2022]
Abstract
The number of peripheral blood B lymphocytes doubles during acute exercise, but the phenotypic composition of this response remains unknown. In two independent exercise studies, using complimentary phenotyping strategies, we investigated the mobilisation patterns of distinct B cell subsets. In study one, nine healthy males (mean±SD age: 22.1±3.4years) completed a continuous cycling bout at 80% V̇O2MAX for 20min. In study two, seven healthy experienced cyclists (mean±SD age: 29.9±4.7years) completed a 30min cycling trial at a workload corresponding to +5% of the individual blood lactate threshold. In study one, CD3-CD19+ B cell subsets were classified into immature (CD27-CD10+), naïve (CD27-CD10-), memory (CD27+CD38-), plasma cells/plasmablasts (CD27+CD38+) and finally, recently purported 'B1' cells (CD27+ CD43+ CD69-). In study two, CD20+ B cells were classified into immature (CD27-IgD-), naïve (CD27-IgD+), and IgM+/IgG+/IgA+ memory cells (CD27+IgD-). Total B cells exhibited a mean increase of 88% (study one) and 60% (study two) during exercise. In both studies, immature cells displayed the greatest increase, followed by memory cells, then naïve cells (study one: immature 130%>mature 105%>naïve 84%; study two: immature 110%>mature 56%>naïve 38%). Our findings show that, unlike T cells and NK cells, B cell mobilisation is not driven by effector status, and, for the first time, that B cell mobilisation during exercise is comprised of immature CD27- IgD-/CD10+ cells.
Collapse
Affiliation(s)
- J E Turner
- Department for Health, University of Bath, Bath, UK
| | - G Spielmann
- Department of Health and Human Performance, University of Houston, TX, USA; School of Kinesiology, Louisiana State University, Baton Rouge, USA
| | - A J Wadley
- Institute of Science and the Environment, University of Worcester, Worcester, UK
| | - S Aldred
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - R J Simpson
- Department of Health and Human Performance, University of Houston, TX, USA
| | - J P Campbell
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
| |
Collapse
|
22
|
Huebner SM, Olson JM, Campbell JP, Bishop JW, Crump PM, Cook ME. Low Dietary c9t11-Conjugated Linoleic Acid Intake from Dairy Fat or Supplements Reduces Inflammation in Collagen-Induced Arthritis. Lipids 2016; 51:807-19. [PMID: 27270404 DOI: 10.1007/s11745-016-4163-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 05/10/2016] [Indexed: 11/26/2022]
Abstract
Dietary cis-9,trans-11 (c9t11) conjugated linoleic acid (CLA) fed at 0.5 % w/w was previously shown to attenuate inflammation in the murine collagen-induced (CA) arthritis model, and growing evidence implicates c9t11-CLA as a major anti-inflammatory component of dairy fat. To understand c9t11-CLA's contribution to dairy fat's anti-inflammatory action, the minimum amount of dietary c9t11-CLA needed to reduce inflammation must be determined. This study had two objectives: (1) determine the minimum dietary anti-inflammatory c9t11-CLA intake level in the CA model, and (2) compare this to anti-inflammatory effects of dairy fat (non-enriched, naturally c9t11-CLA-enriched, or c9t11-CLA-supplemented). Mice received the following dietary fat treatments (w/w) post arthritis onset: corn oil (6 % CO), 0.125, 0.25, 0.375, and 0.5 % c9t11-CLA, control butter (6 % CB), c9t11-enriched butter (6 % EB), or c9t11-CLA-supplemented butter (6 % SB, containing 0.2 % c9t11-CLA). Paw arthritic severity and pad swelling were scored and measured, respectively, over an 84-day study period. All c9t11-CLA and butter diets decreased the arthritic score (25-51 %, P < 0.01) and paw swelling (8-11 %, P < 0.01). Throughout the study, plasma tumor necrosis factor (TNFα) was elevated in CO-fed arthritic mice compared to non-arthritic (NA) mice but was reduced in 0.5 % c9t11-CLA- and EB-fed mice. Interleukin-1β and IL-6 were increased in arthritic CO-fed mice compared to NA mice but were reduced in 0.5 % c9t11-CLA- and EB-fed mice through day 42. In conclusion, 0.125 % c9t11-CLA reduced clinical arthritis as effectively as higher doses, and decreased arthritis in CB-fed mice suggested that the minimal anti-inflammatory levels of c9t11-CLA might be below 0.125 %.
Collapse
Affiliation(s)
- Shane M Huebner
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Jake M Olson
- Molecular and Environmental Toxicology Program, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - James P Campbell
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Jeffrey W Bishop
- Department of Animal Sciences, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Peter M Crump
- Department of Computing and Biometry, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Mark E Cook
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, 53706, USA.
- Molecular and Environmental Toxicology Program, University of Wisconsin-Madison, Madison, WI, 53706, USA.
- Department of Animal Sciences, University of Wisconsin-Madison, Madison, WI, 53706, USA.
| |
Collapse
|
23
|
Obstetric Anaesthetists' Association, Campbell JP, Plaat F, Checketts MR, Bogod D, Tighe S, Moriarty A, Koerner R. Safety guideline: skin antisepsis for central neuraxial blockade. Anaesthesia 2014; 69:1279-86. [PMID: 25187310 DOI: 10.1111/anae.12844] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2014] [Indexed: 11/10/2023]
Abstract
Concise guidelines are presented that recommend the method of choice for skin antisepsis before central neuraxial blockade. The Working Party specifically considered the concentration of antiseptic agent to use and its method of application. The advice presented is based on previously published guidelines, laboratory and clinical studies, case reports, and on the known properties of antiseptic agents.
Collapse
|
24
|
Huebner SM, Olson JM, Campbell JP, Bishop JW, Crump PM, Cook ME. Dietary trans-10,cis-12 CLA reduces murine collagen-induced arthritis in a dose-dependent manner. J Nutr 2014; 144:177-84. [PMID: 24285692 DOI: 10.3945/jn.113.182550] [Citation(s) in RCA: 12] [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: 01/04/2023] Open
Abstract
Dietary trans-10,cis-12 (t10c12) conjugated linoleic acid (CLA) has been shown to reduce inflammation in a murine collagen-induced arthritis (CA) model. To understand the anti-inflammatory potential of t10c12-CLA in the diet, the minimum dose of pure dietary t10c12-CLA capable of reducing CA was investigated. Because plasma inflammatory cytokines often do not reflect the progression of late-stage arthritis, inflamed tissue cytokine concentrations were also investigated in relation to increasing dietary t10c12-CLA amounts. Mice were randomly assigned to the following dietary treatments upon the establishment of arthritis: corn oil (CO) or 0.125%, 0.25%, 0.375%, or 0.5% t10c12-CLA (wt:wt) for 84 d. Sham mice (no arthritis) were fed CO and served as controls. Arthritic paw score, based on subjective assessment of arthritic severity, and paw thickness decreased linearly overall [16-65% (P < 0.001) and 0.5-12% (P < 0.001), respectively] as dietary t10c12-CLA increased (P < 0.001, R(2) < 0.81). Increasing dietary t10c12-CLA was associated with a decrease in plasma interleukin (IL)-1β at days 21 and 42 compared with CO-fed arthritic mice, such that mice fed ≥0.25% t10c12-CLA had IL-1β concentrations that were similar to sham mice. Plasma cytokines returned to sham mice concentrations by day 63 regardless of treatment; however, an arthritis-induced elevation in paw IL-1β decreased linearly as dietary t10c12-CLA concentrations increased at day 84 (P = 0.007, R(2) = 0.92). Similarly, increasing dietary t10c12-CLA linearly decreased paw tumor necrosis factor (TNF)-α (P = 0.05, R(2) = 0.70). In conclusion, ≥0.125% t10c12-CLA dose-dependently reduced inflammation in a murine CA model.
Collapse
|
25
|
Campbell JP, Pieper D. Third ventricle, cerebral aqueduct, and fourth ventricle mixed ependymal neurocytoma: a case report and review of the literature. Childs Nerv Syst 2013; 29:1203-6. [PMID: 23479269 DOI: 10.1007/s00381-013-2064-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 02/25/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE A case report of an 8-year-old female who underwent interhemispheric transcallosal approach to the third ventricle, cerebral aqueduct, and fourth ventricle for resection of a mixed ependymal neurocytoma and review of the literature was evaluated. METHODS An Ovid MEDLINE review of the literature was conducted starting in 1946 to current using search terms as described in our keywords. RESULTS A total of 16 neurocytoma have been described in the literature as either posterior third ventricle or posterior fossa in origin. Of these lesions, five have been described as mixed glial-neuronal and all of these were located in the fourth ventricle. To our knowledge, this is the first described mixed glial-neuronal tumor located in the posterior third ventricle and aqueduct.
Collapse
Affiliation(s)
- James P Campbell
- Department of Neurosurgery, Providence Hospital and Medical Center, 16001 W 9 Mile Rd, Southfield, MI, 48075, USA.
| | - Daniel Pieper
- Department of Neurosurgery, William Beaumont Hospital, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, USA
| |
Collapse
|
26
|
Macafee B, Campbell JP, Ashpole K, Cox M, Matthey F, Acton L, Yentis SM. Reference ranges for thromboelastography (TEG(®) ) and traditional coagulation tests in term parturients undergoing caesarean section under spinal anaesthesia*. Anaesthesia 2012; 67:741-7. [PMID: 22486761 DOI: 10.1111/j.1365-2044.2012.07101.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There has been little published work defining 'normal' thromboelastography (TEG(®) ) values in healthy parturients, and few large studies defining reference ranges for traditional coagulation tests in this patient group. Our aim was to establish peri-operative reference ranges for TEG and for standard laboratory coagulation tests in our pregnant population. Fifty healthy term parturients presenting for elective caesarean section under spinal anaesthesia had blood samples taken pre-operatively, on arrival in the recovery room and, in a subset of 33 women, 4 h after routine thromboprophylaxis with enoxaparin 40 mg. All three samples had TEG analysis, the first and second having standard laboratory coagulation tests in addition. Reference ranges for our pregnant population were established, demonstrating a hypercoagulable state in term parturients and a significant effect of enoxaparin. The standard coagulation reference ranges were within 98% of the local non-pregnant ranges. These reference ranges provide a useful comparator for peri-operative TEG and routine coagulation analysis in term parturients.
Collapse
Affiliation(s)
- B Macafee
- Chelsea and Westminster Hospital, London, UK.
| | | | | | | | | | | | | |
Collapse
|
27
|
Huebner SM, Campbell JP, Butz DE, Fulmer TG, Gendron-Fitzpatrick A, Cook ME. Individual isomers of conjugated linoleic acid reduce inflammation associated with established collagen-induced arthritis in DBA/1 mice. J Nutr 2010; 140:1454-61. [PMID: 20573944 DOI: 10.3945/jn.109.120527] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Previously, dietary conjugated linoleic acid [(CLA), an equal mixture of cis-9, trans-11 (c9t11) and trans-10, cis-12 (t10c12) CLA isomers], was found to reduce inflammation in the murine collagen antibody-induced arthritis model, but less so in the murine collagen-induced arthritis (CIA) model, an arthritic model dependent upon acquired immunity. Because CLA is known to alter the acquired immune response, it was hypothesized that feeding CLA after the establishment of arthritis would reduce paw swelling in the CIA model. In this study, upon the establishment of arthritic symptoms, mice were randomized to the following dietary treatments: corn oil (CO) control (n = 6), 0.5% c9t11-CLA (n = 8), 0.5% t10c12-CLA (n = 6), or 1% combined CLA (1:1 c9t11:t10c12-CLA, n = 6). Paws were scored for severity of arthritis and measured for changes in thickness during an 84-d study period. Dietary c9t11- and combined-CLA similarly decreased the arthritic score (29%, P = 0.036, P = 0.049, respectively, when normalized to initial score) and paw thickness (0.11 mm, P = 0.027, P = 0.035, respectively) compared with CO. Dietary t10c12-CLA reduced the arthritic score (41%, P = 0.007 when normalized) and paw thickness (0.12 mm, P = 0.013) relative to CO. Reduced interleukin-1beta on d 7 and 21 for all CLA treatments (n = 3) relative to CO suggested that antiinflammatory effects of CLA isomers might work by common mechanisms of known pathways involved in chronic inflammation. In conclusion, dietary CLA reduced inflammation associated with CIA, and both c9t11-CLA and t10c12-CLA exhibited antiinflammatory effects.
Collapse
Affiliation(s)
- Shane M Huebner
- Department of Nutritional Sciences, 4Department of Animal Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA
| | | | | | | | | | | |
Collapse
|
28
|
Huebner S, Butz DE, Campbell JP, Cook ME, Assadi‐Porter F. Changes in small molecular weight biomarkers identified by NMR spectroscopy in response to dietary treatment with two conjugated linoleic acid isomers (c9,t11; t10,c12) in a murine collagen‐induced arthritis model. FASEB J 2010. [DOI: 10.1096/fasebj.24.1_supplement.542.4] [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: 11/11/2022]
|
29
|
Abstract
BACKGROUND Many prehospital cardiac arrests occur in public places. Even the best EMS systems have a finite response time. Therefore, it has been recommended that automated external defibrillators (AEDs) be placed in public areas for immediate access by trained members of the general public. OBJECTIVE To determine the locations of multiple cardiac arrests in order to plan for placement of public-access AEDs. METHODS Retrospective review of all primary cardiac arrests in calendar year 1997. Cardiac arrests in which resuscitation was not attempted (DOA), traumatic cases, pediatric cases, and those due to "other" causes were excluded. Location of the cardiac arrest was obtained from the ambulance run ticket. The EMS system is an urban, Midwestern, all-ALS, public-utility model system with fire department first responders that transports approximately 58,000 patients annually. RESULTS There was scene response to 922 cardiac arrests. 377 DOAs and 219 nonprimary cardiac arrests were excluded. There were 326 primary cardiac arrests. Sixteen locations had more than one cardiac arrest: 11 locations had two cardiac arrests, four locations had three cardiac arrests, and one location had four cardiac arrests. The airport, an airline overhaul facility, a casino, and two hotels each had two cardiac arrests; the other locations of multiple cardiac arrests were in nursing homes. The professional sports stadiums had no cardiac arrests. CONCLUSIONS Since very few locations had more than one cardiac arrest, it may be difficult to identify high-yield public places in which to place an AED. Nursing homes may want to consider AED availability.
Collapse
Affiliation(s)
- M Gratton
- University of Missouri-Kansas City School of Medicine and Department of Emergency Medicine, Truman Medical Center 64108, USA.
| | | | | |
Collapse
|
30
|
Metzinger SE, McCollough EG, Campbell JP, Rousso DE. Malar augmentation: a 5-year retrospective review of the silastic midfacial malar implant. Arch Otolaryngol Head Neck Surg 1999; 125:980-7. [PMID: 10488983 DOI: 10.1001/archotol.125.9.980] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To determine the effectiveness and safety of the Silastic midfacial malar implant and to review indications, patient selection, technique, and complications of malar augmentation. DESIGN Five-year retrospective review of clinical cases with at least 2-year follow-up. PATIENTS A cohort of 60 consecutive private patients with complaints of malar hypoplasia or facial asymmetry. SETTING A plastic surgery clinic. INTERVENTION Silastic midfacial malar implants were fitted in each patient. Most underwent implantation via the canine fossa approach and in conjunction with another facial plastic procedure. MAIN OUTCOME MEASURES Subjective patient satisfaction, photographic grading using a visual analog scale, and complications. RESULTS Of the 60 patients, 51 (85.0%) reported an excellent result after at least a 2-year follow-up. Ten patients (16.7%) had some form of undesirable sequelae; however, only 4 (3.4%) of 118 implants had to be revised. Photographically, all 60 patients graded postoperative improvement. CONCLUSIONS Findings support the contention that the Silastic midfacial malar implant is a safe and effective alloplastic alternative to treat malar hypoplasia and facial asymmetry. The complication and revision rates are acceptable. Relative technical ease of insertion makes malar augmentation an excellent adjunct for rhytidectomy and rhinoplasty.
Collapse
Affiliation(s)
- S E Metzinger
- Department of Otorhinolaryngology-Head and Neck Surgery, Louisianna State University Medical Center, New Orleans 70112, USA.
| | | | | | | |
Collapse
|
31
|
Abstract
OBJECTIVE To determine the epidemiological features of pediatric usage of prehospital emergency medical services (EMS) in a defined urban population. METHODS Residents of Kansas City, Mo, younger than 15 years who used EMS during the calendar years 1993-1995 were included. In this geographic area there is a single provider of prehospital care; all numerator data were taken from this single source. Denominator data were provided by 1995 intercensal estimates based on the 1990 US Census. Rates were calculated as an annual average and reported as the number of children transported per 1 000 persons per year. RESULTS There were a total of 7296 pediatric EMS transports during the study period, for an annual rate of 21.9. Infants younger than 1 year had the highest rate (47.4), followed by those aged 1 to 4 years (26.2), 10 to 14 years (17.5), and 5 to 9 years (17.3). Medicaid was the insurer for half and 27% were uninsured. One quarter of the patients used EMS more than once. Children living in ZIP codes in the lowest median income tertile were 5.8 times more likely to use EMS than those in the upper income tertile (95% confidence interval, 5.4-6.3). One third of all transports occurred between the hours of 4 and 8 PM. CONCLUSIONS Children using the Kansas City EMS were more likely to be infants, insured by Medicaid or uninsured, and live in low-income ZIP codes. Further study is needed to determine if this increased usage is due to greater incidence and severity of illness and injury, lack of transportation, lack of education, or other factors.
Collapse
Affiliation(s)
- T C Murdock
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
| | | | | | | |
Collapse
|
32
|
Campbell JP, Brownlee RE, Weissler MC, Martinkosky SJ. Translaryngeal puncture in a collegiate fencer. N C Med J 1998; 59:378-80. [PMID: 9828628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- J P Campbell
- University of Kentucky Chandler Medical Center, Lexington, USA
| | | | | | | |
Collapse
|
33
|
Affiliation(s)
- J P Campbell
- Section of Facial Plastic and Reconstructive Surgery, University of Kentucky, Lexington 40536-0084, USA
| |
Collapse
|
34
|
Campbell JP, Terhune MH, Shotts SD, Jones RO. An ultrastructural comparison of mechanical dermabrasion and carbon dioxide laser resurfacing in the minipig model. Arch Otolaryngol Head Neck Surg 1998; 124:758-60. [PMID: 9677109 DOI: 10.1001/archotol.124.7.758] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To compare the histological and ultrastructural changes in skin collagen with mechanical dermabrasion and pulsed carbon dioxide laser resurfacing in the minipig model. SETTING Academic medical center. SUBJECTS Yucatan minipig animal skin model. MAIN OUTCOME MEASURES Comparison of light microscopic and ultrastructural (electron microscopic) changes in the skin following the 2 resurfacing modalities. RESULTS No significant difference in collagen histological characteristics or ultrastructure was detected between the 2 comparison groups. CONCLUSIONS When mechanical dermabrasion or pulsed carbon dioxide laser resurfacing is used with similar-depth injury to the dermis in this model, the histological changes seen via light microscopy and ultrastructural changes seen via electron microscopy are similar between the 2 treatment modalities.
Collapse
Affiliation(s)
- J P Campbell
- Department of Surgery, University of Kentucky Chandler Medical Center, Lexington 40536-0084, USA.
| | | | | | | |
Collapse
|
35
|
Lindholm DJ, Campbell JP. Predicting survival from out-of-hospital cardiac arrest. Prehosp Disaster Med 1998; 13:51-4. [PMID: 10346407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVE To determine the effect of a return of spontaneous circulation (RO SC) on survival to hospital discharge as compared to other established predictors of survival. METHODS A retrospective case review of all out-of-hospital primary cardiac arrests from 01 January, 1992 to 31 December 1994 was conducted. The relative values of age, race, gender, presenting cardiac rhythm, witnessed event, initiation of CPR by bystanders, response time intervals, and return of spontaneous circulation (ROSC) in an Utstein-template database were tested as predictors of survival of patients who had suffered a cardiac arrest in the out-of-hospital setting. The ROSC was defined as return of spontaneous circulation prior to and present upon arrival at the emergency department. Predictors were evaluated for statistical significance using a logistic regression analysis (p < 0.05). Odds ratios (OR) and 95% confidence intervals (CI) with positive and negative predictive values (PPV, NPV) were calculated. RESULTS Of 832 patients with primary cardiac arrest, 153 (18.4%) had ROSC and 67 (8.1%) survived to hospital discharge. Comparing survivors to nonsurvivors, the mean values for age were 64 to 67 years, with 59.7% to 36.1% being witnessed, 35.8% to 23.9% having bystander CPR initiated, 88.1% to 48.4% having ventricular fibrillation (V-fib) and 82.1% to 64.0% having ROSC. An initial electrocardiographic rhythm of V-fib (p = 0.009; OR = 2.2; CI = 1.2-3.9), and ROSC (p < 0.0001; OR = 5.2; CI = 3.6-7.5) are statistically significant predictors of survival to hospital discharge. The PPV was 13.8% for V-fib and 35.9% for ROSC, and the NPV was 98.0% for V-fib and 98.2% for ROSC. CONCLUSION Presenting V-fib and out-of-hospital ROSC are significant predictors of survival from cardiac arrest. Failure to obtain ROSC in the out-of-hospital setting strongly suggests consideration for terminating resuscitation efforts.
Collapse
Affiliation(s)
- D J Lindholm
- Emergency Medical Services Section, Department of Health, City of Kansas City, Missouri 64108, USA.
| | | |
Collapse
|
36
|
Abstract
BACKGROUND Trauma ultrasound workshops have been recommended for training surgical residents. We assessed the teaching effectiveness of the workshop, comparing swine and dynamic patient ultrasound models. MATERIALS AND METHODS MCQ exams on ultrasound physics and practical skills tests with and without pericardial or peritoneal fluid using four swines and eight dynamic patient ultrasound videos were used to compare pre- and postworkshop performance in 18 surgical residents (Group I) and a matched control group of 18 (Group II). Paired t tests and unpaired t tests for paired and unpaired data, respectively, were used for analysis with a P < 0.05 being considered statistically significant. RESULTS Mean scores (% correct response) +/- SD were as follows (*P < 0.05 vs Group I). [table: see text] For the swine model, the best scores were with pericardial fluid (25.0% pre vs 69.4% post in Group I) and the worst scores were with RUQ fluid (5.6% pre vs 22.2% post in Group I). Postworkshop dynamic video scores were always higher than the swine model scores in Group I (100% correct video scores for pericardial fluid). CONCLUSIONS This study confirms the trauma ultrasound workshop teaching effectiveness. For testing, the swine model (especially RUQ) was more difficult. In postcourse evaluation, the dynamic human video was considered more relevant, realistic, and less costly for repeated testing of the residents.
Collapse
Affiliation(s)
- J Ali
- Department of Surgery, University of Toronto, Ontario, Canada
| | | | | | | | | |
Collapse
|
37
|
Abstract
PURPOSE To report two patients with ocular burns from explosion of microwaved eggs that caused direct vision-threatening corneal damage. METHODS The initial examination and treatment of both patients are described. RESULTS Both patients were initially examined with severe decrease in the visual acuity of both eyes. The first patient required limbal conjunctival transplantation and a subsequent penetrating keratoplasty in the right eye and prolonged treatment of superficial keratitis in the left eye. The second patient sustained bilateral corneal epithelial defects and unilateral intrastromal hemorrhage. CONCLUSIONS Exploding microwaved eggs can cause notable thermal injury to the eyes. The public should be educated about the dangers of cooking eggs in the microwave oven.
Collapse
Affiliation(s)
- R T Yoo
- Washington National Eye Center, Washington Hospital Center, DC, USA.
| | | | | | | |
Collapse
|
38
|
Affiliation(s)
- J P Campbell
- University of Kentucky, Facial Plastic and Reconstructive Surgery, Division of Otolaryngology/Head and Neck Surgery, Chandler Medical Center, Lexington 40536-0084, USA
| |
Collapse
|
39
|
Hester TO, Campbell JP. Diagnosis and management of nasal trauma for primary care physicians. J Ky Med Assoc 1997; 95:386-92. [PMID: 9322412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- T O Hester
- Department of Surgery, University of Kentucky Medical Center, Lexington, USA
| | | |
Collapse
|
40
|
Campbell JP, Gridley TS, Muelleman RL. Measuring response intervals in a system with a 911 primary and an emergency medical services secondary public safety answering point. Ann Emerg Med 1997; 29:492-6. [PMID: 9095010 DOI: 10.1016/s0196-0644(97)70222-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVE Measurement of interval data is important in the accurate recording of events that occur in an emergency medical services system. Measurement of intervals should be a simple task. However, when two separate clocks are needed to record the beginning and end of an interval, accurate measurement may be difficult. We sought to accurately measure the 911 call receipt-to-vehicle departure and 911 calls receipt-to-patient access intervals in a system with primary and secondary public safety answering points (PSAPs). METHODS We conducted a descriptive study between January 1 and July 31, 1993. All 911 calls beginning at the primary PSAP, transferred to the EMS secondary PSAP, and ending with patient access times were eligible. Clock-synchronization errors and unavailability of 911 time logs were the criteria for exclusion. We measured the 911 call receipt-to-vehicle departure interval by adding the primary-PSAP and the EMS secondary-PSAP call-processing intervals. The 911 call receipt-to-patient access interval was the absolute difference between the time when the 911 primary-PSAP phone range and the time of patient access recorded by EMS personnel. RESULTS The data were best described with median and interquartile ranges (IQRs). We found 1,945 calls that met inclusion criteria. Of these, 270 were deleted because of clock errors and 616 for time log unavailability, yielding 1,059 calls for interval determinations. The median 911 call receipt-to-vehicle departure interval was 1.7 minutes (IQR, 1.2 to 2.2 minutes). The median 911 call receipt-to-patient access interval was 8.2 minutes (IQR, 6.4 to 10.5 minutes). CONCLUSION The 911 call receipt-to-vehicle departure and 911 call receipt-to-patient access intervals can be accurately measured in a system with two separate PSAP computer-aided dispatch clocks. These intervals are variable and often lengthy.
Collapse
Affiliation(s)
- J P Campbell
- Department of Emergency Medicine, University of Missouri-Kansas City School of Medicine, USA
| | | | | |
Collapse
|
41
|
Campbell JP, Brownlee RE, Weissler MC, Martinkosky SJ. Translaryngeal Puncture in a Collegiate Fencer. Otolaryngol Head Neck Surg 1997; 116:120-2. [PMID: 9018271 DOI: 10.1016/s0194-59989770363-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- J P Campbell
- Division of Otolaryngology-Head and Neck Surgery, University of Kentucky Chandler Medical Center, Lexington 40536, USA
| | | | | | | |
Collapse
|
42
|
Affiliation(s)
- J P Campbell
- Division of Otolaryngology-Head and Neck Surgery, University of Kentucky Chandler Medical Center, Lexington 40536, USA
| | | | | | | |
Collapse
|
43
|
Campbell JP, McCollough EG, Metzinger SE. Posterior cervical rhytidectomy: a valuable adjunct in facial rejuvenation surgery. Otolaryngol Head Neck Surg 1997; 116:79-90. [PMID: 9018263 DOI: 10.1016/s0194-59989770371-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To describe the aesthetic indications and operative technique of posterior cervical rhytidectomy as a staged procedure after extended cervical-facial rhytidectomy. DESIGN The senior author's series of patients requiring posterior cervical rhytidectomy is reviewed, including preoperative and postoperative aesthetic results. SETTING A private practice plastic surgery clinic. PATIENTS Eleven patients who underwent staged posterior cervical rhytidectomy after extensive cervical-facial rhytidectomy are presented, with follow-up ranging from 3 months to 8 years. During this same duration, 941 primary and 256 secondary cervical-facial rhytidectomies were performed. INTERVENTIONS The preoperative and postoperative results are presented along with a description of the pertinent anatomy and the senior author's operative technique. Potential complications are reviewed. A discussion is included on ways to minimize these untoward sequelae. OUTCOME MEASURE The aesthetic postoperative results are reviewed, and representative clinical photographs are presented. RESULTS Staged posterior cervical rhytidectomy is a safe and effective means of improving certain stigmata of previous cervical-facial rhytidectomy in patients requiring extensive facial rejuvenation. CONCLUSIONS Posterior cervical rhytidectomy is a valuable surgical adjunct in selective patients who demonstrate redundant skin and soft tissue in the posterior cervical region.
Collapse
Affiliation(s)
- J P Campbell
- Section on Facial Plastic and Reconstructive Surgery, University of Kentucky, Lexington 40536-0084, USA
| | | | | |
Collapse
|
44
|
Ali J, Rozycki GS, Campbell JP, Boulanger BR, Waddell JP, Gana TJ. Trauma ultrasound workshop improves physician detection of peritoneal and pericardial fluid. J Surg Res 1996; 63:275-9. [PMID: 8661210 DOI: 10.1006/jsre.1996.0260] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Hemoperitoneum represents a major indication for surgical intervention after trauma. To improve the ability of surgical residents and trauma physicians to detect intraperitoneal and pericardial fluid using ultrasound as a diagnostic modality, we conducted a focused trauma ultrasound workshop consisting of discussion of ultrasound physics, demonstration of instrumentation, review of pertinent literature, videotaped demonstration, and "hands-on" teaching of the skills utilizing live patient models. The ultrasound probes were placed in four standard locations--right and left upper quadrants, epigastrium, and Pouch of Douglas. Skills acquisition was tested by pre- and postworkshop performance on 12 sonograms (3 for each location, 6 were positive for fluid). Thirty physicians (21 residents and 9 staff: Group I) who attended the workshop were compared to 30 matched controls (Group II). The results (means +/- SD) were as follows (R = number right, I = number of "indeterminate," W = number of wrong responses out of 12, *P < 0.05 compared to Group II): [Table: see text] False positive (%) and false negative (%) decreased from 12.9 +/- 1.5 to 8.9 +/- 5.3 and 15.0 +/- 10.4 to 5.0 +/- 5.2, respectively, in Group I but did not change in Group II. Postworkshop ability to detect fluid was significantly (P < 0.05) improved, with no major differences between residents and staff. Our data suggest that these workshops can significantly improve the skills of nonradiologists in sonographic identification of pericardial and intraperitoneal fluid and should therefore be considered an essential component of ultrasound training for trauma physicians.
Collapse
Affiliation(s)
- J Ali
- University of Toronto, Department of Surgery, St. Michael's Hospital, Toronto, Canada
| | | | | | | | | | | |
Collapse
|
45
|
Abstract
STUDY OBJECTIVE Successful resuscitation of cardiac arrest depends partly on the time of first defibrillation. An accurate, practical method of measuring this time has not been devised. We attempted to determine the interval from receipt of a call by emergency medical services personnel to first defibrillation (total defibrillation interval) with synchronized clocks between computer-aided dispatch operations and an event-recording defibrillator. DESIGN A 7-month prospective study measuring the total defibrillation interval. An automated code summary was to be submitted for each participant. SETTING An urban, all-advanced life support, public utility model system. PARTICIPANTS All primary ventricular fibrillation patients seen during the study period. RESULTS Ninety-two patients met study criteria. Data are presented as median (interquartile range). The total defibrillation interval was 9.8 minutes (7.9 to 11.8 minutes). The call-receipt-to-vehicle-at-scene interval was 5.98 minutes (4.4 to 7.3 minutes). The vehicle-at-scene-to-defibrillation interval was 3.6 minutes (2.5 to 4.6 minutes). CONCLUSION The use of synchronized clocks in automated event-recording systems may provide a method of accurately measuring the time elapsed before defibrillation.
Collapse
Affiliation(s)
- J P Campbell
- Department of Emergency Medicine, School of Medicine, Truman Medical Center, University of Missouri-Kansas City, USA
| | | | | | | |
Collapse
|
46
|
Abstract
STUDY OBJECTIVE The phenomenon of altered behavior or performance resulting from awareness of being a part of an experimental study has been termed the "Hawthorne effect." Prehospital studies generally involve paramedics or are designed to use data collected by paramedics. Our objective was to determine whether paramedic performance, as measured by frequency of documentation, can be modified by (1) written notification of the importance of documentation, (2) written notification of a research project involving paramedic documentation, or (3) written notification of a quality-improvement audit of paramedic documentation. DESIGN Prospective, sequential intervention study with five study phases. SETTING Urban, all-advanced life support public utility model emergency medical services system with 55,000 emergency calls per year. PARTICIPANTS One hundred forty-five paramedics who completed all ambulance run reports from August 1992 to May 1993. RESULTS A total of 30,828 run reports was entered into the study. Baseline undocumented parameters ranged from 3.7% to 6.5%. Compared with baseline, a memo to heighten awareness (phase 2) did not alter documentation (P > or = .08). A medication study memo (phase 3) improved medication documentation (P = .0005) and allergies documentation (P = .037). A quality-improvement audit memo (phase 4) improved documentation of all parameters (P < or = .001). CONCLUSION The Hawthorne effect occurs in prehospital research. It does not require direct observation, nor does it require direct feedback. However, it may require a perceived demand for performance. The Hawthorne effect must be considered in the design of prehospital studies and interpretation of data collected by paramedics.
Collapse
Affiliation(s)
- J P Campbell
- School of Medicine, Truman Medical Center, Kansas City, MO, USA
| | | | | |
Collapse
|
47
|
Abstract
This study was conducted to re-examine the osteological anatomy of the orbit. Previous studies examined dried human skulls; this study looks at cadaveric specimens in a population that more closely resembles the population in the United States. Measurements were made of the bony orbit to define safe distances for surgical intervention and to identify distances to intraorbital fissures, canals, and foramina. Safe distances to the optic nerve were identified by subtracting 5 mm from the shortest measured specimen. The safe distances were as follows: medial quadrant, 29 mm; inferior quadrant, 39 mm; superior quadrant, 38 mm; and lateral quadrant, 36 mm. Staying close to the bony wall, not exceeding these parameters, and careful identification of anatomical structures should keep the surgeon from inadvertent damage to the intraorbital structures.
Collapse
Affiliation(s)
- C T McQueen
- Division of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill 27599-7070, USA
| | | | | | | |
Collapse
|
48
|
Abstract
High-resolution ultrasound is capable of detecting foreign bodies of practically any composition. The purpose of this study was to determine in a controlled manner the sensitivity and specificity of ultrasound in the diagnosis of foreign bodies in the hand. Each of 15 fresh-frozen cadaver hands was divided into 21 standardized sites for potential foreign body insertion. Foreign bodies consisted of two sizes of three different materials (wood, glass, and metal). Foreign bodies were randomly assigned to 50% of the available sites. The empty sites served as controls. All hands were scanned by a single radiologist using high-resolution ultrasound at a frequency of 10 MHz. The radiologist was unaware of which specimens contained foreign bodies. Of the 166 foreign bodies inserted in total, 156 were detected by ultrasound. Ten sites were falsely analyzed as negative, for a sensitivity of 94%. There was one false positive result and 148 true negatives. The specificity was therefore 99%. The high specificity of ultrasound allows foreign body presence to be confirmed given a positive result. A combination of ultrasound and x-ray films should allow for diagnosis and localization of virtually all foreign bodies in the hand.
Collapse
Affiliation(s)
- P W Bray
- Division of Plastic Surgery, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | | | | |
Collapse
|
49
|
Farrell HA, Waldman SR, Campbell JP, Jones RO. Duration of buffered lidocaine versus unbuffered lidocaine: a double-blind, randomized prospective study. Ear Nose Throat J 1995; 74:416-8. [PMID: 7628332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- H A Farrell
- Section on Facial Plastic and Reconstructive Surgery, University of Kentucky Medical Center, Lexington, 40536-0084, USA
| | | | | | | |
Collapse
|
50
|
Abstract
STUDY OBJECTIVE To determine whether the vehicle-at-scene-to-patient-access (VSPA) interval could be measured by means of crew reporting to a computer-aided dispatch operation. DESIGN A prospective demonstration-proof-methodology pilot study using crew reporting of access time on emergency calls. SETTING An urban, public utility model (a type of EMS system), all-ALS system. PARTICIPANTS Six ambulance crews (four day and two night). INTERVENTIONS Times were collected by radio reporting. A survey was to be completed for each call. RESULTS Two hundred ninety-two calls met study criteria; 181 had corresponding surveys. Crew reporting compliance ranged from 52.8% to 94%. Poor radio transmission was cited infrequently as a reason for noncompliance. The median VSPA interval for all calls was 1.3 minutes (interquartile range, .8 to 2.6 minutes). Twenty-five percent of calls had intervals of more than 2.5 minutes, and 10% had an interval of more than 5 minutes. CONCLUSION Our study suggests that it is feasible for ambulance crews to report patient access times. Methods to improve the consistency and frequency of crew reporting should be considered. The VSPA access interval varies in length and is not normally distributed.
Collapse
Affiliation(s)
- J P Campbell
- Department of Emergency Medicine, School of Medicine, Truman Medical Center, University of Missouri-Kansas City
| | | | | | | |
Collapse
|