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Steyaert W, Sagath L, Demidov G, Yépez VA, Esteve-Codina A, Gagneur J, Ellwanger K, Derks R, Weiss M, den Ouden A, van den Heuvel S, Swinkels H, Zomer N, Steehouwer M, O'Gorman L, Astuti G, Neveling K, Schüle R, Xu J, Synofzik M, Beijer D, Hengel H, Schöls L, Claeys KG, Baets J, Van de Vondel L, Ferlini A, Selvatici R, Morsy H, Saeed Abd Elmaksoud M, Straub V, Müller J, Pini V, Perry L, Sarkozy A, Zaharieva I, Muntoni F, Bugiardini E, Polavarapu K, Horvath R, Reid E, Lochmüller H, Spinazzi M, Savarese M, Matalonga L, Laurie S, Brunner HG, Graessner H, Beltran S, Ossowski S, Vissers LELM, Gilissen C, Hoischen A. Unravelling undiagnosed rare disease cases by HiFi long-read genome sequencing. medRxiv 2024:2024.05.03.24305331. [PMID: 38746462 PMCID: PMC11092722 DOI: 10.1101/2024.05.03.24305331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Solve-RD is a pan-European rare disease (RD) research program that aims to identify disease-causing genetic variants in previously undiagnosed RD families. We utilised 10-fold coverage HiFi long-read sequencing (LRS) for detecting causative structural variants (SVs), single nucleotide variants (SNVs), insertion-deletions (InDels), and short tandem repeat (STR) expansions in extensively studied RD families without clear molecular diagnoses. Our cohort includes 293 individuals from 114 genetically undiagnosed RD families selected by European Rare Disease Network (ERN) experts. Of these, 21 families were affected by so-called 'unsolvable' syndromes for which genetic causes remain unknown, and 93 families with at least one individual affected by a rare neurological, neuromuscular, or epilepsy disorder without genetic diagnosis despite extensive prior testing. Clinical interpretation and orthogonal validation of variants in known disease genes yielded thirteen novel genetic diagnoses due to de novo and rare inherited SNVs, InDels, SVs, and STR expansions. In an additional four families, we identified a candidate disease-causing SV affecting several genes including an MCF2 / FGF13 fusion and PSMA3 deletion. However, no common genetic cause was identified in any of the 'unsolvable' syndromes. Taken together, we found (likely) disease-causing genetic variants in 13.0% of previously unsolved families and additional candidate disease-causing SVs in another 4.3% of these families. In conclusion, our results demonstrate the added value of HiFi long-read genome sequencing in undiagnosed rare diseases.
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Xu L, Zhao T, Perry L, Frost SA, Di Tanna GL, Wang S, Chen M, Kolt GS, Jan S, Si L. Return on investment of fracture liaison services: a systematic review and analysis. Osteoporos Int 2024:10.1007/s00198-024-07027-2. [PMID: 38300316 DOI: 10.1007/s00198-024-07027-2] [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: 07/17/2023] [Accepted: 01/12/2024] [Indexed: 02/02/2024]
Abstract
Fracture liaison services (FLS) have been proven clinically effective and cost-effective in preventing subsequent fractures among patients with an existing fragility fracture. Little is known about their monetary benefits such as their return on investment (ROI). This systematic review aimed to investigate the ROI of FLS and identify the FLS characteristics with better ROI. Studies on the cost-effectiveness of FLS published between January 2000 and December 2022 were searched from MEDLINE, EMBASE, PubMed, and Cochrane Central. Two independent reviewers conducted study selection and data extraction. ROI was calculated based on the difference between monetary benefits and FLS costs divided by the FLS costs. Subgroup analysis of ROI was performed across FLS types and FLS design details. A total of 23 FLS were included in this review. The majority of them were targeting patients aged over 50 years having fractures without identified sites. The mean ROI of these FLS was 10.49 (with a median ROI of 7.57), and 86.96% of FLS had positive ROI. FLS making treatment recommendations yielded the highest ROI (with a mean ROI of 18.39 and a median of 13.60). Incorporating primary care providers (with a mean ROI of 16.04 and a median of 13.20) or having them as program leaders (with a mean ROI of 12.07 and a median of 12.07) has demonstrated a high ROI. FLS for specific fracture sites had great monetary return. Intensive FLS such as type A and B FLS programs had higher ROI than non-intensive type C and D FLS. This review revealed a 10.49-fold monetary return of FLS. Identified characteristics contributing to greater economic return informed value-for-money FLS designs. Findings highlight the importance of FLS and the feasibility of expanding their contribution in mitigating the economic burden of osteoporotic fracture and are conducive to the promotion of FLS internationally.
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Affiliation(s)
- L Xu
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - T Zhao
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - L Perry
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- South Eastern Sydney Local Health District, Randwick, New South Wales, Australia
| | - S A Frost
- University of Wollongong and South Western Sydney Local Health District, Wollongong, New South Wales, Australia
| | - G L Di Tanna
- Department of Business Economics, Health & Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - S Wang
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - M Chen
- School of Health Policy and Management, Nanjing Medical University, No. 101, Longmian Avenue, Nanjing, 211166, China.
| | - G S Kolt
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
| | - S Jan
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - L Si
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
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Peri V, Devlin P, Perry L, Richards T, Miles LF. Associations Between Nonanemic Iron Deficiency and Postoperative Outcomes in Cardiac Surgery: A Systematic Review and Meta-Analysis. Anesth Analg 2024:00000539-990000000-00712. [PMID: 38241670 DOI: 10.1213/ane.0000000000006822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
BACKGROUND Preoperative screening for iron deficiency is a part of patient blood management protocols. This systematic review, meta-analysis, and meta-regression reviews the association between nonanemic iron deficiency and postoperative outcomes in patients undergoing cardiac surgery. We aimed to determine whether preoperative screening for nonanemic iron deficiency should be recommended in patients undergoing cardiac surgery. METHODS Electronic databases MEDLINE (Ovid), Embase (Ovid), and Scopus were searched from inception until December 9, 2022. Studies were considered for inclusion if they (1) used an observational study design; (2) enrolled adult patients undergoing cardiac surgery; and (3) included an iron-deficient and iron-replete group, defined using serum ferritin and/or transferrin saturation. The primary outcome was the length of acute hospital stay. Secondary outcomes included length of intensive care unit stay, requirement for allogeneic red blood cell transfusion, number of red blood cell units transfused, days alive and at home at postoperative days 30 and 90, all-cause postoperative complications, postoperative infection, mortality, and hospital readmission. Meta-regression was performed to assess the effects of study and patient-level factors on the associations between nonanemic iron deficiency and specific outcomes. Individual study quality was assessed using the Risk of Bias in Non-Randomized Studies of Exposures (ROBINS-E) tool. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework was used to determine the quality of evidence for each outcome. RESULTS Eight studies (2683 patients) were included. No significant association was observed between nonanemic iron deficiency and any of the primary or secondary outcomes except for an increased requirement for allogeneic red blood cell transfusion (odds ratio [OR], 1.39 [95% confidence interval, CI, 1.16-1.68; P < .001; I2 2.8%]). Meta-regression did not identify any potential sources of heterogeneity to explain variation in individual study results. The quality of evidence was rated as "low" or "very low" for all outcomes. CONCLUSIONS Few high-quality studies are available to assess associations between nonanemic iron deficiency and outcomes after cardiac surgery. Acknowledging these limitations, the presence of preoperative nonanemic iron deficiency was not associated with a change in the primary outcome of length of hospital stay, or any patient-centered secondary outcome compared to those without iron deficiency. There was an association with increased requirement for allogeneic red blood cell transfusion, but this did not impact the reported patient-centered outcomes.
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Affiliation(s)
- Varun Peri
- From the Department of Anaesthesia, Austin Health, Melbourne, Australia
| | - Paula Devlin
- From the Department of Anaesthesia, Austin Health, Melbourne, Australia
| | - Luke Perry
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Toby Richards
- Department of Anaesthesiology and Perioperative Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - Lachlan F Miles
- From the Department of Anaesthesia, Austin Health, Melbourne, Australia
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
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James S, Donaghue KC, Perry L, Lowe J, Colman PG, Craig ME. Low-density lipoprotein cholesterol in adolescents and young adults with type 1 diabetes: Data from the Australasian Diabetes Data Network registry. Diabet Med 2023; 40:e15184. [PMID: 37467116 DOI: 10.1111/dme.15184] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/21/2023]
Abstract
AIM To determine low-density lipoprotein cholesterol (LDL-C) screening frequency and levels, and factors associated with elevated LDL-C, in Australasian youth with type 1 diabetes (T1D). METHODS Data were extracted from the Australasian Diabetes Data Network (ADDN), a prospective clinical quality registry, on all T1D healthcare visits attended by young people aged 16-25 years (with T1D duration of >1 year) between January 2011 and December 2020. The primary outcomes were elevated LDL-C > 2.6 mmol/L (100 mg/dL) and threshold for treatment: >3.4 mmol/L (130 mg/dL), according to consensus guidelines. Multivariable Generalised Estimated Equations (GEE) were used to examine factors associated with elevated LDL-C across all visits. RESULTS A cohort of 6338 young people (52.6% men) were identified, of whom 1603 (25.3%) had ≥1 LDL-C measurement documented. At last measurement, mean age, age at T1D diagnosis and T1D duration were 18.3 ± 2.4, 8.8 ± 4.5 and 8.9 ± 4.8 years, respectively. LDL-C was elevated in 737 (46.0%) and at the treatment threshold in 250 (15.6%). In multivariable GEE elevated LDL-C continuously was associated with older age (OR = 0.07; 0.01-0.13, p = 0.02), female sex (OR = 0.31; 0.18-0.43; p < 0.001), higher HbA1c (OR = 0.04; 0.01-0.08; p = 0.01) and having an elevated BMI (OR = 0.17, 0.06-0.39, p < 0.001). CONCLUSIONS LDL-C screening and levels are suboptimal in this cohort, increasing future cardiovascular complication risk. There is an urgent need to understand how healthcare services can support improved screening and management of dyslipidaemia in this population.
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Affiliation(s)
- S James
- University of the Sunshine Coast, Petrie, Queensland, Australia
- University of Melbourne, Parkville, Victoria, Australia
| | - K C Donaghue
- Children's Hospital at Westmead, Westmead, New South Wales, Australia
- University of Sydney, Camperdown, New South Wales, Australia
| | - L Perry
- University of Technology Sydney, Ultimo, New South Wales, Australia
- Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - J Lowe
- University of Toronto, Toronto, Ontario, Canada
| | - P G Colman
- University of Melbourne, Parkville, Victoria, Australia
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - M E Craig
- Children's Hospital at Westmead, Westmead, New South Wales, Australia
- University of Sydney, Camperdown, New South Wales, Australia
- University of New South Wales, Kensington, New South Wales, Australia
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Ein L, Trzcinski L, Perry L, Bark KY, Hadlock T, Guarin DL. Embellishing Emotrics for a More Complete Emotion Analysis: Addition of the Nasolabial Fold. Facial Plast Surg Aesthet Med 2023; 25:409-414. [PMID: 36857744 DOI: 10.1089/fpsam.2022.0235] [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: 03/03/2023] Open
Abstract
Background: The nasolabial fold (NLF) greatly contributes to facial aesthetics; changes to NLF depth and vector are disfiguring in patients with facial paralysis (FP). NLF parameters are integral to clinician-graded outcomes, but automated programs currently lack NLF identification capabilities. Objective: To incorporate an automated NLF identification and quantification function into the facial landmark program, Emotrics, and to compare new Emotrics-derived NLF data to clinician-graded electronic facial paralysis assessment (eFACE) data for accuracy. Methods: Photographs of 135 patients with FP were marked bilaterally, using identification markers manually placed on each NLF. A machine learning model was trained to automatically localize the markers using these data. Once Emotrics accurately identified the NLF and its corresponding vector, photographs of 20 additional patients who underwent facial reanimation procedures were assessed by the algorithm. Results: The enhanced Emotrics algorithm successfully identified the NLF, and measured the vector from midline, in a series of patients with FP. NLF vector data closely matched corresponding eFACE parameters. Furthermore, changes in NLF presence and vector were detected following facial reanimation procedures. Conclusion: The Emotrics program now provides critical NLF data, providing objective parameters for clinicians interested in changing NLF dynamics after FP.
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Affiliation(s)
- Liliana Ein
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lauren Trzcinski
- Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Luke Perry
- Florida Insititute of Technology, Department of Biomedical and Chemical Engineering, Melbourne, Florida, USA
| | - Kee Yoon Bark
- Department of Biomedical Engineering, University of Rochester, Rochester, New York, USA
| | - Tessa Hadlock
- Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Diego L Guarin
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA
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Tan E, Liu D, Perry L, Zhu J, Cid-Serra X, Deane A, Yeo C, Ajani A. Cell-free DNA as a potential biomarker for acute myocardial infarction: A systematic review and meta-analysis. Int J Cardiol Heart Vasc 2023; 47:101246. [PMID: 37560328 PMCID: PMC10407200 DOI: 10.1016/j.ijcha.2023.101246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/27/2023] [Accepted: 07/07/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Tissue necrosis releases cell-free deoxyribonucleic acid (cfDNA), leading to rapid increases in plasma concentration with clearance independent of kidney function. AIM To explore the diagnostic role of cfDNA in acute myocardial infarction (AMI). METHODS This systematic review and meta-analysis included studies of cfDNA in patients with AMI and a comparator group without AMI. The quality assessment of diagnostic accuracy studies-2 (QUADAS-2) tool was used, with AMI determined from the criteria of the original study. Standardised mean differences (SMD) were obtained using a random-effects inverse variance model. Heterogeneity was reported as I2. Pooled sensitivity and specificity were computed using a bivariate model. The area under the curve (AUC) was estimated from a hierarchical summary receiver operating characteristics curve. RESULTS Seventeen studies were identified involving 1804 patients (n = 819 in the AMI group, n = 985 in the comparator group). Circulating cfDNA concentrations were greater in the AMI group (SMD 3.47 (95%CI: 2.54-4.41, p < 0.001)). The studies were of variable methodological quality with substantial heterogeneity (I2 = 98%, p < 0.001), possibly due to the differences in cfDNA quantification methodologies (Chi2 25.16, p < 0.001, I2 = 92%). Diagnostic accuracy was determined using six studies (n = 804), which yielded a sensitivity of 87% (95%CI: 72%-95%) and specificity of 96% (95%CI: 92%-98%). The AUC was 0.96 (95%CI: 0.93-0.98). Two studies reported a relationship between peak cfDNA and peak troponin. No studies reported data for patients with pre-existing kidney impairment. CONCLUSION Plasma cfDNA appears to be a reliable biomarker of myocardial injury. Inferences from existing results are limited owing to methodology heterogeneity.
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Affiliation(s)
- Elinor Tan
- Department of Intensive Care Unit, The Royal Melbourne Hospital, Melbourne, Australia
| | - Daniel Liu
- Department of Anesthesiology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Luke Perry
- Department of Anesthesiology, The Royal Melbourne Hospital, Melbourne, Australia
| | - John Zhu
- Department of General Medicine, The Royal Melbourne Hospital, Melbourne, Australia
| | - Ximena Cid-Serra
- Department of General Medicine, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Adam Deane
- Department of Intensive Care Unit, The Royal Melbourne Hospital, Melbourne, Australia
| | - Colin Yeo
- Department of Cardiology, Changi General Hospital, Singapore
| | - Andrew Ajani
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia
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Perry L, Stimpson G, Singh L, Morrow JM, Shah S, Baranello G, Muntoni F, Sarkozy A. Muscle magnetic resonance imaging involvement patterns in nemaline myopathies. Ann Clin Transl Neurol 2023. [PMID: 37265148 DOI: 10.1002/acn3.51816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/05/2023] [Accepted: 05/15/2023] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE Characterise the diagnostic and prognostic value of muscle MRI patterns as biomarkers in a genetically heterogeneous nemaline myopathy (NM) patient cohort. METHODS Modified Mercuri scoring of lower limb MRI in genetically characterised NM patients referred to the highly specialised service for congenital myopathies at Great Ormond Street Hospital. Findings were compared to clinical data and MRI patterns derived from collated published data. RESULTS Twenty-seven patients with MRI were identified (8 NEB-NM, 13 ACTA1-NM, 6 TPM3-NM). NEB-NM demonstrated sparing of the thigh. ACTA1-NM demonstrated diffuse thigh involvement, notable in the vasti, sartorius and biceps-femoris, with relative adductor and gracilis sparing. TPM3-NM demonstrated diffuse thigh involvement notable in biceps-femoris and adductor magnus with relative rectus femoris, adductor longus and gracilis sparing. In the lower leg, the soleus and tibialis anterior are notably involved in all three genotypes. NEB-NM and ACTA1-NM demonstrated relative gastrocnemii and tibialis posterior sparing, while TPM3-NM showed significantly more tibialis posterior involvement (P =< 0.05). Comparison of involvement patterns with literature datasets highlighted preferential adductor and gracilis sparing in our ACTA1-NM cohort, consistent tibialis posterior involvement in our TPM3-NM cohort and a distinct MRI pattern from those derived from other NM genotypes and congenital myopathies. Greater tibialis anterior involvement correlated with foot drop (P = 0.02). Greater tibialis anterior and extensor hallucis longus involvement correlated with worse mobility (P =< 0.04). INTERPRETATION This is the widest NM MRI data set described to date; we describe distinct muscle involvement patterns for NEB-NM, ACTA1-NM and TPM3-NM which may have utility as diagnostic and prognostic biomarkers and aid in genetic variant interpretation.
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Affiliation(s)
- Luke Perry
- The Dubowitz Neuromuscular Centre, MRC Centre for Neuromuscular Diseases, Neurosciences Unit, Great Ormond Street, Institute of Child Health, Great Ormond Street Hospital, University College London, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, University College London, London, UK
- MRC International Centre for Genomic Medicine in Neuromuscular Diseases, London, UK
| | - Georgia Stimpson
- The Dubowitz Neuromuscular Centre, MRC Centre for Neuromuscular Diseases, Neurosciences Unit, Great Ormond Street, Institute of Child Health, Great Ormond Street Hospital, University College London, London, UK
| | - Leeha Singh
- The Dubowitz Neuromuscular Centre, MRC Centre for Neuromuscular Diseases, Neurosciences Unit, Great Ormond Street, Institute of Child Health, Great Ormond Street Hospital, University College London, London, UK
| | - Jasper M Morrow
- Queen Square Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK
| | - Sachit Shah
- Queen Square Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK
| | - Giovanni Baranello
- The Dubowitz Neuromuscular Centre, MRC Centre for Neuromuscular Diseases, Neurosciences Unit, Great Ormond Street, Institute of Child Health, Great Ormond Street Hospital, University College London, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, University College London, London, UK
- MRC International Centre for Genomic Medicine in Neuromuscular Diseases, London, UK
| | - Francesco Muntoni
- The Dubowitz Neuromuscular Centre, MRC Centre for Neuromuscular Diseases, Neurosciences Unit, Great Ormond Street, Institute of Child Health, Great Ormond Street Hospital, University College London, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, University College London, London, UK
- MRC International Centre for Genomic Medicine in Neuromuscular Diseases, London, UK
| | - Anna Sarkozy
- The Dubowitz Neuromuscular Centre, MRC Centre for Neuromuscular Diseases, Neurosciences Unit, Great Ormond Street, Institute of Child Health, Great Ormond Street Hospital, University College London, London, UK
- MRC International Centre for Genomic Medicine in Neuromuscular Diseases, London, UK
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McCann C, Schwartz J, Perry L, Cheng E. Perforated Carcinoid Tumor of the Appendix: Need for Guidelines for Management With Respect to Prognostic Factors. Am Surg 2023; 89:1213-1215. [PMID: 33502242 DOI: 10.1177/0003134820960027] [Citation(s) in RCA: 1] [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: 12/29/2022]
Abstract
Carcinoid tumors, one of the most common malignant lesions involving the appendix, are typically found incidentally during routine appendectomies. While up to 20% of acute appendicitis cases present with perforation, the incidence of perforation among patients with undiagnosed carcinoid tumors of the appendix is unknown. In addition, there is no consensus on the management of carcinoid tumors in the perforated appendix or its impact on prognosis. We present a case of a 42-year-old woman presented with perforated appendicitis. Final pathology demonstrated the presence of a 1.1 cm, well-differentiated grade 1 neuroendocrine tumor at the tip of the appendix extending into the subserosa, without evidence for lymphovascular invasion. Given the depth of tumor invasion and the relatively young age of the patient, the decision was made to perform an interval completion right hemicolectomy for lymph node sampling. Only a few cases have been reported in the available literature, and it remains unclear whether appendiceal perforation represents an independent negative prognostic factor for patient survival. Additional data from cohort studies are needed to determine the true incidence, prognosis, and optimal management of newly diagnosed carcinoid tumors in the perforated appendix. Furthermore, clear consensus guidelines are needed to identify the subgroup of patients who would benefit from interval or primary right hemicolectomy.
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Affiliation(s)
- Charles McCann
- Department of Surgery, Inspira Health Network, Mullica Hill, NJ, USA
| | - Jandie Schwartz
- Department of Surgery, Inspira Health Network, Mullica Hill, NJ, USA
| | - Luke Perry
- Department of Surgery, Inspira Health Network, Mullica Hill, NJ, USA
| | - Elaine Cheng
- Department of Surgery, Inspira Health Network, Mullica Hill, NJ, USA
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Affiliation(s)
- Luke Perry
- Department of Surgery, Inspira Health Network, Vineland, NJ, USA
| | - Charles McCann
- Department of Surgery, Inspira Health Network, Vineland, NJ, USA
| | - Jandie Schwartz
- Department of Surgery, Inspira Health Network, Vineland, NJ, USA
| | - Melissa Gott
- Department of Surgery, Inspira Health Network, Vineland, NJ, USA
| | - Peter Senatore
- Department of Surgery, Inspira Health Network, Vineland, NJ, USA
| | - Gus Slotman
- Department of Surgery, Inspira Health Network, Vineland, NJ, USA
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Penny‐Dimri JC, Bergmeir C, Perry L, Hayes L, Bellomo R, Smith JA. Machine learning to predict adverse outcomes after cardiac surgery: A systematic review and meta-analysis. J Card Surg 2022; 37:3838-3845. [PMID: 36001761 PMCID: PMC9804388 DOI: 10.1111/jocs.16842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Machine learning (ML) models are promising tools for predicting adverse postoperative outcomes in cardiac surgery, yet have not translated to routine clinical use. We conducted a systematic review and meta-analysis to assess the predictive performance of ML approaches. METHODS We conducted an electronic search to find studies assessing ML and traditional statistical models to predict postoperative outcomes. Our primary outcome was the concordance (C-) index of discriminative performance. Using a Bayesian meta-analytic approach we pooled the C-indices with the 95% credible interval (CrI) across multiple outcomes comparing ML methods to logistic regression (LR) and clinical scoring tools. Additionally, we performed critical difference and sensitivity analysis. RESULTS We identified 2792 references from the search of which 51 met inclusion criteria. Two postoperative outcomes were amenable for meta-analysis: 30-day mortality and in-hospital mortality. For 30-day mortality, the pooled C-index and 95% CrI were 0.82 (0.79-0.85), 0.80 (0.77-0.84), 0.78 (0.74-0.82) for ML models, LR, and scoring tools respectively. For in-hospital mortality, the pooled C-index was 0.81 (0.78-0.84) and 0.79 (0.73-0.84) for ML models and LR, respectively. There were no statistically significant results indicating ML superiority over LR. CONCLUSION In cardiac surgery patients, for the prediction of mortality, current ML methods do not have greater discriminative power over LR as measured by the C-index.
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Affiliation(s)
- Jahan C. Penny‐Dimri
- Department of Surgery, School of Clinical Sciences at Monash HealthMonash UniversityClaytonVictoriaAustralia
| | - Christoph Bergmeir
- Department of Data Science and Artificial Intelligence, Faculty of Information TechnologyMonash UniversityClaytonVictoriaUSA
| | - Luke Perry
- Department of Anaesthesia and Pain ManagementRoyal Melbourne HospitalMelbourneVictoriaAustralia,Department of Critical CareUniversity of MelbourneMelbourneVictoriaAustralia
| | - Linley Hayes
- Department of AnaesthesiaBarwon HealthGeelongVictoriaAustralia
| | - Rinaldo Bellomo
- Department of Critical CareUniversity of MelbourneMelbourneVictoriaAustralia,Australian New Zealand Intensive Care Research CentreMonash UniversityMelbourneVictoriaAustralia,Department of Intensive CareRoyal Melbourne HospitalMelbourneVictoriaAustralia,Department of Intensive Care ResearchAustin HospitalMelbourneVictoriaAustralia
| | - Julian A. Smith
- Department of Surgery, School of Clinical Sciences at Monash HealthMonash UniversityClaytonVictoriaAustralia
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Kaiyrzhanov R, Perry L, Rocca C, Zaki MS, Hosny H, Araujo Martins Moreno C, Phadke R, Zaharieva I, Camelo Gontijo C, Beetz C, Pini V, Movahedinia M, Zanoteli E, DiTroia S, Vuillaumier‐Barrot S, Isapof A, Mehrjardi MYV, Ghasemi N, Sarkozy A, Muntoni F, Whalen S, Vona B, Houlden H, Maroofian R.
GGPS1
‐associated muscular dystrophy with and without hearing loss. Ann Clin Transl Neurol 2022; 9:1465-1474. [PMID: 35869884 PMCID: PMC9463955 DOI: 10.1002/acn3.51633] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/22/2022] [Accepted: 07/03/2022] [Indexed: 11/06/2022] Open
Abstract
Ultra‐rare biallelic pathogenic variants in geranylgeranyl diphosphate synthase 1 (GGPS1) have recently been associated with muscular dystrophy/hearing loss/ovarian insufficiency syndrome. Here, we describe 11 affected individuals from four unpublished families with ultra‐rare missense variants in GGPS1 and provide follow‐up details from a previously reported family. Our cohort replicated most of the previously described clinical features of GGPS1 deficiency; however, hearing loss was present in only 46% of the individuals. This report consolidates the disease‐causing role of biallelic variants in GGPS1 and demonstrates that hearing loss and ovarian insufficiency might be a variable feature of the GGPS1‐associated muscular dystrophy.
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Affiliation(s)
- Rauan Kaiyrzhanov
- Department of Neuromuscular Disorders UCL Queen Square Institute of Neurology London WC1N 3BG UK
| | - Luke Perry
- The Dubowitz Neuromuscular Centre University College London, Great Ormond Street, Institute of Child Health and MRC Centre for Neuromuscular Diseases, Neurosciences Unit, Great Ormond Street Hospital London UK
- MRC UCL International Centre for Genomic Medicine in Neuromuscular Diseases (ICGNMD) London UK
| | - Clarissa Rocca
- Department of Neuromuscular Disorders UCL Queen Square Institute of Neurology London WC1N 3BG UK
| | - Maha S. Zaki
- Clinical Genetics Department Human Genetics and Genome Research Division, National Research Centre 12622 Cairo Egypt
| | - Heba Hosny
- National Institute of Neuromotor System Cairo Egypt
- Diagnostic Department Centogene GmbH 18055 Rostock Germany
| | | | - Rahul Phadke
- The Dubowitz Neuromuscular Centre University College London, Great Ormond Street, Institute of Child Health and MRC Centre for Neuromuscular Diseases, Neurosciences Unit, Great Ormond Street Hospital London UK
| | - Irina Zaharieva
- The Dubowitz Neuromuscular Centre University College London, Great Ormond Street, Institute of Child Health and MRC Centre for Neuromuscular Diseases, Neurosciences Unit, Great Ormond Street Hospital London UK
| | - Clara Camelo Gontijo
- Department of Neurology School of Medicine of Universidade de Sao Paulo Sao Paulo Brazil
| | | | - Veronica Pini
- The Dubowitz Neuromuscular Centre University College London, Great Ormond Street, Institute of Child Health and MRC Centre for Neuromuscular Diseases, Neurosciences Unit, Great Ormond Street Hospital London UK
| | - Mojtaba Movahedinia
- Children Growth Disorder Research Center Shahid Sadoughi University of Medical Sciences Yazd Iran
| | - Edmar Zanoteli
- Department of Neurology School of Medicine of Universidade de Sao Paulo Sao Paulo Brazil
| | - Stephanie DiTroia
- Program in Medical and Population Genetics and Center for Mendelian Genomics Broad Institute of MIT and Harvard Cambridge Massachusetts USA
| | | | - Arnaud Isapof
- Service de neuropédiatrie APHP, Sorbonne Université, Hôpital Armand Trousseau 75012 Paris France
| | | | - Nasrin Ghasemi
- Abortion Research Centre Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences 8916978477 Yazd Iran
| | - Anna Sarkozy
- The Dubowitz Neuromuscular Centre University College London, Great Ormond Street, Institute of Child Health and MRC Centre for Neuromuscular Diseases, Neurosciences Unit, Great Ormond Street Hospital London UK
- MRC UCL International Centre for Genomic Medicine in Neuromuscular Diseases (ICGNMD) London UK
| | - Francesco Muntoni
- The Dubowitz Neuromuscular Centre University College London, Great Ormond Street, Institute of Child Health and MRC Centre for Neuromuscular Diseases, Neurosciences Unit, Great Ormond Street Hospital London UK
- MRC UCL International Centre for Genomic Medicine in Neuromuscular Diseases (ICGNMD) London UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre Great Ormond Street Institute of Child Health, University College London London UK
| | - Sandra Whalen
- UF de Génétique Clinique Centre de Référence Maladies Rares Anomalies du Développement et Syndromes Malformatifs, AP‐HP. Sorbonne Université, Hôpital Armand Trousseau 75012 Paris France
| | - Barbara Vona
- Institute of Human Genetics University Medical Center Göttingen Göttingen Germany
- Institute for Auditory Neuroscience and Inner Ear Lab University Medical Center Göttingen Göttingen Germany
| | - Henry Houlden
- Department of Neuromuscular Disorders UCL Queen Square Institute of Neurology London WC1N 3BG UK
| | - Reza Maroofian
- Department of Neuromuscular Disorders UCL Queen Square Institute of Neurology London WC1N 3BG UK
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Hillner R, Perry L, Gong Y, Khayat A, Badheka A, Chivukula VK. CARD24: Assessment of EXCOR Operation Using Image-Based Quantitative Analysis. ASAIO J 2022. [DOI: 10.1097/01.mat.0000841032.22017.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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13
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Perry L, Bashian C, Gott M, Kushnir L, Slotman G. Gallstones Associated With Chronic Ingestion of Silver Colloid. Am Surg 2020; 88:2937-2938. [PMID: 33108891 DOI: 10.1177/0003134820951494] [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: 11/15/2022]
Affiliation(s)
- Luke Perry
- Department of Surgery, Inspira Health Network, Vineland, NJ, USA
| | | | - Melissa Gott
- Department of Surgery, Inspira Health Network, Vineland, NJ, USA
| | - Leon Kushnir
- Department of Surgery, Inspira Health Network, Vineland, NJ, USA
| | - Gus Slotman
- Department of Surgery, Inspira Health Network, Vineland, NJ, USA
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Perry L, Radzevich J, Kelter D, Gott M, Slotman G, Kulkarni N, Gundlapalli V. Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). Am Surg 2020; 88:2065-2067. [PMID: 32931319 DOI: 10.1177/0003134820951422] [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] [Indexed: 12/31/2022]
Affiliation(s)
- Luke Perry
- 375822 Department of Surgery, Inspira Health Network, Vineland, NJ, USA
| | - Joseph Radzevich
- 375822 Department of Surgery, Inspira Health Network, Vineland, NJ, USA
| | - David Kelter
- 375822 Department of Surgery, Inspira Health Network, Vineland, NJ, USA
| | - Melissa Gott
- 375822 Department of Surgery, Inspira Health Network, Vineland, NJ, USA
| | - Gus Slotman
- 375822 Department of Surgery, Inspira Health Network, Vineland, NJ, USA
| | - Nandini Kulkarni
- 375822 Department of Surgery, Inspira Health Network, Vineland, NJ, USA
| | - Vinay Gundlapalli
- 375822 Department of Surgery, Inspira Health Network, Vineland, NJ, USA
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Perry L, Chew L, Biebel C, Senatore P. Fibroepithelial Spindle Cell Tumor of the Rectum. Am Surg 2020; 88:2400-2401. [PMID: 32909444 DOI: 10.1177/0003134820951446] [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: 11/15/2022]
Affiliation(s)
- Luke Perry
- Department of Colorectal Surgery, Inspira Health Network, Vineland, NJ, USA
| | - Lauren Chew
- Department of Colorectal Surgery, Inspira Health Network, Vineland, NJ, USA
| | - Craig Biebel
- Department of Colorectal Surgery, Inspira Health Network, Vineland, NJ, USA
| | - Peter Senatore
- Department of Colorectal Surgery, Inspira Health Network, Vineland, NJ, USA
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MacMillan K, Bourque A, Perry L, Stoughton W. Acute non‐ambulatory tetraparesis in a 6‐month‐old Standardbred weanling caused by a cervical vertebral epidural haematoma. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K. MacMillan
- Department of Health Management Atlantic Veterinary College University of Prince Edward Island Charlottetown Canada
| | - A. Bourque
- Department of Pathology and Microbiology Atlantic Veterinary College University of Prince Edward Island Charlottetown Canada
| | - L. Perry
- Department of Health Management Atlantic Veterinary College University of Prince Edward Island Charlottetown Canada
| | - W. Stoughton
- Department of Health Management Atlantic Veterinary College University of Prince Edward Island Charlottetown Canada
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Adams CE, Montgomery AA, Aburrow T, Bloomfield S, Briley PM, Carew E, Chatterjee-Woolman S, Feddah G, Friedel J, Gibbard J, Haynes E, Hussein M, Jayaram M, Naylor S, Perry L, Schmidt L, Siddique U, Tabaksert AS, Taylor D, Velani A, White D, Xia J. Adding evidence of the effects of treatments into relevant Wikipedia pages: a randomised trial. BMJ Open 2020; 10:e033655. [PMID: 32086355 PMCID: PMC7045027 DOI: 10.1136/bmjopen-2019-033655] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To investigate the effects of adding high-grade quantitative evidence of outcomes of treatments into relevant Wikipedia pages on further information-seeking behaviour by the use of routinely collected data. SETTING Wikipedia, Cochrane summary pages and the Cochrane Library. DESIGN Randomised trial. PARTICIPANTS Wikipedia pages which were highly relevant to up-to-date Cochrane Schizophrenia systematic reviews that contained a Summary of Findings table. INTERVENTIONS Eligible Wikipedia pages in the intervention group were seeded with tables of best evidence of the effects of care and hyperlinks to the source Cochrane review. Eligible Wikipedia pages in the control group were left unchanged. MAIN OUTCOME MEASURES Routinely collected data on access to the full text and summary web page (after 12 months). RESULTS We randomised 70 Wikipedia pages (100% follow-up). Six of the 35 Wikipedia pages in the intervention group had the tabular format deleted during the study but all pages continued to report the same data within the text. There was no evidence of effect on either of the coprimary outcomes: full-text access adjusted ratio of geometric means 1.30, 95% CI: 0.71 to 2.38; page views 1.14, 95% CI: 0.6 to 2.13. Results were similar for all other outcomes, with exception of Altmetric score for which there was some evidence of clear effect (1.36, 95% CI: 1.05 to 1.78). CONCLUSIONS The pursuit of fair balance within Wikipedia healthcare pages is impressive and its reach unsurpassed. For every person who sought and clicked the reference on the 'intervention' Wikipedia page to seek more information (the primary outcome), many more are likely to have been informed by the page alone. Enriching Wikipedia content is, potentially, a powerful way to improve health literacy and it is possible to test the effects of seeding pages with evidence. This trial should be replicated, expanded and developed. TRIAL REGISTRATION NUMBER IRCT2017070330407N2.
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Affiliation(s)
- Clive E Adams
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Tony Aburrow
- Health Sciences, Research, John Wiley Ltd, Chichester, UK
| | - Sophie Bloomfield
- Department of Critical Care, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
| | - Paul M Briley
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Ebun Carew
- General Medicine, Nottingham University Hospitals Healthcare NHS Trust, Nottingham, Nottinghamshire, UK
| | | | - Ghalia Feddah
- Emergency Department, Gold Coast University Hospitals, Gold Coast, Queensland, Australia
| | - Johannes Friedel
- Faculty Management and Business Science, University of Aalen, Aalen, Germany
| | - Josh Gibbard
- The Acute Stroke Unit - Huggett Suite, Royal Lancaster Infirmary, Lancaster, UK
| | - Euan Haynes
- Haematology, Gateshead Health NHS Foundation Trust, Gateshead, Gateshead, UK
| | - Mohsin Hussein
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
| | - Mahesh Jayaram
- Psychaitry, University of Melbourne, Melbourne, Victoria, Australia
| | - Samuel Naylor
- Emergency Department, Gold Coast University Hospitals, Gold Coast, Queensland, Australia
| | - Luke Perry
- Department of Anaesthesia, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Lena Schmidt
- Bristol Medical School, University of Bristol Faculty of Health Sciences, Bristol, Bristol, UK
- Fakultät Gesundheit, Sicherheit und Gesellschaft, Hochschule Furtwangen University, Furtwangen, Germany
| | - Umer Siddique
- Community Recovery Psychiatry, North East London NHS Foundation Trust, London, UK
| | - Ayla Serena Tabaksert
- Liaison Psychiatry, Northumbria Healthcare NHS Foundation Trust, North Shields, Tyne and Wear, UK
| | | | - Aarti Velani
- Acute Medicine, Lewisham and Greenwich NHS Trust, London, UK
| | - Douglas White
- Accident and Emergency, Epsom and Saint Helier University Hospitals NHS Trust Epsom Hospital, Epsom, Surrey, UK
| | - Jun Xia
- Nottingham Ningbo GRADE Centre, Nottingham China Health Institute, The University of Nottingham Ningbo, Ningbo, China
- Division of Epidemiology and Public Health, School of Medicine, The University of Nottingham, Nottingham, UK
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Perry L, Slotman G. A381 Clinical Characteristics and Outcomes Vary by Sex in Open Roux-en-Y Gastric Bypass. Surg Obes Relat Dis 2019. [DOI: 10.1016/j.soard.2019.08.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Perry L, Schwartz J, Slotman G, Ustwani OA, Kulkarni N. Occult Renal Cell Carcinoma Presenting as a Palpable Supraclavicular Virchow's Node. Am Surg 2019. [DOI: 10.1177/000313481908500711] [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: 11/16/2022]
Affiliation(s)
- Luke Perry
- Department of Surgical Oncology Inspira Health Network Vineland, New Jersey
| | - Jandie Schwartz
- Department of Surgical Oncology Inspira Health Network Vineland, New Jersey
| | - Gus Slotman
- Department of Surgical Oncology Inspira Health Network Vineland, New Jersey
| | - Omar Al Ustwani
- Department of Medical Oncology Inspira Health Network Vineland, New Jersey
| | - Nandini Kulkarni
- Department of Surgical Oncology Inspira Health Network Vineland, New Jersey
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Perry L, Schwartz J, Slotman G, Al Ustwani O, Kulkarni N. Occult Renal Cell Carcinoma Presenting as a Palpable Supraclavicular Virchow's Node. Am Surg 2019; 85:e342-e344. [PMID: 31405440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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21
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Deli A, McGranahan M, Addison A, Perry L, Farag S, Singh K. Management of acute cholecystitis: A comparison of outcomes following emergency cholecystectomy versus medical management. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- Manisha Ramphul
- Lister Hospital, East and North Hertfordshire Trust, Stevenage, UK
| | - Luke Perry
- Lister Hospital, East and North Hertfordshire Trust, Stevenage, UK
| | - Charu Bhatia
- Lister Hospital, East and North Hertfordshire Trust, Stevenage, UK
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Lee M, Perry L, Granzow J. Suction Assisted Protein Lipectomy (SAPL) Even for the Treatment of Chronic Fibrotic and Scarified Lower Extremity Lymphedema. Lymphology 2016; 49:36-41. [PMID: 29906063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Chronic lymphedema results from the accumulation of adipose tissue and fibrotic solids and poses a significant challenge for the treating clinician. Despite its many challenges, chronic lymphedema can be safely and effectively treated using a minimally invasive technique known as suction assisted protein lipectomy (SAPL). We present the use of SAPL in a 65-year-old female with a history of chronic, congenital, non-compressible, solid predominant lymphedema for over 40 years. Her lymphedema was complicated by multiple episodes of severe cellulitis that often required hospitalization and treatment with intravenous antibiotics. The patient also had an excisional procedure designed to debulk the lymphedema swelling performed over 35 years prior by an outside provider. The procedure resulted in substantial scarring and fibrosis between the skin and underlying fascia over a significant area of the leg with only minimal improvement in symptoms. Following SAPL, a stable excess volume reduction of 86% was achieved along with a significant improvement in range of motion of the knee. Furthermore, the patient had no further episodes of recurrent cellulitis. We have found SAPL to be effective even in patients with complex, chronic lymphedema presentations with extensive preexisting scarring from prior surgery..
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Furie N, Shteynberg D, Elkhatib R, Perry L, Ullmann Y, Feferman Y, Preis M, Flugelman MY, Tzchori I. Fibulin-5 regulates keloid-derived fibroblast-like cells through integrin beta-1. Int J Cosmet Sci 2015; 38:35-40. [PMID: 26095157 DOI: 10.1111/ics.12245] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 06/05/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Keloid scar is pathological tissue that appears after skin injury, and that is more aggressive than hypertrophic scars. Keloid scars are characterized by increased proliferation of fibroblast-like cells (FLCs) and the accumulation of extracellular matrix, mainly collagen. Fibulin-5, a glycoprotein secreted by many cell types, is a component of the extracellular matrix. We investigated the effect of fibulin-5 on the adhesion and proliferation of FLCs derived from keloid scars and the role of integrin beta-1 in these activities. METHODS Fibroblast-like cells were isolated from six keloid scars and cultured on plates coated with fibulin-5 or with gelatin. Cells were incubated for 72-96 h to examine proliferation rates and incubated for 240 min, with washings at 20, 40, 60, 90, 120, 180 min, to assess adhesion rates. To examine the role of integrin beta-1, the anti-human integrin beta-1 (CD29) antibody was added to the culture medium. RESULTS Fibroblast-like cells from keloids cultured on a fibulin-5-coated surface showed a significantly reduced proliferation rate and a delayed adhesion rate, compared to cells cultured on gelatin-coated dishes. Adherence of these cells to fibulin-5 pre-coated wells was significantly reduced in the presence of anti-human integrin beta-1 (CD29) antibodies. Our current findings are similar to previously observed reduced proliferation in vascular smooth muscle cells overexpressing fibulin-5. We did not test the effects of fibulin-5 on normal fibroblasts. CONCLUSION This study demonstrates the pivotal role of the extracellular protein, fibulin-5, on the adhesion and proliferation of human keloid-derived cells, through binding to integrin beta-1.
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Affiliation(s)
- N Furie
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa 34361, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion IIT, P.O.B. 9649, Efron Street, Bat Galim, Haifa 31096, Israel
| | - D Shteynberg
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa 34361, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion IIT, P.O.B. 9649, Efron Street, Bat Galim, Haifa 31096, Israel
| | - R Elkhatib
- Ruth and Bruce Rappaport Faculty of Medicine, Technion IIT, P.O.B. 9649, Efron Street, Bat Galim, Haifa 31096, Israel.,Department of Plastic Surgery, Ramabam - Health Care Campus, P.O.B 9602, Haifa 3109601, Israel
| | - L Perry
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa 34361, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion IIT, P.O.B. 9649, Efron Street, Bat Galim, Haifa 31096, Israel
| | - Y Ullmann
- Ruth and Bruce Rappaport Faculty of Medicine, Technion IIT, P.O.B. 9649, Efron Street, Bat Galim, Haifa 31096, Israel.,Department of Plastic Surgery, Ramabam - Health Care Campus, P.O.B 9602, Haifa 3109601, Israel
| | - Y Feferman
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa 34361, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion IIT, P.O.B. 9649, Efron Street, Bat Galim, Haifa 31096, Israel
| | - M Preis
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa 34361, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion IIT, P.O.B. 9649, Efron Street, Bat Galim, Haifa 31096, Israel
| | - M Y Flugelman
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa 34361, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion IIT, P.O.B. 9649, Efron Street, Bat Galim, Haifa 31096, Israel
| | - I Tzchori
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa 34361, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion IIT, P.O.B. 9649, Efron Street, Bat Galim, Haifa 31096, Israel
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Walter A, Guderson C, Slaughter K, Perry L, Mcmeekin S, Moore K. Are current treatments effective, in gynecologic cancer patients with central nervous system metastasis? Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Walter A, Gunderson C, Slaughter K, Perry L, McMeekin S, Moore K. IB2 cervical carcinoma: Outcomes by primary therapy. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gunderson C, Farrell R, Slaughter K, Ding K, Lauer J, Perry L, McMeekin D, Moore K. The influence of obesity on disease characteristics and survival among patients with epithelial ovarian cancer. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Slaughter K, Gunderson C, Perry L, Thomas E, Farrell R, Lauer J, Ding K, McMeekin D, Moore K. Acquired platinum resistance among women with high-grade serous epithelial ovarian cancer. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Perry L, Gunderson C, Walter A, Vesely S, Moore K, Park A. The effect of age on completion of prescribed chemoradiation among patients with cervix cancer. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gunderson C, Thomas E, Slaughter K, Farrell R, Ding K, Lauer J, Perry L, McMeekin D, Moore K. Venous thromboembolism carries a particularly grave prognosis with epithelial ovarian cancer. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Perry L, Adams RD, Bennett AR, Lupton DJ, Jackson G, Good AM, Thomas SHL, Vale JA, Thompson JP, Bateman DN, Eddleston M. National toxicovigilance for pesticide exposures resulting in health care contact – An example from the UK's National Poisons Information Service. Clin Toxicol (Phila) 2014; 52:549-55. [DOI: 10.3109/15563650.2014.908203] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Previs RA, Bevis KS, Huh W, Tillmanns T, Perry L, Moore K, Chapman J, McClung C, Kiet T, Java J, Chan J, Secord AA. A prognostic nomogram to predict overall survival in women with recurrent ovarian cancer treated with bevacizumab and chemotherapy. Gynecol Oncol 2014; 132:531-6. [PMID: 24472410 DOI: 10.1016/j.ygyno.2014.01.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 07/07/2013] [Revised: 01/10/2014] [Accepted: 01/20/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To develop a nomogram to predict overall survival (OS) in women with recurrent ovarian cancer treated with bevacizumab and chemotherapy. METHODS A multicenter retrospective study was conducted. Potential prognostic variables included age; stage; grade; histology; performance status; residual disease; presence of ascites and/or pleural effusions; number of chemotherapy regimens, treatment-free interval (TFI) prior to bevacizumab administration, and platinum sensitivity. Multivariate analysis was performed using Cox proportional hazards regression. The predictive model was developed into a nomogram to predict five-year OS. RESULTS 312 women with recurrent ovarian cancer treated with bevacizumab and chemotherapy were identified; median age was 59 (range: 19-85); 86% women had advanced stage (III-IV) disease. The majority had serous histology (74%), high grade cancers (93.5%), and optimal cytoreductions (69.5%). Fifty-one percent of women received greater than two prior chemotherapeutic regimens. TFI (AHR=0.98, 95% CI 0.97-1.00, p=0.022) was the only statistically significant predictor in a multivariate progression-free survival (PFS) analysis. In a multivariate OS analysis, prior number of chemotherapy regimens, TFI, platinum sensitivity, and presence of ascites were significant. A nomogram to predict five-year OS was constructed and internally validated (bootstrap-corrected concordance index=0.737). CONCLUSION Our multivariate model identified prior number of chemotherapy regimens, TFI, platinum sensitivity, and the presence of ascites as prognostic variables for OS in women with recurrent ovarian cancer treated with bevacizumab combined with chemotherapy. Our nomogram to predict five-year OS may be used to identify women who may benefit from bevacizumab and chemotherapy, but further validation is needed.
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Affiliation(s)
- R A Previs
- Duke University Medical Center, Durham, NC, USA.
| | - K S Bevis
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - W Huh
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - T Tillmanns
- West Clinic and University of Tennessee Health Science Center, Memphis, TN, USA
| | - L Perry
- Stevenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK, USA
| | - K Moore
- Stevenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK, USA
| | - J Chapman
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA; Stanford Women's Cancer Center, Stanford Hospital and Clinics, Palo Alto, CA, USA
| | - C McClung
- Stanford Women's Cancer Center, Stanford Hospital and Clinics, Palo Alto, CA, USA
| | - T Kiet
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - J Java
- Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - J Chan
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
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Thomas E, Slaughter K, Gunderson C, Perry L, Lauer J, Farrell R, Ding K, McMeekin D, Moore K. The use of biologic agents and clinical trials may prolong survival for women with primary platinum resistant ovarian carcinoma. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Slaughter K, James B, Nugent E, Bishop E, Perry L, McMeekin D, Moore K. Characteristics and outcomes of platinum-resistant patients treated in a phase I clinic. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Perry L, Hutchinson D, De-Soyza A, Eggleton P, Kelly C. FRI0160 Disease activity and autoantibody positivity are increased in rheumatoid arthritis patients with co-existent bronchiectasis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mohan SB, Perry L, Malhotra JM, Lyddiatt A. ASSESSMENT OF BEER FOAM STABILITY BY HIGH PERFORMANCE LIQUID IMMUNOAFFINITY CHROMATOGRAPHY (HPLIAC). Journal of the Institute of Brewing 2013. [DOI: 10.1002/j.2050-0416.1993.tb01165.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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de Brito-Ashurst I, Perry L, Sanders TAB, Thomas JE, Dobbie H, Yaqoob MM. Applying research in nutrition education planning: a dietary intervention for Bangladeshi chronic kidney disease patients. J Hum Nutr Diet 2012; 26:403-13. [PMID: 23240718 DOI: 10.1111/jhn.12022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Effective nutrition health interventions are theory-based, as well as being drawn from practice and research, aiming to successfully accomplish dietary behavioural changes. However, the integration of theory, research and practice to develop community dietary educational programmes is a challenge that many interventionists feel ill equipped to achieve. METHODS In the present study, a community-based education programme was designed for Bangladeshi patients with chronic kidney disease and hypertension. The goal of this programme was to reduce dietary salt intake in this population group, with a view to reducing their blood pressure and slowing kidney disease progression. RESULTS The present study sets out the first four steps of a six-step model for creating a behaviour change programme. CONCLUSIONS These four steps were concerned with the translation of theory and evidence into intervention objectives, and illustrate how a practical, community-based intervention was developed from behavioural theory, relevant research, knowledge of practice and the target patient group. Steps 5 and 6, which are concerned with implementation and evaluation, will be reported separately.
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Affiliation(s)
- I de Brito-Ashurst
- Department of Nutrition and Dietetics, The Royal Brompton & Harefield NHS Foundation Trust, London, UK.
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Farrell R, Nugent E, Mathews C, Bishop E, Perry L, Landrum L, Lee S, Kim Y, Nam J, Kim Y, McMeekin D. Outcomes and disease progression after cervical excisional procedures (EPS), loop electroexcisional procedure (LEEP) or cone biopsy specimens (CKC), and radical hysterectomy (RH) for early stage invasive cervical cancer. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Nugent E, Bishop E, Mathews C, Perry L, Farrell R, Landrum L, Moxley K. The prognostic impact of isolated pelvic lymph node metastasis in a contemporary population of early stage and loco-regionally advanced carcinoma of the uterine cervix. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Perry L, Mathews C, Nugent E, Farrell R, Moore K. Para-aortic nodal metastases in the modern era: still a dismal prognosis. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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De Brito-Ashurst I, Perry L, Sanders T, Thomas J, Dobbie H, Yaqoob M. PP077-MON A DIETITIAN'S ROLE IN THE MANAGEMENT OF BLOOD PRESSURE: RESULTS OF A RANDOMISED CONTROLLED TRIAL IN BRITISH BANGLADESHI CHRONIC KIDNEY DISEASE PATIENTS. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s1744-1161(12)70416-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Wright L, Hill KM, Bernhardt J, Lindley R, Ada L, Bajorek BV, Barber PA, Beer C, Golledge J, Gustafsson L, Hersh D, Kenardy J, Perry L, Middleton S, Brauer SG, Nelson MR. Stroke management: updated recommendations for treatment along the care continuum. Intern Med J 2012; 42:562-9. [DOI: 10.1111/j.1445-5994.2012.02774.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Heathfield S, Parker B, Zeef L, Bruce I, Alexander Y, Collins F, Stone M, Wang E, Williams AS, Wright HL, Thomas HB, Moots RJ, Edwards SW, Bullock C, Chapman V, Walsh DA, Mobasheri A, Kendall D, Kelly S, Bayley R, Buckley CD, Young SP, Rump-Goodrich L, Middleton J, Chen L, Fisher R, Kollnberger S, Shastri N, Kessler BM, Bowness P, Nazeer Moideen A, Evans L, Osgood L, Williams AS, Jones SA, Nowell MA, Mahadik Y, Young S, Morgan M, Gordon C, Harper L, Giles JL, Paul Morgan B, Harris CL, Rysnik OJ, McHugh K, Kollnberger S, Payeli S, Marroquin O, Shaw J, Renner C, Bowness P, Nayar S, Cloake T, Bombardieri M, Pitzalis C, Buckley C, Barone F, Barone F, Nayar S, Cloake T, Lane P, Coles M, Buckley C, Williams EL, Edwards CJ, Cooper C, Oreffo RO, Dunn S, Crawford A, Wilkinson M, Le Maitre C, Bunning R, Daniels J, Phillips KLE, Chiverton N, Le Maitre CL, Kollnberger S, Shaw J, Ridley A, Wong-Baeza I, McHugh K, Keidel S, Chan A, Bowness P, Gullick NJ, Abozaid HS, Jayaraj DM, Evans HG, Scott DL, Choy EH, Taams LS, Hickling M, Golor G, Jullion A, Shaw S, Kretsos K, Bari SF, Rhys-Dillon B, Amos N, Siebert S, Phillips KLE, Chiverton N, Bunning RD, Haddock G, Cross AK, Le Maitre CL, Kate I, Phillips E, Cross A, Chiverton N, Haddock G, Bunning RAD, Le Maitre CL, Ceeraz S, Spencer J, Choy E, Corrigall V, Crilly A, Palmer H, Lockhart J, Plevin R, Ferrell WR, McInnes I, Hutchinson D, Perry L, DiCicco M, Humby F, Kelly S, Hands R, Buckley C, McInnes I, Taylor P, Bombardieri M, Pitzalis C, Mehta P, Mitchell A, Tysoe C, Caswell R, Owens M, Vincent T, Hashmi TM, Price-Forbes A, Sharp CA, Murphy H, Wood EF, Doherty T, Sheldon J, Sofat N, Goff I, Platt PN, Abdulkader R, Clunie G, Ismajli M, Nikiphorou E, Young A, Tugnet N, Dixey J, Banik S, Alcorn D, Hunter J, Win Maw W, Patil P, Hayes F, Main Wong W, Borg FA, Dasgupta B, Malaviya AP, Ostor AJ, Chana JK, Ahmed AA, Edmonds S, Hayes F, Coward L, Borg F, Heaney J, Amft N, Simpson J, Dhillon V, Ayalew Y, Khattak F, Gayed M, Amarasena RI, McKenna F, Amarasena RI, McKenna F, Mc Laughlin M, Baburaj K, Fattah Z, Ng N, Wilson J, Colaco B, Williams MR, Adizie T, Dasgupta B, Casey M, Lip S, Tan S, Anderson D, Robertson C, Devanny I, Field M, Walker D, Robinson S, Ryan S, Hassell A, Bateman J, Allen M, Davies D, Crouch C, Walker-Bone K, Gainsborough N, Gullick NJ, Lutalo PM, Davies UM, Walker-Bone K, Mckew JR, Millar AM, Wright SA, Bell AL, Thapper M, Roussou T, Cumming J, Hull RG, Thapper M, Roussou T, McKeogh J, O'Connor MB, Hassan AI, Bond U, Swan J, Phelan MJ, Coady D, Kumar N, Farrow L, Bukhari M, Oldroyd AG, Greenbank C, McBeth J, Duncan R, Brown D, Horan M, Pendleton N, Littlewood A, Cordingley L, Mulvey M, Curtis EM, Cole ZA, Crozier SR, Georgia N, Robinson SM, Godfrey KM, Sayer AA, Inskip HM, Cooper C, Harvey NC, Davies R, Mercer L, Galloway J, Low A, Watson K, Lunt M, Symmons D, Hyrich K, Chitale S, Estrach C, Moots RJ, Goodson NJ, Rankin E, Jiang CQ, Cheng KK, Lam TH, Adab P, Ling S, Chitale S, Moots RJ, Estrach C, Goodson NJ, Humphreys J, Ellis C, Bunn D, Verstappen SM, Symmons D, Fluess E, Macfarlane GJ, Bond C, Jones GT, Scott IC, Steer S, Lewis CM, Cope A, Mulvey MR, Macfarlane GJ, Symmons D, Lovell K, Keeley P, Woby S, Beasley M, McBeth J, Viatte S, Plant D, Lunt M, Fu B, Parker B, Galloway J, Solymossy C, Worthington J, Symmons D, Dixey J, Young A, Barton A, Williams FM, Osei-Bordom DC, Popham M, MacGregor A, Spector T, Little J, Herrick A, Pushpakom S, Ennis H, McBurney H, Worthington J, Newman W, Ibrahim I, Plant D, Hyrich K, Morgan A, Wilson A, Isaacs J, Barton A, Sanderson T, Hewlett S, Calnan M, Morris M, Raza K, Kumar K, Cardy CM, Pauling JD, Jenkins J, Brown SJ, McHugh N, Nikiphorou E, Mugford M, Davies C, Cooper N, Brooksby A, Bunn D, Symmons D, MacGregor A, Dures E, Ambler N, Fletcher D, Pope D, Robinson F, Rooke R, Hewlett S, Gorman CL, Reynolds P, Hakim AJ, Bosworth A, Weaver D, Kiely PD, Skeoch S, Jani M, Amarasena R, Rao C, Macphie E, McLoughlin Y, Shah P, Else S, Semenova O, Thompson H, Ogunbambi O, Kallankara S, Patel Y, Baguley E, Jani M, Halsey J, Severn A, Bukhari M, Selvan S, Price E, Husain MJ, Brophy S, Phillips CJ, Cooksey R, Irvine E, Siebert S, Lendrem D, Mitchell S, Bowman S, Price E, Pease CT, Emery P, Andrews J, Bombardieri M, Sutcliffe N, Pitzalis C, Lanyon P, Hunter J, Gupta M, McLaren J, Regan M, Cooper A, Giles I, Isenberg D, Griffiths B, Foggo H, Edgar S, Vadivelu S, Coady D, McHugh N, Ng WF, Dasgupta B, Taylor P, Iqbal I, Heron L, Pilling C, Marks J, Hull R, Ledingham J, Han C, Gathany T, Tandon N, Hsia E, Taylor P, Strand V, Sensky T, Harta N, Fleming S, Kay L, Rutherford M, Nicholl K, Kay L, Rutherford M, Nicholl K, Eyre T, Wilson G, Johnson P, Russell M, Timoshanko J, Duncan G, Spandley A, Roskell S, Coady D, West L, Adshead R, Donnelly SP, Ashton S, Tahir H, Patel D, Darroch J, Goodson NJ, Boulton J, Ellis B, Finlay R, Lendrem D, Mitchell S, Bowman S, Price E, Pease CT, Emery P, Andrews J, Bombardieri M, Sutcliffe N, Pitzalis C, Lanyon P, Hunter J, Gupta M, McLaren J, Regan M, Cooper A, Giles I, Isenberg D, Vadivelu S, Coady D, McHugh N, Griffiths B, Foggo H, Edgar S, Ng WF, Murray-Brown W, Priori R, Tappuni T, Vartoukian S, Seoudi N, Picarelli G, Fortune F, Valesini G, Pitzalis C, Bombardieri M, Ball E, Rooney M, Bell A, Merida AA, Isenberg D, Tarelli E, Axford J, Giles I, Pericleous C, Pierangeli SS, Ioannou J, Rahman A, Alavi A, Hughes M, Evans B, Bukhari M, Parker B, Zaki A, Alexander Y, Bruce I, Hui M, Garner R, Rees F, Bavakunji R, Daniel P, Varughese S, Srikanth A, Andres M, Pearce F, Leung J, Lim K, Regan M, Lanyon P, Oomatia A, Petri M, Fang H, Birnbaum J, Amissah-Arthur M, Gayed M, Stewart K, Jennens H, Braude S, Gordon C, Sutton EJ, Watson KD, Gordon C, Yee CS, Lanyon P, Jayne D, Isenberg D, Rahman A, Akil M, McHugh N, Ahmad Y, Amft N, D'Cruz D, Edwards CJ, Griffiths B, Khamashta M, Teh LS, Zoma A, Bruce I, Dey ID, Kenu E, Isenberg D, Pericleous C, Garza-Garcia A, Murfitt L, Driscoll PC, Isenberg D, Pierangeli S, Giles I, Ioannou Y, Rahman A, Reynolds JA, Ray DW, O'Neill T, Alexander Y, Bruce I, Segeda I, Shevchuk S, Kuvikova I, Brown N, Bruce I, Venning M, Mehta P, Dhanjal M, Mason J, Nelson-Piercy C, Basu N, Paudyal P, Stockton M, Lawton S, Dent C, Kindness K, Meldrum G, John E, Arthur C, West L, Macfarlane MV, Reid DM, Jones GT, Macfarlane GJ, Yates M, Loke Y, Watts R, MacGregor A, Adizie T, Christidis D, Dasgupta B, Williams M, Sivakumar R, Misra R, Danda D, Mahendranath KM, Bacon PA, Mackie SL, Pease CT. Basic science * 232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bishop E, Perry L, Previs R, Alvarez-Secord A, Moore K. Downstream effects of first line bevacizumab (bev) on outcomes after recurrence in advanced ovarian cancer. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Chan J, Alvarez-Secord A, Tillmanns T, Moore K, Bevis K, ElNaggar A, Perry L, McClung C, Tian C, Huh W. Outcomes of ovarian cancer patients after bevacizumab and chemotherapy in primary vs. recurrent setting – A multi-institutional study. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ueda S, Alvarez-Secord A, Huh W, Tillmanns T, Moore K, Previs R, Perry L, Kiet T, Tian C, Chan J. Determining surrogate endpoints predictive of overall survival in patients treated with bevacizumab for advanced ovarian cancer — A multi-institutional study. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Pawlicki T, Perry L. SU-E-T-65: Using Gauge R&R for Analyzing the Process of Daily IGRT. Med Phys 2011. [DOI: 10.1118/1.3612016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Nip WFR, Perry L, McLaren S, Mackenzie A. Dietary intake, nutritional status and rehabilitation outcomes of stroke patients in hospital. J Hum Nutr Diet 2011; 24:460-9. [DOI: 10.1111/j.1365-277x.2011.01173.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Druce MR, Walker D, Maher KT, Dodzo K, Perry L, Ball S, Peaston R, Chew SL, Drake WM, Akker SA, Grossman AB. The effect of exogenous glucocorticoids on plasma catecholamines and metanephrines in patients without phaeochromocytomas. Horm Metab Res 2011; 43:292-5. [PMID: 21264798 DOI: 10.1055/s-0030-1270520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of the study was to evaluate the effects of steroid administration under standardised conditions in a range of patients both normal and with adrenal pathologies and to review the impact on plasma catecholamines and metanephrines. Corticosteroid administration has been linked to the development of hypertensive crises in patients with phaeochromocytoma, however a mechanism for this is not fully understood. We aimed to add useful information about the effect of steroids on levels of these hormones under usual circumstances. A prospective, observational cohort study of 50 patients undergoing the low-dose dexamethasone suppression test (LDDST) was undertaken. Additional blood samples were taken at the start and end of the standard LDDST. Biochemical analysis was carried out for plasma catecholamines and plasma free metanephrines. Demographic and hormonal data were acquired from review of the notes or measured at baseline. No significant changes in plasma catecholamines or metanephrines were seen at the end of the LDDST compared to baseline. This was also true of subgroup analysis, divided by age, gender, or type of underlying pathology. Our results suggest that hypertensive reaction responses, rare as they are, are unlikely to be related to normal adrenal physiology. Thus LDDST is likely to be safe under most circumstances, however caution should be exercised in patients with adrenal masses with imaging characteristics compatible with phaeochromocytoma. It may be prudent to defer glucocorticoid administration until functioning phaeochromocytoma has been excluded biochemically.
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Affiliation(s)
- M R Druce
- Department of Endocrinology, Barts and London Medical School, St Bartholomew's Hospital, London, UK.
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