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Yen AW, Leung JW, Koo M, Leung FW. Safety and effectiveness of underwater cold snare resection without submucosal injection of large non-pedunculated colorectal lesions. Endosc Int Open 2022; 10:E791-E800. [PMID: 35692912 PMCID: PMC9187401 DOI: 10.1055/a-1784-4523] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/29/2021] [Indexed: 11/06/2022] Open
Abstract
Background and study aims Adverse events are uncommon with cold snaring, but cold techniques are generally reserved for lesions ≤ 9 mm out of concern for incomplete resection or inability to mechanically resect larger lesions. In a non-distended, water-filled lumen, colorectal lesions are not stretched, enabling capture and en bloc resection of large lesions. We assessed the effectiveness and safety of underwater cold snare resection (UCSR) without submucosal injection (SI) of ≥ 10 mm non-pedunculated, non-bulky (≤ 5 mm elevation) lesions with small, thin wire snares. Patients and methods Retrospective analysis of an observational cohort of lesions removed by UCSR during colonoscopy. A single endoscopist performed procedures using a small thin wire (9-mm diameter) cold or (10-mm diameter) hybrid snare. Results Fifty-three lesions (mean 15.8 mm [SD 6.9]; range 10-35 mm) were removed by UCSR from 44 patients. Compared to a historical cohort, significantly more lesions were resected en bloc by UCSR (84.9 % [45/53]; P = 0.04) compared to conventional endoscopic mucosal resection (EMR) (64.0 % [32/50]). Results were driven by high en bloc resection rates for 10- to 19-mm lesions (97.3 % [36/37]; P = 0.01). Multiple logistic regression analysis adjusted for potential confounders showed en bloc resection was significantly associated with UCSR compared to conventional EMR (OR 3.47, P = 0.027). Omission of SI and forgoing prophylactic clipping of post-resection sites did not result in adverse outcomes. Conclusions UCSR of ≥ 10 mm non-pedunculated, non-bulky colorectal lesions is feasible with high en bloc resection rates without adverse outcomes. Omission of SI and prophylactic clipping decreased resource utilization with economic benefits. UCSR deserves further evaluation in a prospective comparative study.
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Affiliation(s)
- Andrew W. Yen
- Sacramento Veterans Affairs Medical Center, VANCHCS, Division of Gastroenterology, Mather, California, United States,University of California Davis School of Medicine, Sacramento, California, United States
| | - Joseph W. Leung
- Sacramento Veterans Affairs Medical Center, VANCHCS, Division of Gastroenterology, Mather, California, United States,University of California Davis School of Medicine, Sacramento, California, United States
| | - Malcom Koo
- Graduate Institution of Long-term Care, Tzu Chi University of Science and Technology, Hualien City, Hualien, Taiwan,Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Felix W. Leung
- Sepulveda Ambulatory Care Center, VAGLAHS, Division of Gastroenterology, North Hills, California, United States,David Geffen School of Medicine at UCLA, Los Angeles, California, United States
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Tseng CW, Hsieh YH, Koo M, Leung FW. Comparing right colon adenoma detection rate during water exchange and air insufflation: a double-blind randomized controlled trial. Tech Coloproctol 2021; 26:35-44. [PMID: 34705136 DOI: 10.1007/s10151-021-02537-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/04/2021] [Accepted: 10/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Randomized controlled trials (RCTs) have reported that water exchange (WE) produced the highest adenoma detection rate (ADR) but did not evaluate right colon adenoma detection rate (rADR) as a primary outcome and only one of the trials employed blinded colonoscopists. The aim of our study was to determine whether, compared with air insufflation, WE significantly increases rADR and right colon serrated lesion detection rate (rSLDR) and decreases adenoma miss rate (rAMR). METHODS This prospective, double-blind RCT was conducted at a regional hospital in Taiwan between December 2015 and February 2020. Standard WE and air insufflation were performed. After cecal intubation, the second blinded endoscopist examined the right colon and obtained rADR (primary outcome) and rSLDR. Then, the primary colonoscopist reinserted the scope to the cecum with WE in both groups and performed a tandem examination of the right colon to obtain rAMR. RESULTS There were 284 patients (50.9% male, mean age 58.9 ± 9.4 years) who were randomized to WE (n = 144) or air insufflation (n = 140). The baseline characteristics were similar. The rADR (34.7% vs. 22.3%, p = 0.025), Boston Bowel Preparation Scale scores (mean, 2.6 ± 0.6vs. 2.2 ± 0.6, p < 0.001), rSLDR (18.1% vs. 7.1%, p = 0.007), and rAMR (31.5% vs. 45.2%, p = 0.038) were significantly different between WE and air insufflation. CONCLUSIONS The current study demonstrated a significantly higher rADR and rSLDR with the WE method performed by blinded colonoscopists. The impact of the significant findings in this report on the occurrence of interval cancers deserves to be studied.
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Affiliation(s)
- C- W Tseng
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 2 Minsheng Road, Dalin, Chiayi, 62247, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Y- H Hsieh
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 2 Minsheng Road, Dalin, Chiayi, 62247, Taiwan. .,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
| | - M Koo
- Graduate Institute of Long-Term Care, Tzu Chi University of Science and Technology, Hualien, Taiwan.,Dalla Lana School of Public Health, University of Toronto, Ontario, ON, Canada
| | - F W Leung
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hill, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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3
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Alhussein M, Runeckles K, Koo M, Moayedi Y, Duero Posada J, Ross H, Rao V, Billia F. VENO-ARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION FOR PATIENTS WITH CARDIOGENIC SHOCK: A SINGLE CENTER EXPERIENCE. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.387] [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: 11/15/2022] Open
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4
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Lu MC, Hsu BB, Koo M, Lai NS. Higher risk of incident ankylosing spondylitis in patients with uveitis: a secondary cohort analysis of a nationwide, population-based health claims database. Scand J Rheumatol 2017; 46:468-473. [PMID: 28485181 DOI: 10.1080/03009742.2017.1282686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Ankylosing spondylitis (AS) is a progressive, systemic, inflammatory autoimmune disease that typically affects young adults. Uveitis is a common extra-articular manifestation of AS. Nevertheless, the magnitude of the risk of AS among patients with uveitis is not clear. The aim of this secondary retrospective cohort study was to investigate the risk of incident AS in patients with uveitis using data from a nationwide, population-based health claims research database. METHOD Using Taiwan's National Health Insurance Research Database, we identified 6637 patients with uveitis between 2000 and 2012. A comparison cohort was assembled, which consisted of five patients without uveitis, based on frequency matching for gender, 10 year age interval, and index year, for each patient with uveitis. Both groups were followed until diagnosis of AS or the end of the follow-up period. A Poisson regression model was used to calculate the incidence rate ratio for AS between the uveitis cohort and the comparison cohort. RESULTS Patients with uveitis exhibited a significantly higher incidence of AS than the comparison cohort (adjusted incidence rate ratio = 2.57, p < 0.001). Subgroup analysis with stratification by the interval between the diagnosis of uveitis and AS indicated that the adjusted incidence rates were significantly higher in the uveitis cohort with an interval of up to 7.9 years. CONCLUSION A significant increased risk in AS among patients with uveitis was observed, with a time lag of up to 7.9 years between the diagnosis of uveitis and subsequent diagnosis of AS.
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Affiliation(s)
- M-C Lu
- a Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital , Buddhist Tzu Chi Medical Foundation , Chiayi , Taiwan.,b School of Medicine , Tzu Chi University , Hualien , Taiwan
| | - B-B Hsu
- a Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital , Buddhist Tzu Chi Medical Foundation , Chiayi , Taiwan
| | - M Koo
- c Department of Medical Research, Dalin Tzu Chi Hospital , Buddhist Tzu Chi Medical Foundation , Chiayi , Taiwan.,d Dalla Lana School of Public Health , University of Toronto , Toronto , Canada
| | - N-S Lai
- a Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital , Buddhist Tzu Chi Medical Foundation , Chiayi , Taiwan.,b School of Medicine , Tzu Chi University , Hualien , Taiwan
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5
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Colomina M, Koo M, Basora M, Pizones J, Mora L, Bagó J. Intraoperative tranexamic acid use in major spine surgery in adults: a multicentre, randomized, placebo-controlled trial † †This Article is accompanied by Editorial Aew470. Br J Anaesth 2017; 118:380-390. [DOI: 10.1093/bja/aew434] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2016] [Indexed: 11/13/2022] Open
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6
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Lai NS, Koo M, Yu CL, Lu MC. Immunopathogenesis of systemic lupus erythematosus and rheumatoid arthritis: the role of aberrant expression of non-coding RNAs in T cells. Clin Exp Immunol 2017; 187:327-336. [PMID: 27880973 DOI: 10.1111/cei.12903] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 12/27/2022] Open
Abstract
Non-coding RNAs (ncRNAs), including microRNAs (miRNAs) and long non-coding RNAs (lncRNAs), are RNA molecules that do not translate into protein. Both miRNAs and lncRNAs are known to regulate gene expression and to play an essential role in T cell differentiation and function. Both systemic lupus erythematosus (SLE), a prototypic systemic autoimmune disease, and rheumatoid arthritis (RA), a representative disease of inflammatory arthritis, are characterized by a complex dysfunction in the innate and adaptive immunity. T cells play a central role in cell-mediated immune response and multiple defects in T cells from patients with SLE and RA have been observed. Abnormality in T cell signalling, cytokine and chemokine production, T cell activation and apoptosis, T cell differentiation and DNA methylation that are associated closely with the aberrant expression of a number of miRNAs and lncRNAs have been implicated in the immunopathogenesis of SLE and RA. This review aims to provide an overview of the current state of research on the abnormal expression of miRNAs and lncRNAs in T cells and their roles in the immunopathogenesis of SLE and RA. In addition, by comparing the differences in aberrant expression of miRNAs and lncRNAs in T cells between patients with SLE and RA, controversial areas are highlighted that warrant further investigation.
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Affiliation(s)
- N-S Lai
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - M Koo
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - C-L Yu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - M-C Lu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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7
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Sumter TF, Xian L, Huso T, Koo M, Chang YT, Almasri TN, Chia L, Inglis C, Reid D, Resar LMS. The High Mobility Group A1 (HMGA1) Transcriptome in Cancer and Development. Curr Mol Med 2016; 16:353-93. [PMID: 26980699 DOI: 10.2174/1566524016666160316152147] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 02/15/2016] [Accepted: 03/10/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND & OBJECTIVES Chromatin structure is the single most important feature that distinguishes a cancer cell from a normal cell histologically. Chromatin remodeling proteins regulate chromatin structure and high mobility group A (HMGA1) proteins are among the most abundant, nonhistone chromatin remodeling proteins found in cancer cells. These proteins include HMGA1a/HMGA1b isoforms, which result from alternatively spliced mRNA. The HMGA1 gene is overexpressed in cancer and high levels portend a poor prognosis in diverse tumors. HMGA1 is also highly expressed during embryogenesis and postnatally in adult stem cells. Overexpression of HMGA1 drives neoplastic transformation in cultured cells, while inhibiting HMGA1 blocks oncogenic and cancer stem cell properties. Hmga1 transgenic mice succumb to aggressive tumors, demonstrating that dysregulated expression of HMGA1 causes cancer in vivo. HMGA1 is also required for reprogramming somatic cells into induced pluripotent stem cells. HMGA1 proteins function as ancillary transcription factors that bend chromatin and recruit other transcription factors to DNA. They induce oncogenic transformation by activating or repressing specific genes involved in this process and an HMGA1 "transcriptome" is emerging. Although prior studies reveal potent oncogenic properties of HMGA1, we are only beginning to understand the molecular mechanisms through which HMGA1 functions. In this review, we summarize the list of putative downstream transcriptional targets regulated by HMGA1. We also briefly discuss studies linking HMGA1 to Alzheimer's disease and type-2 diabetes. CONCLUSION Further elucidation of HMGA1 function should lead to novel therapeutic strategies for cancer and possibly for other diseases associated with aberrant HMGA1 expression.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - L M S Resar
- Department of Medicine, Faculty of the Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Research Building, Room 1025, Baltimore, MD 21205-2109, USA.
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8
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Lu MC, Lai CL, Tsai CC, Koo M, Lai NS. Increased risk of pulmonary and extra-pulmonary tuberculosis in patients with rheumatic diseases. Int J Tuberc Lung Dis 2016; 19:1500-6. [PMID: 26614192 DOI: 10.5588/ijtld.15.0087] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Impaired immunity in patients with rheumatic diseases can increase the risk of pulmonary tuberculosis (PTB). However, it is less clear whether rheumatic diseases affect the risk of extra-pulmonary tuberculosis (EPTB). OBJECTIVE To investigate the risk of PTB and EPTB in patients with rheumatic diseases using a population-based database. DESIGN From Taiwan's National Health Insurance Research Database, 8536 patients with tuberculosis (TB) were frequency-matched with 42,680 controls for sex, 10-year age group and index year. Subjects were retrospectively traced back for their first diagnosis of rheumatic diseases. The association between TB and rheumatic diseases was assessed using multivariate logistic regression analyses. RESULTS The risk of developing PTB was significantly higher in patients with systemic lupus erythematosus (adjusted odds ratio [aOR] 4.90, P < 0.001), rheumatoid arthritis (RA) (aOR 2.00, P < 0.001) and Sjögren's syndrome (aOR 6.11, P < 0.001). In addition, the risks of developing EPTB were significantly higher in RA patients (aOR 4.67, P < 0.001), those with Sjögren's syndrome (aOR 5.94, P < 0.001), and the group comprising progressive systemic sclerosis, polymyositis or dermatomyositis (aOR 8.31, P = 0.021). CONCLUSION Elevated risks of PTB and EPTB were associated with various rheumatic diseases. Rheumatologists should be vigilant to the possibility of TB, and particularly EPTB, in their patients.
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Affiliation(s)
- M-C Lu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - C-L Lai
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Pulmonology and Critical Care, Dalin Tzu Chi Hospital, Taiwan
| | - C-C Tsai
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Infectious Diseases, Dalin Tzu Chi Hospital, Taiwan
| | - M Koo
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - N-S Lai
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
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9
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Lopes-Pimentel P, Pasqualetto A, Koo M, Sabaté A. Patent foramen ovale diagnosed with echocardiographic checking of the positioning of a central venous catheter. Rev Esp Anestesiol Reanim 2016; 63:248-249. [PMID: 25687942 DOI: 10.1016/j.redar.2015.01.005] [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] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/07/2015] [Accepted: 01/18/2015] [Indexed: 06/04/2023]
Affiliation(s)
- P Lopes-Pimentel
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España.
| | - A Pasqualetto
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España
| | - M Koo
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España
| | - A Sabaté
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España
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10
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Pérez García L, Lopes-Pimentel P, Romero N, Koo M. [Cardiac tamponade by pneumopericardium due to stab injury]. Rev Esp Anestesiol Reanim 2016; 63:184-185. [PMID: 26047968 DOI: 10.1016/j.redar.2015.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 04/29/2015] [Indexed: 06/04/2023]
Affiliation(s)
- L Pérez García
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - P Lopes-Pimentel
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España.
| | - N Romero
- Servicio de Radiodiagnóstico, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - M Koo
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
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Affiliation(s)
- A. Sabate
- Idibell Feixa Llarga s/n Hospitalet; Barcelona Spain
| | - M. Koo
- Idibell Feixa Llarga s/n Hospitalet; Barcelona Spain
| | - D. Lopez
- Idibell Feixa Llarga s/n Hospitalet; Barcelona Spain
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12
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Chen JC, Koo M, Hwang JH. Risks of peripheral arterial occlusive disease in patients with obstructive sleep apnoea: a population-based case-control study. Clin Otolaryngol 2015; 40:437-42. [DOI: 10.1111/coa.12393] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2015] [Indexed: 01/10/2023]
Affiliation(s)
- J.-C. Chen
- Department of Neurosurgery; Dalin Tzu Chi Hospital; Buddhist Tzu Chi Medical Foundation; Chiayi Taiwan
- School of Medicine; Tzu Chi University; Hualien Taiwan
| | - M. Koo
- Department of Medical Research; Dalin Tzu Chi Hospital; Buddhist Tzu Chi Medical Foundation; Chiayi Taiwan
- Dalla Lana School of Public Health; University of Toronto; Toronto ON Canada
| | - J.-H. Hwang
- School of Medicine; Tzu Chi University; Hualien Taiwan
- Department of Otolaryngology; Dalin Tzu Chi Hospital; Buddhist Tzu Chi Medical Foundation; Chiayi Taiwan
- Sleep Center; Dalin Tzu Chi Hospital; Buddhist Tzu Chi Medical Foundation; Chiayi Taiwan
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13
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Thomas JS, Koo M, Shakib S, Wu J, Khanal S. Impact of a compulsory final year medical student curriculum on junior doctor prescribing. Intern Med J 2015; 44:156-60. [PMID: 24528813 DOI: 10.1111/imj.12316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 10/09/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Attendance at face-to-face sessions and completion of online components of the National Prescribing Curriculum was made compulsory for final year medical students at the University of Adelaide in 2010. AIMS To determine the impact of a compulsory prescribing curriculum for final year medical students on their prescribing competencies at the start of clinical practice. Graduates' attitudes to their medical school training in prescribing were also surveyed. METHODS Two cohorts of medical graduates from the University of Adelaide who commenced medical practice in 2010 and 2011 were required to complete a prescribing task using the National Inpatient Medication Chart (NIMC) at orientation and after 6 months of clinical practice. The main outcome measure was a performance in a scenario-based prescribing test, as determined by test scores and overall safety of prescriptions at orientation and 6 months of clinical practice. RESULTS There was a small difference in the average total score for the prescribing task between the 2010 and 2011 cohorts at orientation (P = 0.0007). The 2011 cohort had a higher number of safer charts at commencement of practice. We found no difference between the 2010 and 2011 cohorts in attitudes towards their undergraduate pharmacology education, and new graduates feel poorly prepared. CONCLUSION Medical graduates who are required to complete a practically oriented prescribing curriculum in final year perform slightly better on a prescribing assessment at commencement of practice. More work on preparing graduates for this complex task before graduation is needed.
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Affiliation(s)
- J S Thomas
- Clinical Education, University of Adelaide, Adelaide, South Australia, Australia
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14
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Bonet A, Koo M, Sabaté A, Otero I, Bocos J, Pi A. Ultrasound-guided saphenous nerve block is an effective technique for perioperative analgesia in ambulatory arthroscopic surgery of the internal knee compartment. ACTA ACUST UNITED AC 2015; 62:428-35. [PMID: 25561423 DOI: 10.1016/j.redar.2014.10.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 10/26/2014] [Accepted: 10/29/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Arthroscopic knee surgery is a minimally invasive technique with moderate pain during the first 24h. Our main objective was to evaluate the efficacy of ultrasound guided saphenous nerve block as a method of pain control intraoperatively and postoperatively for this surgery. MATERIAL AND METHODS A prospective and observational study. All patients received general anesthesia with laryngeal mask in the saphenous group, nerve block was performed with 10 ml ropivacaine 0.475%. Location of the surgery (external compartment group/internal compartment group), morphine consumption, VAS for pain at 5, 30, 60 and 120 min and 24 h after surgery, need for rescue medication, onset of nausea and vomiting, length of stay in PACU, delayed discharge and satisfaction were evaluated. RESULTS The study included 73 patients. Of these, 46 received saphenous nerve block and 27 didn't receive it. Consumption of intraoperative, postoperative and total morphine was significantly lower in the saphenous group as well as VAS at 24h. In the subgroup of internal compartment surgery differences in VAS 24 h, morphine consume and lenght of stay in PACU were mantained. CONCLUSIONS The ultrasound-guided block of saphenous nerve, particularly in the internal compartment arthroscopic knee surgery, decreases analgesic requirements, obtaining more effective pain control in the first 24 h postoperatively and without any known side effects.
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Affiliation(s)
- A Bonet
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
| | - M Koo
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - A Sabaté
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - I Otero
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - J Bocos
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - A Pi
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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15
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Lu MC, Yin WY, Liu SQ, Koo M, Tung CH, Huang KY, Lai NS. Increased prevalence of JC polyomavirus viruria was associated with arthritis/arthralgia in patients with systemic lupus erythematosus. Lupus 2014; 24:687-94. [PMID: 25406489 DOI: 10.1177/0961203314559629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/27/2014] [Accepted: 10/20/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this paper is to investigate the prevalence of reactivation of the human polyomavirus John Cunningham virus (JCV) in patients with systemic lupus erythematosus (SLE) and its associated clinical manifestations. METHODS Sixty-one patients with SLE and 22 controls were enrolled. Urine JCV viral load was quantified by real-time polymerase chain reaction (PCR). Length variants of the VP1 gene were analyzed using capillary electrophoresis. RESULTS The prevalence of JCV viruria (63.9% vs. 18.2%, p < 0.001) and urine JCV viral load (2.92 ± 2.76 vs. 0.81 ± 1.85 copies/ml by log10 scale, p < 0.001) were significantly higher in patients with SLE compared with controls. JCV viruria (+) SLE patients had a higher occurrence of arthritis/arthralgia compared with JCV viruria (-) SLE patients (64.1% vs. 22.7%, p = 0.003). In SLE patients, the urine JCV viral load was significantly associated with the occurrence of arthritis/arthralgia. SLE patients with urine JCV viral load >10,000 copies/ml exhibited a 12.75-fold (95% confidence interval 2.88-56.40) risk in clinical arthritis/arthralgia, 18.90-fold (95% confidence interval 2.10-170.39) risk in persistent arthritis, and significantly greater number of length variants in the VP1 gene of JCV compared with JCV viruria (-) SLE patients. CONCLUSION Reactivation of JCV in the urinary tract of SLE patients was very common. Both JCV viruria and urine JCV viral load were associated with the occurrence of arthritis/arthralgia in patients with SLE. High urine JCV viral load also was associated with the genetic variant in the VP1 gene.
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Affiliation(s)
- M-C Lu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - W-Y Yin
- School of Medicine, Tzu Chi University, Hualien, Taiwan Division of General Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - S-Q Liu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - M Koo
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - C-H Tung
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - K-Y Huang
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - N-S Lai
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan School of Medicine, Tzu Chi University, Hualien, Taiwan
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Pariente L, Camarena P, Koo M, Sabaté A, Armengol J. [Hypoglossal nerve neuropraxia after shoulder hemiarthroplasty]. Rev Esp Anestesiol Reanim 2014; 61:277-280. [PMID: 23787368 DOI: 10.1016/j.redar.2013.04.011] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 04/11/2013] [Accepted: 04/17/2013] [Indexed: 06/02/2023]
Abstract
We report a case of hypoglossal nerve damage after shoulder hemiarthroplasty with the patient in "beach chair" position, performed with general anesthesia with orotracheal intubation, and without complications. An ultrasound-guided interscalene block was previously performed in an alert patient. After the intervention, the patient showed clinical symptomatology compatible with paralysis of the right hypoglossal nerve that completely disappeared after 4 weeks. Mechanisms such as hyperextension of the neck during intubation, endotracheal tube cuff pressure, excessive hyperextension, or head lateralization during surgery have been described as causes of this neurological damage. We discuss the causes, the associated factors and suggest preventive measures.
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Affiliation(s)
- L Pariente
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España.
| | - P Camarena
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España
| | - M Koo
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España
| | - A Sabaté
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España
| | - J Armengol
- Servicio de Traumatología y Ortopedia, Hospital Universitario de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España
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17
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Costa M, Dalmau A, Sabate A, Koo M, Aparicio I, Contreras L. Low plasma fibrinogen levels and blood product transfusion in liver transplantation. Minerva Anestesiol 2014; 80:568-573. [PMID: 24280814] [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: 06/02/2023]
Abstract
BACKGROUND Risk of bleeding in liver transplantation is determined by surgical technique, preoperative hemoglobin and antifibrinolitic therapy. We hypothesized that keeping these confounders factors identical, preoperative plasma fibrinogen level of ≤2 g/L influenced on blood product requirements. METHODS Adult patients underwent orthotropic liver transplantation (LT) during the period between January 1998 and December 2009. Cases were selected according to a propensity matching analysis meeting the following criteria: surgical vena cava preservation, tranexamic acid administration and hemoglobin range between 90 to 120 g/L. Intraoperative management was protocolized. The main variable was the percentage of patients that did not require red blood cells (RBC's). RESULTS Six hundred sixty-four patients with LT, 208 excluded, 266 who cannot be matched, the analysis was performed on 190 patients. Two cohorts: Low fibrinogen (≤2 g/L) (61 cases) and standard fibrinogen (>2 g/L) (129 cases) were analyzed. Preoperative platelet count (73.5±52 vs. 104±65; 103/mm3) was different in contrast to the hemoglobin (104.2±8.6 vs. 105.6±8.3; g/L). Use of RBC's resulted significantly higher in the low fibrinogen group (median, 3 vs. 2). The number of patients with no blood product requirements was fewer in the low fibrinogen group (8 cases, 13% vs. 45 cases, 35%). The critical level of plasma fibrinogen (1 g/L) was reached after graft reperfusion in 7 cases (5.5%) in the standard fibrinogen group vs. 24 cases (39%) in the low fibrinogen group. CONCLUSION Our data suggest that preoperative plasma fibrinogen level of ≤2 g/L increases requirements for blood products during the surgical procedure of liver transplantation.
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Affiliation(s)
- M Costa
- Department of Anesthesia and Resuscitation, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain -
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18
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Fine S, Koo M, Gill T, Marin M, Poulin-Costello M, Barron R, Mittmann N. The use of granulocyte colony-stimulating factors in a Canadian outpatient setting. Curr Oncol 2014; 21:e229-40. [PMID: 24764708 DOI: 10.3747/co.21.1575] [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: 11/15/2022] Open
Abstract
BACKGROUND Data on real-life utilization of granulocyte colony-stimulating factors (g-csfs) in Canada are limited. The objective of the present study was to describe the reasons for, and the patterns of, g-csf use in selected outpatient oncology clinics in Ontario and Quebec. METHODS In a retrospective longitudinal cohort study, a review of medical records from 9 Canadian oncology clinics identified patients being prescribed filgrastim (fil) and pegfilgrastim (peg). Patient characteristics, reasons for g-csf use, and treatment patterns were descriptively analyzed. RESULTS Medical records of 395 patients initiating g-csf therapy between January 2008 and January 2009 were included. Of this population, 80% were women, and breast cancer was the predominant diagnosis (59%). The most commonly prescribed g-csf was fil (56% in Ontario and 98% in Quebec). The most frequent reason for g-csf use was primary prophylaxis (42% for both fil and peg), followed by secondary prophylaxis (37% fil, 41% peg). Those proportions varied by tumour type and chemotherapy regimen. Delayed g-csf administration (more than 1 day after the end of chemotherapy) was frequently observed for fil, but rarely reported for peg, and that finding was consistent across tumours and concurrent chemotherapy regimens. CONCLUSIONS The use of g-csf varies with the malignancy type and the provincial health care setting. The most commonly prescribed g-csf agent was fil, and most first g-csf prescriptions were for primary prophylaxis. Delays were frequently observed for patients receiving fil, but were rarely reported for those receiving peg.
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Affiliation(s)
- S Fine
- Peel Regional Cancer Centre, Credit Valley Hospital, Mississauga, ON
| | - M Koo
- Health Outcomes and Pharmacoeconomic (HOPE) Research Centre, Sunnybrook Research Institute, Toronto, ON
| | - T Gill
- OptumInsight, Burlington, ON
| | - M Marin
- OptumInsight, Burlington, ON
| | | | | | - N Mittmann
- Health Outcomes and Pharmacoeconomic (HOPE) Research Centre, Sunnybrook Research Institute, Toronto, ON. ; Department of Pharmacology, University of Toronto, Toronto, ON
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19
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Lopes-Pimentel P, Pasqualetto A, Koo M, Sabaté A. [Echocardiograph imaging of a type A aortic dissection with a pericardial rupture]. Rev Esp Anestesiol Reanim 2013; 60:357-358. [PMID: 22749301 DOI: 10.1016/j.redar.2012.05.011] [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] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 05/04/2012] [Indexed: 06/01/2023]
Affiliation(s)
- P Lopes-Pimentel
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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20
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Bilbao Ares A, Sabaté A, Porteiro L, Ibáñez B, Koo M, Pi A. [Neurological complications associated with ultrasound-guided interscalene and supraclavicular block in elective surgery of the shoulder and arm. Prospective observational study in a university hospital]. ACTA ACUST UNITED AC 2013; 60:384-91. [PMID: 23659835 DOI: 10.1016/j.redar.2013.02.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [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: 11/13/2012] [Revised: 02/14/2013] [Accepted: 02/24/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The incidence of postoperative neurological symptoms after performing interscalene block varies between 4 and 16%. The majority of cases are resolved spontaneously within a year, but some patients have their symptoms permanently. Our objective was to assess the incidence of postoperative neurological symptoms after performing the ultrasound-assisted interscalene and supraclavicular anaesthetic blocks. MATERIAL AND METHODS A prospective and observational study was conducted on consecutive patients who had undergone upper extremity surgery with an interscalene or supraclavicular block as an isolated technique, or as a complement to general anaesthesia. Seven days after the intervention, a telephone interview was conducted that focused on the detection of neurological symptoms in the operated limb. Further serial interviews were conducted on patients with symptoms (after the first, the third and the sixth month, and one year after surgery) until resolution of symptoms. Neurological evaluation was offered to those patients with persistent symptoms after one year. RESULTS A total of 121 patients were included, on whom 96 interscalene blocks and 22 supraclavicular blocks were performed. Postoperative neurological symptoms were detected in 9.9% (95% CI, 5-15%) of patients during the first week. No significant differences were observed between interscalene (9%) and supraclavicular block (14%). After 3 months the symptoms persisted in 9 patients (7.4%), with symptoms remaining in 4 patients (3.3%) after 1.5 years. Electromyogram was performed on 3 patients who tested positive for nerve damage. CONCLUSIONS A high incidence of postoperative neurological symptoms was observed, and a worrying percentage of permanence of them. There were no significant differences in incidence according to the type of block, or any features of the patient or the anaesthesia technique that were associated with the incidence of these symptoms, except a marginal relationship with age. These complications must be clearly explained to the patients before performing these blocks.
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Affiliation(s)
- A Bilbao Ares
- Servicio de Anestesia y Reanimación, Complejo Hospitalario de Navarra, Pamplona, Navarra, España.
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21
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Abstract
Risk of bleeding and transfusion in liver transplantation is determined by age, severity of liver disease, as well as hemoglobin and plasma fibrinogen values. During the hepatectomy and the anhepatic phase, the coagulopathy is related to a decrease in clotting factors caused by surgical bleeding, facilitated by the increased portal hypertension and esophageal-gastric venous distension. Corrections of hematologic disturbances by administration of large volumes of crystalloid, colloid, or blood products may worsen the coagulopathy. Also, impaired clearance of fibrinolytic enzymes released from damaged cells can lead to primary fibrinolysis. At time of graft reperfusion further deterioration may occur as characterized by global reduction among all coagulation factors, decreased plasminogen activator inhibitor factors, and simultaneous generation of tissue plasminogen activator. In situations with inherent risk of bleeding, hypofibrinogenemia must be corrected. Concern about unwanted events is a major limitation of preventive therapy. There is some evidence for the efficacy of antifibrinolytic drugs to reduce red blood cell requirements. A guide for antifibrinolytic therapy are clot firmness in trhomboelastometry or alternatively, diffuse bleeding associated to a fibrinogen value less than 1 g/L. Because thrombin generation is limited in severe thrombocytopenia, platelet administration is recommended when active bleeding coexists with a platelet count below 50,000/mm(3). When the administration of hemoderivates and antifibrinolytic drugs does not correct severe bleeding, consumption coagulopathy and secondary fibrinolysis should be suspected. Treatment of affected patients should be based upon correcting the underlying cause, mostly related to tissue hypoxia due to critical hypoperfusion.
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Affiliation(s)
- A Sabate
- Department of Anesthesia and Reanimation, Hospital Universitari de Bellvitge, IDIBELL, Health Universitat de Barcelona Campus, Barcelona, Spain.
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22
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Sabaté A, Acosta Villegas F, Dalmau A, Koo M, Sansano Sánchez T, García Palenciano C. [Anesthesia in the patient with impaired liver function]. Rev Esp Anestesiol Reanim 2012; 58:574-81. [PMID: 22279877 DOI: 10.1016/s0034-9356(11)70142-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We review information on impaired liver function, focusing on concepts relevant to anesthesia and postoperative recovery. The effects of impaired function are analyzed by systems of the body, with attention to the complications the patient with liver cirrhosis may develop according to type of surgery. Approaches to correcting coagulation disorders in the cirrhotic patient are particularly controversial because an increase in volume may be a factor in bleeding owing to increased portal venous pressure and imbalances in the factors that favor or inhibit coagulation. Perioperative morbidity and mortality correlate closely to Child-Pugh class and the score derived from the model for end-stage liver disease (MELD). Patients in Child class A are at moderate risk and surgery is therefore not contraindicated. Patients in Child class C or with a MELD score over 20, on the other hand, are at high risk and should not undergo elective surgical procedures. Abdominal surgery is generally considered to put patients with impaired liver function at high risk because it causes changes in hepatic blood flow and increases intraoperative bleeding because of high portal venous pressures.
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Affiliation(s)
- A Sabaté
- Servicio de Anestesiología y Reanimación, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona.
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23
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Koo M, Sabaté A, Magalló P, García MA, Domínguez J, de Lama ME, López S. [Multidisciplinary protocol for computed tomography imaging and angiographic embolization of splenic injury due to trauma: assessment of pre-protocol and post-protocol outcomes]. Rev Esp Anestesiol Reanim 2011; 58:538-542. [PMID: 22279872 DOI: 10.1016/s0034-9356(11)70137-2] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To assess conservative treatment of splenic injury due to trauma, following a protocol for computed tomography (CT) and angiographic embolization. To quantify the predictive value of CT for detecting bleeding and need for embolization. MATERIAL AND METHODS The care protocol developed by the multidisciplinary team consisted of angiography with embolization of lesions revealed by contrast extravasation under CT as well as embolization of grade III-V injuries observed, or grade I-II injuries causing hemodynamic instability and/or need for blood transfusion. We collected data on demographic variables, injury severity score (ISS), angiographic findings, and injuries revealed by CT. Pre-protocol and post-protocol outcomes were compared. The sensitivity and specificity of CT findings were calculated for all patients who required angiographic embolization. RESULTS Forty-four and 30 angiographies were performed in the pre- and post-protocol periods, respectively. The mean (SD) ISSs in the two periods were 25 (11) and 26 (12), respectively. A total of 24 (54%) embolizations were performed in the pre-protocol period and 28 (98%) after implementation of the protocol. Two and 7 embolizations involved the spleen in the 2 periods, respectively; abdominal laparotomies numbered 32 and 25, respectively, and 10 (31%) vs 4 (16%) splenectomies were performed. The specificity and sensitivity values for contrast extravasation found on CT and followed by embolization were 77.7% and 79.5%. CONCLUSIONS The implementation of this multidisciplinary protocol using CT imaging and angiographic embolization led to a decrease in the number of splenectomies. The protocol allows us to take a more conservative treatment approach.
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Affiliation(s)
- M Koo
- Servicio de Anestesiología y Reanimación, Hospital Universitari de Bellvitge, Idibell, Barcelona.
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24
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Abstract
Background This economic analysis aimed to determine, from the perspective of a Canadian provincial government payer, the cost-effectiveness of docetaxel (Taxotere: Sanofi–Aventis, Laval, QC) in combination with doxorubicin and cyclophosphamide (tac) compared with 5-fluorouracil, doxorubicin, and cyclophosphamide (fac) following primary surgery for breast cancer in women with operable, axillary lymph node–positive breast cancer. Methods A Markov model looking at two time phases—5-year treatment and long-term follow-up—was constructed. Clinical events included clinical response (based on disease-free survival and overall survival) and rates of febrile neutropenia, stomatitis, diarrhea, and infections. Health states were “no recurrence,” “locoregional recurrence,” “distant recurrence,” and “death.” Costs were based on published sources and are presented in 2006 Canadian dollars. Model inputs included chemotherapy drug acquisition costs, chemotherapy administration costs, relapse and follow-up costs, costs for management of adverse events, and costs for granulocyte colony-stimulating factor (g-csf) prophylaxis. A 5% discount rate was applied to costs and outcomes alike. Health utilities were obtained from published sources. Results For tac as compared with fac, the incremental cost was $6921 per life-year (ly) gained and $6,848 per quality-adjusted life-year (qaly) gained. The model was robust to changes in input variables (for example, febrile neutropenia rate, utility). When g-csf and antibiotics were given prophylactically before every cycle, the incremental ratios increased to $13,183 and $13,044 respectively. Conclusions Compared with fac, tac offered improved response at a higher cost. The cost-effectiveness ratios were low, indicating good economic value in the adjuvant setting of node-positive breast cancer patients.
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Affiliation(s)
- N Mittmann
- HOPE Research Centre, Division of Clinical Pharmacology, Sunnybrook Health Sciences Centre, Toronto, ON
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25
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You HJ, Kim DW, Koo M, Jang SO, Jung YH, Hong SH, Lee BJ. Inclined slot-excited annular electron cyclotron resonance plasma source for hyperthermal neutral beam generation. Rev Sci Instrum 2011; 82:013502. [PMID: 21280826 DOI: 10.1063/1.3523425] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
An inclined slot-excited antenna (ISLAN) electron cyclotron resonance (ECR) plasma source is newly designed and constructed for higher flux hyperthermal neutral beam (HNB) generation. The developed ISLAN source is modified from vertical slot-excited antenna (VSLAN) source in two aspects: one is the use of inclined slots instead of vertical slots, and the other is a cusp magnetic field configuration rather than a toroidal configuration. Such modifications allow us to have more uniform arrangement of slots and magnets, then enabling plasma generation more uniform and thinner. Moreover, ECR plasma allows higher ionization rate, enabling plasma density higher even in submillitorr pressures, therefore decreasing the collision rate and∕or the reionization rate of the reflected atoms while passing through the plasma, and eventually getting higher flux of HNBs. In this paper, we report the design features and the plasma characteristics of the ISLAN source by doing plasma measurements and electromagnetic simulations. It was found that ISLAN source can be a high potential source for larger flux HNB generation; the source was found to give higher plasma densities and better uniformities than inductively coupled plasma source, particularly in low pressure ranges. Also, it is important that using ISLAN gives easier matching and better stability, i.e., ISLAN shows similar field patterns and good plasma symmetries irrespective of the variations of the mean diameter of the ring resonator and∕or the presence of a limiter or a reflector, and the operating pressures.
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Affiliation(s)
- H-J You
- National Fusion Research Institute, Daejeon, South Korea.
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Sabaté A, Ferreres E, Valcárcel M, Dalmau A, Koo M, Fabregat J. Rocuronium Profile During Orthotopic Liver Transplantation: Effect of Changing the Order of Vascular Clamp Release at Reperfusion of the Hepatic Graft. Transplant Proc 2010; 42:1760-2. [DOI: 10.1016/j.transproceed.2010.02.072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 01/11/2010] [Accepted: 02/26/2010] [Indexed: 10/19/2022]
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27
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Yom C, Moon B, Park Y, Koo M. 0045 The significance of annexin A1 expression in breast cancer. Breast 2009. [DOI: 10.1016/s0960-9776(09)70090-6] [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: 10/20/2022] Open
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Koo M, Moon B, Choi K, Yom C, Park Y. 0025 A comparative study of immunohistochemical staining and fluorescence in situ hybridization method of HER-2/neu in breast cancer. Breast 2009. [DOI: 10.1016/s0960-9776(09)70074-8] [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: 11/26/2022] Open
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29
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Yom C, Park Y, Bae W, Koo M, Moon B. 0107 Outcomes of immediate reconstruction with absorbable polypropylene mesh in breast conserving surgery for early breast cancer. Breast 2009. [DOI: 10.1016/s0960-9776(09)70149-3] [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: 11/26/2022] Open
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30
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Yom C, Koo M, Moon B, Park Y. 0022 Ultrasound-guided Mammotome® biopsy for breast microcalcification using 2-dimensional mammography localization. Breast 2009. [DOI: 10.1016/s0960-9776(09)70071-2] [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: 10/20/2022] Open
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31
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Koo M, Sabaté A, Bassas E, Lacambra M, López S. [Mortality in patients with multiple injuries: analysis using the trauma and injury severity score in a referral hospital]. Rev Esp Anestesiol Reanim 2009; 56:83-91. [PMID: 19334656 DOI: 10.1016/s0034-9356(09)70337-8] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND AND OBJECTIVES A growing number of patients with multiple injuries are being treated. Injury severity scales can be used to assess outcomes objectively. This study aimed to assess our hospital's cases on the basis of the Trauma and Injury Severity Score (TRISS) and compare outcomes to those reported in the Major Trauma Outcome Study, as well as to determine preventable mortality and analyze causes of death and associated factors. PATIENTS AND METHODS Data were extracted from the records of patients admitted with multiple injuries in 2005 and were used to calculate the Revised Trauma Score (RTS), the Injury Severity Score (ISS), and the TRISS or probability of survival. Hospital mortality was also calculated. A TRISS between 25 and 50 was considered to indicate a preventable avoidable death; a TRISS over 50 indicated a preventable death. Logistic regression analysis was used to identify factors associated with mortality. RESULTS We studied the cases of 198 patients with a mean (SD) age of 43.9 (19) years. Ninety-three percent had suffered blunt trauma. The mean ISS, the prehospital RTS, and the TRISS were 16.9 (11.2), 10.8 (2.5), and 0.95 (0.2), respectively. Twenty-five patients died. Fifteen deaths were classified as preventable or potentially preventable. Factors related to exitus were head injury and age (odds ratios, 4.6 and 4.0, respectively). CONCLUSIONS The rate of preventable death in our hospital was higher than expected. Mortality was strongly associated with head injury and age. The TRISS model can identify preventable deaths objectively.
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Affiliation(s)
- M Koo
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Bellvitge.
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32
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Koo M, Kim SH, Lee N, Yoo MY, Ryu SY, Kwon DY, Kim YS. 3-Hydroxy-3-methylglutaryl-CoA (HMG-CoA) reductase inhibitory effect of Vitis vinifera. Fitoterapia 2007; 79:204-6. [PMID: 18191910 DOI: 10.1016/j.fitote.2007.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Accepted: 11/15/2007] [Indexed: 10/22/2022]
Abstract
Activity-guided fractionation of the methanol extract of Vitis vinifera bark led to the isolation of epsilon-viniferin, ampelopcin A, vitisin A and vitisin B. Vitisin A and vitisin B showed a remarkable inhibitory activity against 3-hydroxy-3-methylglutaryl-Coenzyme A (HMG-CoA) reductase with IC50 value of 42.1 microM and 23.9 microM, respectively.
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Affiliation(s)
- M Koo
- Korea Food Research Institute, Baekhyun-dong, Bundang-gu, Sungnam-si, Gyeonggi-do 463-746, South Korea.
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Koo M, Sabaté A, Ramos E, Dalmau A, León E, Fabregat J, Rafecas A. [Factors related to renal dysfunction after liver transplantation in patients with normal preoperative function]. Rev Esp Anestesiol Reanim 2006; 53:538-44. [PMID: 17297829] [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] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To determine perioperative factors related to postoperative renal dysfunction in patients receiving liver transplants who had normal renal function before surgery. PATIENTS AND METHODS We analyzed the cases of 189 consecutive patients. Patients with hepatorenal syndrome and previously diagnosed renal insufficiency were excluded, as were patients undergoing a second transplant operation. Postoperative renal dysfunction was diagnosed when creatinine levels exceeded 1.5 mg x dL(-1) in the first postoperative week. Multivariate analysis of preoperative variables (patient characteristics; Child-Pugh score; status with the United Network for Organ Sharing; and sodium, coagulation, hemoglobin, and creatinine levels); intraoperative variables (blood product units required, duration of surgery, reperfusion syndrome, surgical technique, and crystalloids required); and postoperative variables (hemodialysis or filtration, reoperation, mortality, creatinine levels at 6 and 12 months). RESULTS One hundred fifty patients with normal kidney function were included. Postoperative renal dysfunction developed in 45 (30%). Differences between patients with and without postoperative renal dysfunction were found for weight; sex; Child-Pugh score; blood transfusion requirements (mean [SD] of 2.36 [2.4] units of packed red cells in the group of patients with renal dysfunction vs 1.3 [1.8] in the patients with normal function); and reperfusion syndrome (26 [66.7%] patients with renal dysfunction and 35 [21.5%] without). The last 2 variables continued to be significantly correlated with renal dysfunction in the multivariate analysis with a relative risk of 1.25, (95% confidence interval [CI], 1.01-1.55) for units of blood transfusion and 2.41 (95% CI, 1.04-5.57) for reperfusion syndrome. Renal replacement therapy was used in 4 patients (2.7%). Mortality rates were similar. At 6 and 12 months, 26 (17.3%) and 18 (12%) patients had renal dysfunction. CONCLUSIONS Acute renal dysfunction is a frequent complication following a liver transplant and it is associated with transfusion of more units of blood products even when the average transfusion amount is not large.
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Affiliation(s)
- M Koo
- Unidad de Trasplante Hepático del Hospital Universitario de Bellvitge, Barcelona.
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Serrano A, Koo M, García Huete L, Dalmau A. [Intestinal ischemia due to closed abdominal injury: a case report]. Rev Esp Anestesiol Reanim 2005; 52:573-5. [PMID: 16363306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Pak VV, Koo M, Lee N, Kim MS, Kwon DY. Structure—Activity Relationships of the Peptide Ile-Ala-Val-Pro and Its Derivatives Revealed Using the Semi-Empirical AM1 Method. Chem Nat Compd 2005. [DOI: 10.1007/s10600-005-0176-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tucker A, Cotterchio M, Gallinger S, Kreiger N, McLaughlin J, Koo M. 263-S: Access to an Educational Colorectal Cancer Website and Subject Participation in the Ontario Familial Colorectal Cancer Registry (OFCCR). Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s66b] [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: 11/12/2022] Open
Affiliation(s)
- A Tucker
- University of Toronto, Toronto, ON
| | | | | | | | | | - M Koo
- University of Toronto, Toronto, ON
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Martí Valeri C, Sabaté A, Masdevall C, Camprubí I, Dalmau A, Gracia T, Koo M, Sanzol R, Suárez M, Montero A. [Influence of the severity of obesity on morbidity and mortality after gastric bypass surgery]. Rev Esp Anestesiol Reanim 2004; 51:195-204. [PMID: 15168927] [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] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To determine the influence of severity of obesity on morbidity and mortality following Roux-en-Y gastric bypass and vertical ringed gastroplasty, with severity classified as morbid obesity (MO) defined by a body mass index (BMI) between 35 and 55 Kg/m2 and super-morbid obesity (SMO) defined by a BMI exceeding 55 Kg/m2. METHOD A series of patients who underwent the aforementioned type of gastric bypass surgery were followed for 5 years. The patients were classified as to whether they had associated sleep apnea syndrome, alveolar hypoventilation, or "overlap syndrome". RESULTS A total of 105 patients were enrolled: 70 (66.7%) classified as having MO and 35 (33.3%) classified as having SMO. Distribution by sex was significantly different in the 2 groups, but respiratory diseases were similar. PaO2 was higher in the MO group, PaCO2 was lower, and the alveolar-arterial gradient was smaller. Duration of surgery was shorter in the MO group (120.43 +/- 32.97 vs. 136.76 +/- 28.28 minutes). The percentage of complications was similar in the 2 groups (32.86% and 45.7% in the MO and SMO groups, respectively), although the incidence of respiratory complications was higher in SMO patients (8.57% vs. 20% in the MO and SMO groups, respectively). No differences were observed in the rates of surgical, hemodynamic, or infectious complications. Length of hospital stay was similar (6.44 vs. 6.69 for MO and SMO patients, respectively). CONCLUSIONS More severe obesity can be associated with preoperative arterial blood gas alterations in patients with concomitant respiratory disease and a higher incidence of respiratory complications in the early phase of recovery from gastric bypass surgery.
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Affiliation(s)
- C Martí Valeri
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona
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Alcázar MT, Koo M, Ramiro O, Villalonga R, Sabaté A, Montero A. [Hemothorax as complication of laparoscopic technique]. Rev Esp Anestesiol Reanim 2003; 50:150-3. [PMID: 12708212] [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] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
A 69-year-old woman with a hiatal hernia and esophagitis caused by reflux was scheduled for laparoscopic Nissen fundoplication. Anesthetic induction was accomplished with fentanyl, propofol and rocuronium and maintenance with sevoflurane and rocoronium. Hemodynamics were stable until the end of surgery, when a sudden decrease in blood pressure to 40/20 mm Hg and arterial carbon dioxide tension to 14 mm Hg were observed. Anesthetic insufflation was stopped and physiological saline solution and ephedrine were administered. Hemothorax and air embolism were ruled out. After hemodynamic recovery, renewal of anesthetic insufflation was contraindicated, laparoscopy was halted, and hemoperitoneum was ruled out. After extubation, the patient was transferred to the recovery room, where hemodynamic instability worsened progressively. A chest radiograph suggest left hemothorax and an emergency thoracotomy was performed. After evacuation of multiple clots from the pleural cavity, the point of hemorrhage was located at the right crus of the diaphragm and bleeding was arrested. Postoperative recovery continued with no further events. The most common complications of laparoscopy are pneumothorax, gastroesophageal perforation and hemorrhage. However, given the complexity of the technique, the possibility of bleeding in the pleural cavity, as occurred in this case, should be considered. This case highlights the importance of rigorous intraoperative monitoring and postoperative surveillance by the anesthesiologist.
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Affiliation(s)
- M T Alcázar
- Servicio de Anestesiología y Reanimación, Ciudad Sanitaria y Universitaria de Bellvitge (CSUB).
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Dalmau A, Sabaté A, Koo M, Rafecas A, Figueras J, Jaurrieta E. Prophylactic use of tranexamic acid and incidence of arterial thrombosis in liver transplantation. Anesth Analg 2001; 93:516. [PMID: 11473891 DOI: 10.1097/00000539-200108000-00057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Koo M, Dalmau A, Camprubi I, Sabaté A, Cochs J. [Changes in the bispectral index and the spectral edge frequency 90 during different phases of anesthesia with sevoflurane]. Rev Esp Anestesiol Reanim 2001; 48:321-5. [PMID: 11591280] [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] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
INTRODUCTION Electroencephalographic monitoring is one of the techniques used to measure hypnosis during anesthesia. Efforts to find a means to apply this monitoring function are justified by cases of intraoperative awakening and are in the interest of guaranteeing patient welfare and controlling anesthesia. OBJECTIVES To determine the changes in two electroencephalographic parameters, the bispectral index (BIS) and the spectral edge frequency 90 (SEF90), during the different phases of anesthesia. Patients and method. Forty-eight patients undergoing abdominal surgery were studied prospectively. Anesthesia was induced by propofol, fentanyl or sevoflurane. Anesthesia was maintained with sevoflurane and O2/N2O at a concentration of 70% to maintain BIS between 40 and 60. Variables monitored were heart rate, blood pressure, arterial oxygen saturation (with a pulse oximeter), expired CO2 partial pressure, inspired and expired sevoflurane partial pressure, esophageal temperature, SEF90 (defined as the frequency below which 90% of the power in the electroencephalogram resides) and BIS. All variables were recorded during three phases: induction, maintenance and recovery from anesthesia. We then performed an analysis of variance, with p < 0.05 considered significant. RESULTS During induction mean BIS decreased from 95.6 to 34.7 after intubation, while SEF90 fell from 20.5 Hz to 11.9 Hz. During maintenance BIS, SEF90 and expired sevoflurane partial pressure remained constant. During recovery mean BIS increased from 59.2 to 92.3 upon extubation, and SEF90 went from 15.1 to 22.2 Hz; although heart rate increased, blood pressure did not. The mean electroencephalographic values recorded when movement occurred were 77 for BIS (range 58-96) and 18 for SEF90 (range 13-18). CONCLUSION Electroencephalographic monitoring is useful for distinguishing between states of consciousness and unconsciousness during anesthesia, and is valid for the phases of induction and recovery. BIS values over 58 and SEF90 values over 13 may indicate inadequate hypnosis.
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Affiliation(s)
- M Koo
- Médico adjunto.Servicio de Anestesiología y Reanimación, Ciudad Sanitaria y Universitaria de Bellvitge, Príncipes de España, Barcelona, Spain
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Dalmau A, Sabaté A, Acosta F, Garcia-Huete L, Koo M, Sansano T, Rafecas A, Figueras J, Jaurrieta E, Parrilla P. Tranexamic acid reduces red cell transfusion better than epsilon-aminocaproic acid or placebo in liver transplantation. Anesth Analg 2000; 91:29-34. [PMID: 10866882 DOI: 10.1097/00000539-200007000-00006] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [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: 11/26/2022]
Abstract
UNLABELLED We evaluated the efficacy of the prophylactic administration of epsilon-aminocaproic acid and tranexamic acid for reducing blood product requirements in orthotopic liver transplantation (OLT) in a prospective, double-blinded study performed in 132 consecutive patients. Patients were randomized to three groups and given one of three drugs prophylactically: tranexamic acid, 10 mg. kg(-1). h(-1); epsilon-aminocaproic acid, 16 mg. kg(-1). h(-1), and placebo (isotonic saline). Perioperative management was standardized. Coagulation tests, thromboelastogram, and blood requirements were recorded during OLT and in the first 24 h. There were no differences in diagnosis, Child score, or preoperative coagulation tests among groups. Administration of packed red blood cells was significantly reduced (P = 0.023) during OLT in the tranexamic acid group, but not in the epsilon-aminocaproic acid group. There were no differences in transfusion requirements after OLT. Thromboembolic events, reoperations, and mortality were similar in the three groups. Prophylactic administration of tranexamic acid, but not epsilon-aminocaproic acid, significantly reduces total packed red blood cell usage during OLT. IMPLICATIONS In a randomized study of 132 consecutive patients undergoing liver transplantation, we found that tranexamic acid, but not epsilon-aminocaproic acid, reduced intraoperative total packed red blood cell transfusion.
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Affiliation(s)
- A Dalmau
- Department of Anaesthesiology and Surgery, Princeps D'Espanya Hospital, Barcelona, Spain.
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Koo M, Miró J, Sánchez F, Cochs J. [Electroencephalographic and hemodynamic monitoring at various desflurane concentrations]. Rev Esp Anestesiol Reanim 1999; 46:391-5. [PMID: 10613076] [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] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVES To assess the electroencephalographic patterns and hemodynamic changes produced by desflurane at 0.5, 1 and 1.5 MAC. MATERIAL AND METHODS Twenty-four patients undergoing gynecological surgery under general anesthesia were enrolled prospectively. We monitored electroencephalographic (EEG) patterns and hemodynamic parameters as well as inspired and expired desflurane fractions. Anesthetic induction was with 2 mg/kg of propofol, 2 to 3 mg/kg of fentanyl and 0.1 mg/kg vecuronium. Spectral edge frequency (SEF90) and the EEG delta ratio were recorded along with mean systolic and diastolic pressures, heart rate, oxygen saturation and expired CO2 fraction during induction, intubation, 5 min after intubation and at 0.5, 1 and 1.5 MAC during weaning from anesthesia and extubation. RESULTS Blood pressure fell significantly at 1.5 MAC and increased when anesthesia was withdrawn; heart rate did not change significantly. SEF90 and the delta ratio changed, however, at each phase. SEF90 fell notably at the moment of induction but gradually increased, rising upon intubation, 5 min later, at 0.5 MAC and upon withdrawal of anesthesia. A significant decrease in SEF90 appeared when 1.5 MAC was reached, related to achievement of a deeper plane of anesthesia. CONCLUSIONS Automated EEG processing can provide a good measure of depth of anesthesia, as it reflects significant changes related to level of anesthesia at each phase. These differences are not always observable with routine monitoring of hemodynamic parameters.
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Affiliation(s)
- M Koo
- Servicio de Anestesiología y Reanimación, Ciudad Sanitaria y Universitaria de Bellvitge, L'Hospitalet de Llobregat, Barcelona
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Dalmau A, Sabaté A, Acosta F, Garcia-Huete L, Koo M, Reche M, Rafecas A, Figueras J, Jaurrieta E. Comparative study of antifibrinolytic drugs in orthotopic liver transplantation. Transplant Proc 1999; 31:2361-2. [PMID: 10500617 DOI: 10.1016/s0041-1345(99)00378-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A Dalmau
- Liver Transplant Unit, C.S.U. Bellvitge, University of Barcelona, Spain
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44
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Koo M, Bendahmane M, Lettieri GA, Paoletti AD, Lane TE, Fitchen JH, Buchmeier MJ, Beachy RN. Protective immunity against murine hepatitis virus (MHV) induced by intranasal or subcutaneous administration of hybrids of tobacco mosaic virus that carries an MHV epitope. Proc Natl Acad Sci U S A 1999; 96:7774-9. [PMID: 10393897 PMCID: PMC22137 DOI: 10.1073/pnas.96.14.7774] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Hybrids of tobacco mosaic virus (TMV) were constructed with the use of fusion to the coat protein peptides of 10 or 15 amino acids, containing the 5B19 epitope from the spike protein of murine hepatitis virus (MHV) and giving rise to TMV-5B19 and TMV-5B19L, respectively. The TMV hybrids were propagated in tobacco plants, and the virus particles were purified. Immunogold labeling, with the use of the monoclonal MAb5B19 antibody, showed specific decoration of hybrid TMV particles, confirming the expression and display of the MHV epitope on the surface of the TMV. Mice were immunized with purified hybrid viruses after several regimens of immunization. Mice that received TMV-5B19L intranasally developed serum IgG and IgA specific for the 5B19 epitope and for the TMV coat protein. Hybrid TMV-5B19, administered by subcutaneous injections, elicited high titers of serum IgG that was specific for the 5B19 epitope and for coat protein, but IgA that was specific against 5B19 was not observed. Mice that were immunized with hybrid virus by subcutaneous or intranasal routes of administration survived challenge with a lethal dose (10 x LD50) of MHV strain JHM, whereas mice administered wild-type TMV died 10 d post challenge. Furthermore, there was a positive correlation between the dose of administered immunogen and protection against MHV infection. These studies show that TMV can be an effective vaccine delivery vehicle for parenteral and mucosal immunization and for protection from challenge with viral infection.
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MESH Headings
- Administration, Intranasal
- Amino Acid Sequence
- Animals
- Epitopes/administration & dosage
- Epitopes/immunology
- Female
- Hemagglutinins, Viral/administration & dosage
- Hemagglutinins, Viral/immunology
- Hepatitis B Vaccines
- Hepatitis, Viral, Animal/immunology
- Hepatitis, Viral, Animal/prevention & control
- Immunization Schedule
- Injections, Subcutaneous
- Membrane Glycoproteins/administration & dosage
- Membrane Glycoproteins/immunology
- Mice
- Mice, Inbred BALB C
- Murine hepatitis virus/immunology
- Spike Glycoprotein, Coronavirus
- Tobacco Mosaic Virus/immunology
- Vaccines, Synthetic
- Viral Envelope Proteins/administration & dosage
- Viral Envelope Proteins/immunology
- Viral Hepatitis Vaccines
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Affiliation(s)
- M Koo
- Department of Cell Biology, Division of Plant Biology, BCC 206, La Jolla, CA 92037, USA
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Ruiz V, Koo M, García E, Crespo JM, Mayoral V, Casals P, Cochs J. [The incidence of intraoperative conciousness in emergency surgery and its possible relation to the post-traumatic stress syndrome. Presentation of three cases]. Rev Esp Anestesiol Reanim 1998; 45:106-9. [PMID: 9612029] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Intraoperative awakening and recall of specific events is a rare complication (0.2 to 1.3%) of surgery. The possibility of developing serious psychiatric complications, such as posttraumatic stress disorder (PTSD) makes the prevention and detection of intraoperative awareness a subject of special interest. We describe our experience with three patients in whom awareness was detected during emergency surgery under general anesthesia. We conducted two structured interviews with the patients three months after surgery in order to detect the possible development of psychiatric complications. One patient suffered insomnia and reexperience of the event during the first two weeks after surgery. Improvement was spontaneous. None of the patients suffered PTSD. Efforts to decrease the incidence of episodes of intraoperative awakening with specific recall must be based on clinical observation and exhaustive monitoring of the patient, including anesthetic gases, given that no ideal method of monitoring depth of anesthesia exists. Cases should be detected in the first few days after surgery by means of a specific test. Likewise, possible causes for the episode should be explained to the patient, who should be followed for six months so that early diagnosis of PTSD or other psychiatric complications can be made.
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Affiliation(s)
- V Ruiz
- Servicio de Anestesiología y Reanimación, Hospital Prínceps d'Espanya, Barcelona
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McDermott MF, Schmidt-Wolf G, Sinha AA, Koo M, Porter MA, Briant L, Cambon-Thomsen A, Maclaren NK, Fiske D, Bertera S, Trucco M, Amos CI, McDevitt HO, Kastner DL. No linkage or association of telomeric and centromeric T-cell receptor beta-chain markers with susceptibility to type 1 insulin-dependent diabetes in HLA-DR4 multiplex families. Eur J Immunogenet 1996; 23:361-70. [PMID: 8909943 DOI: 10.1111/j.1744-313x.1996.tb00009.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The T-cell receptor beta locus (TCRB) on chromosome 7q35 was studied as a candidate region for genetic susceptibility to type 1 insulin-dependent diabetes (IDDM). A highly polymorphic microsatellite marker mapping to the TCRBV6.7 gene and a TCRB C-region RFLP were used to genotype the members of a total of 21 multiplex IDDM families from two different geographical areas. There was no evidence to support linkage to either of these markers with IDDM, and conventional two-point analysis excluded linkage to the telomeric end of the TCRB complex, in the region of the highly informative TCRBV6.7 marker. There was significant linkage of IDDM to the class II HLA-D locus with significant lod scores > 3.0 obtained for the HLA-DRB1 and HLA-DQB1 genes. Affected sib-pair (ASP) and transmission disequilibrium (TDT) association tests confirmed these findings.
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Affiliation(s)
- M F McDermott
- Arthritis and Rheumatism Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA
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Fernandes J, Morali G, Wolever TM, Blendis LM, Koo M, Jenkins DJ, Rao AV. Effect of acute lactulose administration on serum acetate levels in cirrhosis. CLIN INVEST MED 1994; 17:218-25. [PMID: 7923999] [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: 01/27/2023]
Abstract
Lactulose has been used successfully in the treatment of portal-systemic encephalopathy but its exact mechanism of action is not known. The aim of this study was to observe the systemic effects of the colonic fermentation of an acute lactulose dose in cirrhotics and normal subjects. Six cirrhotic patients and 6 normal subjects were placed on 2 identical 2-d metabolic diets, 1 of which was supplemented with lactulose (1 g/100 kcals to a maximum of 28 g/d). Lactulose increased colonic fermentation in cirrhotic and normal subjects as evidenced by higher breath hydrogen and serum acetate levels. The increase in serum acetate levels after lactulose compared to control was similar in cirrhotic compared to normal subjects. However, the mean serum acetate concentration in the cirrhotics was significantly greater than that in the control subjects (p = 0.039), indicating increased endogenous production, or decreased peripheral utilization of acetate by the cirrhotic liver, or both. No change was observed in blood ammonia, glucose, insulin, or free fatty acid levels with lactulose.
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Affiliation(s)
- J Fernandes
- Department of Nutritional Sciences, Faculty of Medicine, Toronto Hospital, University of Toronto, Ontario
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Abstract
The effect of cholesterol and oxidized cholesterol on azoxymethane-induced colonic preneoplasia was evaluated in C57BL/6J and BALB/cJ mouse strains. Mice were fed either a control AIN 76 semisynthetic diet or the control diet supplemented with 0.1% or 0.3% cholesterol, or 0.1% or 0.3% oxidized cholesterol for an 8-week period. For the first 4 weeks of the experiment, mice received weekly injections of azoxymethane (5 mg/kg body weight). Dietary cholesterol increased fecal concentrations of neutral and acid sterols. A dose-response relationship was observed in both mouse strains between the level of dietary cholesterol or oxidized cholesterol and formation of preneoplastic aberrant crypt foci. Enhanced cell proliferation along with alterations in several crypt morphometric parameters were also observed. These anomalies were enhanced to a greater extent by oxidized cholesterol. This data shows a very strong effect of cholesterol in enhancing the development of preneoplastic lesions in chemically induced cells. It also demonstrated that the state of oxidation of cholesterol influences colonic preneoplasia. This factor has been overlooked in previous animal experiments.
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Affiliation(s)
- C W Kendall
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada
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Abstract
This investigation was undertaken to study the role of Bifidobacteria and bifidogenic factor Neosugar in the process of 1,2-dimethylhydrazine-induced colonic carcinogenesis in CF1 mice. Intestinal colonization and selective proliferation of Bifidobacteria were achieved by oral administration of indigenous Bifidobacteria and the incorporation of 5% Neosugar in the diet of animals. The Bifidobacteria were isolated from the feces of CF1 mice and were identified to be Bifidobacterium pseudolongum biovar b. This incidence of aberrant crypts and foci were significantly lower 38 weeks after the last injection of the carcinogen in animals fed Bifidobacteria than in animals treated with the carcinogen alone. The aberrance also appeared to be confined to the more distal end of the colon in animals fed bifidogenic diet. Such changes in the precursor lesions of colonic carcinogenesis are presumably due to the increase in the number of Bifidobacteria and their acidifying action in the lower intestinal tract of the animals.
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Affiliation(s)
- M Koo
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada
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Jacob CO, Fronek Z, Lewis GD, Koo M, Hansen JA, McDevitt HO. Heritable major histocompatibility complex class II-associated differences in production of tumor necrosis factor alpha: relevance to genetic predisposition to systemic lupus erythematosus. Proc Natl Acad Sci U S A 1990; 87:1233-7. [PMID: 2105500 PMCID: PMC53445 DOI: 10.1073/pnas.87.3.1233] [Citation(s) in RCA: 498] [Impact Index Per Article: 14.6] [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: 12/30/2022] Open
Abstract
We report on the production of tumor necrosis factor (TNF)-alpha and TNF-beta by mitogen-activated peripheral blood lymphocytes or enriched monocyte subpopulations from human leukocyte antigen (HLA)-typed healthy subjects. The results indicate that HLA-DR2- and DQw1-positive donors frequently exhibit low production of TNF-alpha, whereas DR3- and DR4-positive subjects show high levels of TNF-alpha production. No correlation between TNF-alpha levels and HLA-A, -B, and -C genotype was found. The relevance of this quantitative polymorphism to the genetic predisposition to lupus nephritis in systemic lupus erythematosus (SLE) patients was investigated. DR2, DQw1-positive SLE patients show low levels of TNF-alpha inducibility; this genotype is also associated with an increased incidence of lupus nephritis. DR3-positive SLE patients, on the other hand, are not predisposed to nephritis, and these patients have high TNF-alpha production. DR4 haplotype is associated with high TNF-alpha inducibility and is negatively correlated with lupus nephritis. These data may help explain the strong association between HLA-DR2, DQw1 in SLE patients and their susceptibility to nephritis.
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Affiliation(s)
- C O Jacob
- Department of Microbiology and Immunology, Stanford University School of Medicine, CA 94305-5402
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