1
|
Juviler P, Meyers JM, Levatino E, Axford J, Barker E, Correll L, Decker AS, Faria J, Gloff M, Loria A, McKenna M, Schriefer J, Stevens TP, Verna S, Wegman S, Wolcott K, Wakeman D. Reducing Unplanned Intubations in the Neonatal Intensive Care Unit After Children's Surgery: A Quality Improvement Project. J Pediatr Surg 2024; 59:45-52. [PMID: 37845122 DOI: 10.1016/j.jpedsurg.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Unplanned intubation following children's surgery is associated with increased postoperative mortality. In response to being a National Surgical Quality Improvement Program - Pediatric (NSQIP-P) high outlier for postoperative unplanned intubation, we aimed to reduce postoperative unplanned intubation events by 25% in one year. METHODS/INTERVENTION A multidisciplinary team of stakeholders was assembled in 2018. Most unplanned intubation events occurred in the neonatal intensive care unit (NICU). Based on apparent causes of unplanned intubations identified in case reviews, an extubation readiness checklist and a postoperative pain management guideline emphasizing non-opioid analgesics were implemented for NICU patients in September 2019. Postoperative unplanned intubation events were tracked prospectively and evaluated using quality improvement statistical process control methods. RESULTS Unplanned intubations in the NICU decreased from 0.27 to 0.07 events per patient in the post-intervention group (September 2019-June 2022, n = 145) compared to the pre-intervention group (January 2016-August 2019, n = 200), representing a 76% reduction. Postoperative opioid administration decreased significantly, while acetaminophen usage increased significantly over time. Balancing measures of postoperative pneumonia rate (1.5% vs 0.0%, p = 0.267) and median hospital length of stay [40 (IQR 51) days vs 27 (IQR 60), p = 0.124] were not different between cohorts. The 30-day mortality rate for postoperative patients in the NICU significantly declined [6.5% (n = 13) vs 0.7% (n = 1), p < 0.001]. CONCLUSIONS Postoperative unplanned intubation rates for NICU patients decreased following a quality improvement effort focused on opioid stewardship and extubation readiness. TYPE OF STUDY Prospective Quality Improvement. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Peter Juviler
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jeffrey M Meyers
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Elizabeth Levatino
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Jessica Axford
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Erin Barker
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Lynnie Correll
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Andrew S Decker
- Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - John Faria
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, NY, USA
| | - Marjorie Gloff
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Anthony Loria
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Margo McKenna
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, NY, USA
| | - Jan Schriefer
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Timothy P Stevens
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Sarah Verna
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Sarah Wegman
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Kori Wolcott
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Derek Wakeman
- Division of Pediatric Surgery, Department of Surgery, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
2
|
Yelverton CA, O'Keeffe LM, Bartels HC, McDonnell C, Geraghty AA, O'Brien EC, Killeen SL, Twomey P, Kilbane M, Crowley RK, McKenna M, McAuliffe FM. Association between maternal blood lipids during pregnancy and offspring growth trajectories in a predominantly macrosomic cohort: findings from the ROLO longitudinal birth cohort study. Eur J Pediatr 2023; 182:5625-5635. [PMID: 37819419 DOI: 10.1007/s00431-023-05251-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 10/13/2023]
Abstract
The purpose of this study is to examine associations between maternal lipid profiles in pregnancy and offspring growth trajectories in a largely macrosomic cohort. This is a secondary analysis of the ROLO birth cohort (n = 293), which took place in the National Maternity Hospital, Dublin, Ireland. Infants were mostly macrosomic, with 55% having a birthweight > 4 kg. Maternal mean age was 32.4 years (SD 3.9 years), mean BMI was 26.1 kg/m2 (SD 4.4 kg/m2) and 48% of children born were males. Total cholesterol, high density lipoprotein cholesterol (HDL-cholesterol), low density lipoprotein cholesterol (LDL-cholesterol) and triglycerides were measured from fasting blood samples of mothers at 14 and 28 week gestation. The change in maternal lipid levels from early to late pregnancy was also examined. Offspring abdominal circumference and weight were measured at 20- and 34-week gestation, birth, 6 months, 2 years and 5 years postnatal. Linear spline multilevel models examined associations between maternal blood lipid profiles and offspring growth. We found some weak, significant associations between maternal blood lipids and trajectories of offspring growth. Significant findings were close to the null, providing limited evidence. For instance, 1 mmol/L increase in maternal triglycerides was associated with faster infant weight growth from 20- to 34-week gestation (0.01 kg/week, 95% CI - 0.02, - 0.001) and slower abdominal circumference from 2 to 5 years (0.01 cm/week, 95% CI - 0.02, - 0.001). These findings do not provide evidence of a clinically meaningful effect. Conclusion: These findings raise questions about the efficacy of interventions targeting maternal blood lipid profiles in pregnancies at risk of macrosomia. New studies on this topic are needed. What is Known: • Maternal fat accumulation during early pregnancy may potentially support fetal growth in the third trimester by providing a reserve of lipids that are broken down and transferred to the infant across the placental barrier. • There are limited studies exploring the impact of maternal lipid profiles on infant and child health using growth trajectories spanning prenatal to postnatal life. What is New: • Maternal blood lipid profiles were not associated with offspring growth trajectories of weight and abdominal circumference during pregnancy up to 5 years of age in a largely macrosomic cohort, as significant findings were close to the null, providing limited evidence for a clinically meaningful relationship. • Strengths of this work include the use of infant growth trajectories that span prenatal to postnatal life and inclusion of analyses of the change of maternal lipid levels from early to late pregnancy and their associations with offspring growth trajectories from 20-week gestation to 5 years of age.
Collapse
Affiliation(s)
- C A Yelverton
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - L M O'Keeffe
- School of Public Health, University College Cork, Cork, Ireland
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - H C Bartels
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - C McDonnell
- Department of Paediatric Endocrinology & Diabetes, Children's Health Ireland, Temple Street Hospital, Dublin, Ireland
| | - A A Geraghty
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - E C O'Brien
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
- School of Biological, Health and Sports Sciences, Technological University Dublin, Dublin, Ireland
| | - S L Killeen
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - P Twomey
- Department of Clinical Chemistry, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - M Kilbane
- Department of Clinical Chemistry, St Vincent's University Hospital, Dublin, Ireland
| | - R K Crowley
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Endocrinology & Diabetes Mellitus, St Vincent's University Hospital, Dublin, Ireland
| | - M McKenna
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Endocrinology & Diabetes Mellitus, St Vincent's University Hospital, Dublin, Ireland
| | - F M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.
| |
Collapse
|
3
|
Ishman SL, Maturo S, Schwartz S, McKenna M, Baldassari CM, Bergeron M, Chernobilsky B, Ehsan Z, Gagnon L, Liu YCC, Smith DF, Stanley J, Zalzal H, Dhepyasuwan N. Expert Consensus Statement: Management of Pediatric Persistent Obstructive Sleep Apnea After Adenotonsillectomy. Otolaryngol Head Neck Surg 2023; 168:115-130. [PMID: 36757810 PMCID: PMC10105630 DOI: 10.1002/ohn.159] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/03/2022] [Accepted: 08/13/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To develop an expert consensus statement regarding persistent pediatric obstructive sleep apnea (OSA) focused on quality improvement and clarification of controversies. Persistent OSA was defined as OSA after adenotonsillectomy or OSA after tonsillectomy when adenoids are not enlarged. METHODS An expert panel of clinicians, nominated by stakeholder organizations, used the published consensus statement methodology from the American Academy of Otolaryngology-Head and Neck Surgery to develop statements for a target population of children aged 2-18 years. A medical librarian systematically searched the literature used as a basis for the clinical statements. A modified Delphi method was used to distill expert opinion and compose statements that met a standardized definition of consensus. Duplicate statements were combined prior to the final Delphi survey. RESULTS After 3 iterative Delphi surveys, 34 statements met the criteria for consensus, while 18 statements did not. The clinical statements were grouped into 7 categories: general, patient assessment, management of patients with obesity, medical management, drug-induced sleep endoscopy, surgical management, and postoperative care. CONCLUSION The panel reached a consensus for 34 statements related to the assessment, management and postoperative care of children with persistent OSA. These statements can be used to establish care algorithms, improve clinical care, and identify areas that would benefit from future research.
Collapse
Affiliation(s)
- Stacey L. Ishman
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Stephen Maturo
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Seth Schwartz
- Virginia Mason Medical Center, Seattle, Washington, USA
| | - Margo McKenna
- University of Rochester Medical Center/Golisano Children’s Hospital, Rochester, New York, USA
| | - Cristina M. Baldassari
- Eastern Virginia Medical School/Children’s Hospital of the King’s Daughter, Norfolk, Virginia, USA
| | - Mathieu Bergeron
- Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada
| | | | - Zarmina Ehsan
- University of Missouri—Kansas City, Kansas City, Missouri, USA
| | - Lisa Gagnon
- Yale University/Connecticut Pediatric Otolaryngology, New Haven, Connecticut, USA
| | - Yi-Chun Carol Liu
- Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas, USA
| | - David F. Smith
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jeffrey Stanley
- University of Michigan Health/Michigan Medicine, Ann Arbor, Michigan, USA
| | - Habib Zalzal
- Children’s National Health System, Washington, District of Columbia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology—Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| |
Collapse
|
4
|
Sinha A, McKenna M, Kollikonda S, Yao M, Mei L, Valentine L, Russo ML, Hornacek D, Kho R. The risk of venous thromboembolism in patients with and without leiomyomas undergoing hysterectomy. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.113] [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: 11/01/2022]
|
5
|
McKenna M, Ye T, Nannapaneni R, Patel C. 58 Should Single Group and Save (G&S) Sampling be Implemented in Spinal Cord Stimulation Surgery (SCSS)? Br J Surg 2021. [DOI: 10.1093/bjs/znab259.650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
SCSS is offered to patients who have persistent chronic neuropathic pain after trials of conservative management. Although severe bleeding complications are rare, it is common practice to take two G&S samples from patients pre-operatively. Unnecessary testing can induce patient anxiety and is a financial burden to the NHS. We aim to determine if a single G&S sample before SCSS would be beneficial, and to assess the association between number of risk factors for bleeding and blood loss in SCSS.
Method
Retrospective analysis of 100 patients in one centre who had SCSS over a 3-year period. Bleeding risk factors, haemoglobin levels and complications were recorded for each patient. A review of current literature along with a cost analysis was subsequently performed.
Results
An average drop in haemoglobin levels of 9g/L post-operatively was seen. No patients required blood transfusions. There was no statistically significant difference (P = 0.364) between number of risk factors and blood loss.
Conclusions
The results obtained suggest that SCSS carries a low risk of adverse bleeding requiring blood transfusions. With the lack of guidelines for preoperative G&S samples it is difficult to make decisions on the amount of samples needed before SCSS. Single G&S sampling in patients without bleeding risk factors can reduce patient burden, save costs, and reduce environmental footprints left by laboratory tests. Those with risk factors may still benefit from two pre-operative G&S samples to ensure patient safety.
Collapse
Affiliation(s)
- M McKenna
- Neuroscience Department, University Hospital of Wales, Cardiff, United Kingdom
| | - T Ye
- Cardiff University, University Hospital of Wales, Cardiff, United Kingdom
| | - R Nannapaneni
- Neuroscience Department, University Hospital of Wales, Cardiff, United Kingdom
| | - C Patel
- Neuroscience Department, University Hospital of Wales, Cardiff, United Kingdom
| |
Collapse
|
6
|
Allman M, McKenna M, Leopard D, Backhouse S. 1342 Screening Patients’ Temperature in COVID-era Outpatient Clinics: An Overreliance on Unreliable Devices? Br J Surg 2021. [DOI: 10.1093/bjs/znab259.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
The Covid-19 pandemic continues to impair patient access to hospital clinics. One way of enabling outpatient services to continue safely is to screen for pyrexia by checking patients’ temperature prior to their clinic appointment. Infrared tympanic thermometers (ITT) are commonly used as a surrogate marker of core temperature. Non-contact infrared cutaneous thermometers (NICT) are increasingly favoured as they require no direct contact with patients. The aim was to measure the concordance of temperature readings between ITT and NICT on patients attending ENT outpatient clinic at one hospital.
Method
Body temperature was recorded using ITT and NICT on 63 sequential patients. Agreement was tested using a Bland-Altman plot with 95% confidence interval and paired T-tests.
Results
Mean body temperature was significantly lower (p < 0.05) for the NICT [36.3 °C (95% CI 36.2 °C-36.4 °C)] compared with the ITT [36.6 °C (95% CI 36.5 °C-36.7 °C)]. The NICT measured on average 0.34 °C (95% CI 0.33 °C-0.35 °C) lower than the ITT. The Bland-Altman plot showed moderate agreement of the two methods (SD 0.46 °C; limits -1.25 °c to 0.57 °c); however, disagreement was greater at higher and lower temperature extremes.
Conclusions
Screening patients for pyrexia aims to help prevent spread of COVID-19. False negatives result in a missed opportunity to break the chain of transmission. A significant proportion of false negatives may reverse any intended benefit. NICT are convenient but may be more susceptible to false negatives when assessing for pyrexia and may provide little more than false reassurance when used for pyrexia screening.
Collapse
Affiliation(s)
- M Allman
- Princess of Wales Hospital, Bridgend, United Kingdom
| | - M McKenna
- Prince Charles Hospital, Merthyr Tydfil, United Kingdom
| | - D Leopard
- Morriston Hospital, Swansea, United Kingdom
| | - S Backhouse
- Princess of Wales Hospital, Bridgend, United Kingdom
| |
Collapse
|
7
|
Scherpereel A, Antonia S, Bautista Y, Grossi F, Kowalski D, Zalcman G, Nowak A, Fujimoto N, Peters S, Tsao A, Mansfield A, Popat S, Sun X, Padilla B, Aanur P, Daumont M, Bennett B, McKenna M, Baas P. LBA1 First-line nivolumab (NIVO) plus ipilimumab (IPI) versus chemotherapy (chemo) for the treatment of unresectable malignant pleural mesothelioma (MPM): Patient-reported outcomes (PROs) from CheckMate 743. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
8
|
McKenna M, Abdelaal A. Group & save sampling in lumbar decompression: A review into current practice. J Perioper Pract 2020; 31:15-17. [PMID: 33225836 DOI: 10.1177/1750458920950664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The risks, benefits and technical aspects of surgery require careful consideration. One element of this is the requirement of postoperative blood transfusion. Patients who undergo elective lumbar decompression are at a low risk of requiring a postoperative transfusion yet undergo multiple preoperative group & save tests. For those who are at a low risk of bleeding, a single group & save sample may be adequate. This review analysed the postoperative blood loss and transfusion rate associated with lumbar decompression surgery without fusion in one institution. A subsequent cost analysis and review of the literature was performed. The aim was to assess whether single group & save sampling, within the context of lumbar decompression, was cost effective and amenable to the patient without impacting patient care. Average blood loss was estimated as a drop in Hb of 12.3g/dl. Six patients (14%) had Hb loss of over 20g/dl. No patients underwent a blood transfusion. Through examination of medical records, we found that 65% of patients (35) were suitable for single group & save sampling, estimating a saving of £2415.95 (53%). Selective group & save testing holds economic potential and safeguards patients from undergoing unnecessary testing. The next step after this review would be a prospective multi-centre study.
Collapse
Affiliation(s)
- M McKenna
- 97644Royal Gwent Hospital, Newport, UK
| | | |
Collapse
|
9
|
Lookabaugh S, McKenna M, Karelsky S, Davis M, Didas A, Allen P, Faria J. Drug-induced sleep endoscopy findings in surgically-naïve obese vs non-obese children. Int J Pediatr Otorhinolaryngol 2020; 138:110289. [PMID: 32814210 DOI: 10.1016/j.ijporl.2020.110289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine if drug-induced sleep endoscopy (DISE) findings are different in obese versus non-obese pediatric patients with obstructive sleep apnea (OSA) or sleep-disordered breathing (SDB). METHODS Prospective, observational cohort study from June 2017 to June 2018 at a tertiary academic pediatric medical center that included surgically-naïve children ages 2-12 with diagnoses of OSA or sleep-disordered breathing. Subjects with a known diagnosis of craniofacial syndromes, genetic disorders, prior adenoidectomy or tonsillectomy, or chronic tonsillitis as the indication for surgery were excluded. Two groups were assessed for patterns of obstruction based on DISE videos at each anatomic airway level using a previously published DISE scoring system. The groups included obese subjects (BMI ≥ 95th percentile) and non-obese controls (BMI <85th percentile). Each video was graded by two blinded, fellowship-trained Pediatric Otolaryngologists. RESULTS Fifty-one patients were included, 26 non-obese and 25 obese. Based on anatomic airway level, there was no statistically significant difference in airway obstruction at the velum (p = 0.134), adenoid (p = 0.592), lateral pharyngeal walls (p = 0.867), tongue base (p = 0.977), or supraglottis (p = 0.428) between obese and non-obese children. CONCLUSION Our prospective study did not associate severity of obstruction with obesity status based on anatomic airway levels. Further studies are needed to elucidate the etiology of the high rate of persistent obstructive sleep apnea in obese children.
Collapse
Affiliation(s)
- Sarah Lookabaugh
- Department of Otolaryngology Head and Neck Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA.
| | - Margo McKenna
- Department of Otolaryngology Head and Neck Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Sveta Karelsky
- Department of Otolaryngology Head and Neck Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael Davis
- Department of Anesthesiology, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Amanda Didas
- Department of Otolaryngology Head and Neck Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Paul Allen
- Department of Otolaryngology Head and Neck Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - John Faria
- Department of Otolaryngology Head and Neck Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
10
|
McKenna M, Suárez-Bonnet A, Smith K, Stewart S. Diagnosis and treatment of a caecal mucocoele in a dog. J Small Anim Pract 2020; 62:305-309. [PMID: 32974903 DOI: 10.1111/jsap.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 07/25/2019] [Accepted: 08/09/2019] [Indexed: 11/28/2022]
Abstract
An 11-year-old male intact Staffordshire Bull terrier was referred for diabetic ketoacidosis. Abdominal ultrasonographic examination revealed a 5 cm × 2 cm intraluminal caecal mass-like structure. Exploratory laparotomy and typhlectomy were subsequently performed. Histopathology of the caecal mass-like structure was consistent with a caecal mucocoele, defined as a cystic dilation of the caecal lumen with stasis of mucus. This lesion has been previously described in humans, where it is termed an appendiceal mucocoele. The patient was euthanased 58 days post-operatively due to unrelated diabetic complications.
Collapse
Affiliation(s)
- M McKenna
- Department of Clinical Science and Services, Royal Veterinary College, North Mymms, Hertfordshire, AL9 7TA, UK
| | - A Suárez-Bonnet
- Department of Pathobiology and Population Sciences, Royal Veterinary College, North Mymms, Hertfordshire, AL9 7TA, UK
| | - K Smith
- Department of Pathobiology and Population Sciences, Royal Veterinary College, North Mymms, Hertfordshire, AL9 7TA, UK
| | - S Stewart
- Department of Clinical Science and Services, Royal Veterinary College, North Mymms, Hertfordshire, AL9 7TA, UK
| |
Collapse
|
11
|
Waser N, Adam A, Schweikert B, Vo L, McKenna M, Breckenridge M, Penrod J, Goring S. 1243P Pathologic response as early endpoint for survival following neoadjuvant therapy (NEO-AT) in resectable non-small cell lung cancer (rNSCLC): Systematic literature review and meta-analysis. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
12
|
Núñez ES, Myrtle A, McKenna D, Brown L, Fauset-Jones J, McKenna M. WS02.4 Developing an enhanced transition pathway for young people with additional needs at the Manchester Adult Cystic Fibrosis Centre (MACFC). J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30174-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
13
|
Rouce R, Thakkar A, Sharma S, Shah N, Reyna A, Ramos C, Lapteva N, Zhang H, Mehta B, Perconti S, McKenna M, Gee A, Lulla P, Castello J, Brenner M, Heslop H, Rooney C. Use of highly characterized EBV-Specific T Cells outside of the immediate Post-Transplant setting. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
14
|
Weiand D, McKenna M. Describing the End of Life Experience of Patients Supported with a Life-Sustaining Left Ventricular Assist Device (LVAD) as Bridge to Transplantation in a UK Centre. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.760] [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
|
15
|
Yang L, McAlarnen L, McKenna M. 11: Laparoscopic techniques for Essure device removal. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.01.145] [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]
|
16
|
Ramos IR, Meade AD, Ibrahim O, Byrne HJ, McMenamin M, McKenna M, Malkin A, Lyng FM. Raman spectroscopy for cytopathology of exfoliated cervical cells. Faraday Discuss 2018; 187:187-98. [PMID: 27032537 DOI: 10.1039/c5fd00197h] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Cervical cancer is the fourth most common cancer affecting women worldwide but mortality can be decreased by early detection of pre-malignant lesions. The Pap smear test is the most commonly used method in cervical cancer screening programmes. Although specificity is high for this test, it is widely acknowledged that sensitivity can be poor mainly due to the subjective nature of the test. There is a need for new objective tests for the early detection of pre-malignant cervical lesions. Over the past two decades, Raman spectroscopy has emerged as a promising new technology for cancer screening and diagnosis. The aim of this study was to evaluate the potential of Raman spectroscopy for cervical cancer screening using both Cervical Intraepithelial Neoplasia (CIN) and Squamous Intraepithelial Lesion (SIL) classification terminology. ThinPrep® Pap samples were recruited from a cervical screening population. Raman spectra were recorded from single cell nuclei and subjected to multivariate statistical analysis. Normal and abnormal ThinPrep® samples were discriminated based on the biochemical fingerprint of the cells using Principal Component Analysis (PCA). Principal Component Analysis - Linear Discriminant Analysis (PCA-LDA) was employed to build classification models based on either CIN or SIL terminology. This study has shown that Raman spectroscopy can be successfully applied to the study of routine cervical cytology samples from a cervical screening programme and that the use of CIN terminology resulted in improved sensitivity for high grade cases.
Collapse
Affiliation(s)
- I R Ramos
- DIT Centre for Radiation and Environmental Science, FOCAS Research Institute, Dublin Institute of Technology, Kevin St, Dublin 8, Ireland. and School of Physics, Dublin Institute of Technology, Kevin St, Dublin 8, Ireland
| | - A D Meade
- School of Physics, Dublin Institute of Technology, Kevin St, Dublin 8, Ireland
| | - O Ibrahim
- DIT Centre for Radiation and Environmental Science, FOCAS Research Institute, Dublin Institute of Technology, Kevin St, Dublin 8, Ireland. and School of Physics, Dublin Institute of Technology, Kevin St, Dublin 8, Ireland
| | - H J Byrne
- FOCAS Research Institute, Dublin Institute of Technology, Kevin St, Dublin 8, Ireland
| | - M McMenamin
- Cytopathology Department, Altnagelvin Hospital, Western Health and Social Care Trust, Derry, Northern Ireland, UK
| | - M McKenna
- Cytopathology Department, Altnagelvin Hospital, Western Health and Social Care Trust, Derry, Northern Ireland, UK
| | - A Malkin
- School of Biological Sciences, Dublin Institute of Technology, Kevin St, Dublin 8, Ireland
| | - F M Lyng
- DIT Centre for Radiation and Environmental Science, FOCAS Research Institute, Dublin Institute of Technology, Kevin St, Dublin 8, Ireland. and School of Physics, Dublin Institute of Technology, Kevin St, Dublin 8, Ireland
| |
Collapse
|
17
|
McMenamin M, McKenna M, McDowell A, Dawson C, McKenna R. Intra- and inter-observer reproducibility of CINtec ® PLUS in ThinPrep ® cytology preparations. Cytopathology 2017; 28:284-290. [PMID: 28685883 DOI: 10.1111/cyt.12426] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study evaluated the intra- and inter-observer reproducibility of the dual-stain biomarker, CINtec® PLUS cytology in ThinPrep® specimens, for improved specificity in the detection of cervical disease in women testing human papillomavirus (HPV) positive. METHODS A total of 972 cases of HPV-positive women from a triage and primary HPV screening population were selected from an ongoing study evaluating the clinical performance of CINtec® PLUS cytology. For reproducibility analyses, three cytotechnologists rescreened sets of slides which they had previously reported themselves and which were previously reported by each of the other cytotechnologists. The original results of slides previously screened by each of the three cytotechnologists were also compared with the results of an expert reference evaluator. RESULTS Intra- and inter-observer agreement for paired evaluations between reviewers ranged from 82.8% to 94.9% (kappa 0.65-0.91) and 89.2% to 93% (kappa 0.83-0.88), respectively. Reproducibility analyses between the cytotechnologists and the reference evaluator revealed agreements ranging from 95.5% to 98% (kappa 0.89-0.96). CONCLUSION Evaluation of the dual-stain biomarker showed a high level of agreement across all evaluators suggesting that CINtec® PLUS cytology will perform well in the hands of cytotechnologists and pathologist reviewers and could be introduced into cellular pathology laboratories that employ ThinPrep® LBC with a minimum effort.
Collapse
Affiliation(s)
- M McMenamin
- Cytopathology Department, Altnagelvin Hospital, Western Health and Social Care Trust, Londonderry, UK
| | - M McKenna
- Cytopathology Department, Altnagelvin Hospital, Western Health and Social Care Trust, Londonderry, UK
| | - A McDowell
- Northern Ireland Centre for Stratified Medicine, Biomedical Sciences Institute, AltnagelvinHospital, University of Ulster, Londonderry, UK
| | - C Dawson
- Cytopathology Department, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - R McKenna
- Cytopathology Department, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK
| |
Collapse
|
18
|
Farr T, Petersen A, McKenna M. Effects of an acute oral dose of digoxin on plasma K+ regulation, muscle performance and excitability during and following high-intensity cycling. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2016.12.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
19
|
Flynn SP, Monaghan R, Bogan J, McKenna M, Cowley A, Daniels S, Hughes G, Kelleher SM. Controlling wettability of PECVD-deposited dual organosilicon/carboxylic acid films to influence DNA hybridisation assay efficiency. J Mater Chem B 2017; 5:8378-8388. [DOI: 10.1039/c7tb01925d] [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: 01/01/2023]
Abstract
Plasma oxidation of Zeonor and deposition of TEOS/AA thin film showing dual layer effect on the surface.
Collapse
Affiliation(s)
- S. P. Flynn
- National Centre for Plasma Science and Technology
- Glasnevin
- Dublin 9
- Ireland
- School of Chemistry
| | - R. Monaghan
- National Centre for Plasma Science and Technology
- Glasnevin
- Dublin 9
- Ireland
- Biomedical Diagnostic Institute
| | - J. Bogan
- School of Physical Sciences
- Dublin City University
- Dublin 9
- Ireland
| | - M. McKenna
- National Centre for Plasma Science and Technology
- Glasnevin
- Dublin 9
- Ireland
- Biomedical Diagnostic Institute
| | - A. Cowley
- National Centre for Plasma Science and Technology
- Glasnevin
- Dublin 9
- Ireland
| | - S. Daniels
- National Centre for Plasma Science and Technology
- Glasnevin
- Dublin 9
- Ireland
- Biomedical Diagnostic Institute
| | - G. Hughes
- School of Physical Sciences
- Dublin City University
- Dublin 9
- Ireland
| | - S. M. Kelleher
- National Centre for Plasma Science and Technology
- Glasnevin
- Dublin 9
- Ireland
- School of Chemistry
| |
Collapse
|
20
|
Ward HJT, Baird D, McKenna M, Mooney A, Lee A. Understanding high resource users across health and social care in Scotland using linked data. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw171.058] [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: 11/14/2022] Open
|
21
|
Ellison WT, Racca R, Clark CW, Streever B, Frankel AS, Fleishman E, Angliss R, Berger J, Ketten D, Guerra M, Leu M, McKenna M, Sformo T, Southall B, Suydam R, Thomas L. Modeling the aggregated exposure and responses of bowhead whales Balaena mysticetus to multiple sources of anthropogenic underwater sound. ENDANGER SPECIES RES 2016. [DOI: 10.3354/esr00727] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
22
|
McKenna M, McMenamin M, McDowell A. HPV16 and HPV18 genotyping triage in young women with borderline cytology or mild dyskaryosis: effect of age on genotype-specific risk of high-grade CIN. Cytopathology 2016; 27:261-8. [PMID: 26873051 DOI: 10.1111/cyt.12316] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 11/18/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Human papillomavirus (HPV) triage of borderline cytology or mild dyskaryosis is limited by the higher prevalence of HPV in women with these findings relative to those with high-grade cervical intraepithelial neoplasia (≥CIN2). This is particularly relevant in young women in whom HPV prevalence is discernible. In a previous analysis of HPV triage and colposcopy outcomes in Northern Ireland, we revealed a substantial amount of prevalent high-grade disease in women below 30 years of age. We explored the role of genotyping for HPV16/HPV18 in this population by assessing the risk of high-grade lesions associated with these genotypes and the effect of age on type-specific risk. METHODS Of the 866 women eligible for HPV triage, those who tested positive for HPV were referred to colposcopy. The relative risk of ≥CIN2 for HPV16, HPV18 and non-HPV16/18 high-risk genotype positivity was determined for cobas(®) HPV Test-positive results. RESULTS The relative risk of high-grade CIN was significantly greater in women infected with HPV16 and/or HPV18 compared with non-HPV16/18 infections, regardless of age (2.23 and 0.45, respectively). In women under 30 years of age, HPV16-associated risk of ≥CIN2 was significantly greater than that of HPV18 and the non-HPV16/18 genotypes (1.74 versus 1.03 and 0.58, respectively). In women aged ≥30 years, HPV18 infection presented the greatest risk of ≥CIN2 (3.03). The relative risk of ≥CIN2 associated with non-HPV16/18 genotypes was lower (range, 0.32-0.58) for both age groups. CONCLUSION This analysis demonstrates the value of genotyping for HPV16/HPV18 and age stratification to improve the specificity of HPV triage and to tailor management relative to the risk of high-grade CIN and cancer.
Collapse
Affiliation(s)
- M McKenna
- Cytopathology Department, Altnagelvin Hospital, Londonderry, UK
| | - M McMenamin
- Cytopathology Department, Altnagelvin Hospital, Londonderry, UK
| | - A McDowell
- Northern Ireland Centre for Stratified Medicine, Ulster University, Londonderry, UK
| |
Collapse
|
23
|
Farr, Petersen A, McKenna M. Effects of contracting muscle mass on arterial and venous [K+) and muscular fatigue during intense intermittent cycling. J Sci Med Sport 2015. [DOI: 10.1016/j.jsams.2015.12.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
24
|
Affiliation(s)
- M. McKenna
- Royal Liverpool and Broadgreen University Hospitals NHS Trust Liverpool UK
| | - M. Davies
- Royal Liverpool and Broadgreen University Hospitals NHS Trust Liverpool UK
| |
Collapse
|
25
|
Zou W, McDonough J, Yin L, Fisher T, Siderits R, McKenna M, Khan A, Yue N, Teo B. SU-E-T-455: Characterization of 3D Printed Materials for Proton Beam Therapy. Med Phys 2014. [DOI: 10.1118/1.4888788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
26
|
Zou W, Fisher T, Swann B, Siderits R, McKenna M, Khan A, Yue N, Zhang M. MO-H-19A-03: Patient Specific Bolus with 3D Printing Technology for Electron Radiotherapy. Med Phys 2014. [DOI: 10.1118/1.4889225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
27
|
Serpiello F, McKenna M, Coratella G, Markworth J, Tarperi C, Bishop D, Stepto N, Cameron-Smith D, Schena F. Futsal and Continuous Exercise Induce Similar Changes in Specific Skeletal Muscle Signalling Proteins. Int J Sports Med 2014; 35:863-70. [DOI: 10.1055/s-0034-1367045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- F. Serpiello
- Institute of Sport, Exercise and Active Living (ISEAL), College of Sport and Exercise Science, Victoria University, Melbourne, Australia
| | - M. McKenna
- Institute of Sport, Exercise and Active Living (ISEAL), College of Sport and Exercise Science, Victoria University, Melbourne, Australia
| | - G. Coratella
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Faculty of Sport Sciences, University of Verona, Italy
| | - J. Markworth
- The University of Auckland, Liggins Institute, Auckland, New Zealand
| | - C. Tarperi
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Faculty of Sport Sciences, University of Verona, Italy
| | - D. Bishop
- Institute of Sport, Exercise and Active Living (ISEAL), College of Sport and Exercise Science, Victoria University, Melbourne, Australia
| | - N. Stepto
- Institute of Sport, Exercise and Active Living (ISEAL), College of Sport and Exercise Science, Victoria University, Melbourne, Australia
| | - D. Cameron-Smith
- The University of Auckland, Liggins Institute, Auckland, New Zealand
| | - F. Schena
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Faculty of Sport Sciences, University of Verona, Italy
| |
Collapse
|
28
|
Toher C, Lindsay K, McKenna M, Kilbane M, Curran S, Harrington L, Uduma O, McAuliffe FM. Relationship between vitamin D knowledge and 25-hydroxyvitamin D levels amongst pregnant women. J Hum Nutr Diet 2013; 27:261-9. [DOI: 10.1111/jhn.12150] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C. Toher
- Centre for Global Health; Trinity College; Dublin Ireland
| | - K. Lindsay
- UCD Obstetrics and Gynaecology; School of Medicine and Medical Science; National Maternity Hospital; University College Dublin; Dublin Ireland
| | - M. McKenna
- Metabolism Laboratory; St Vincent's University Hospital; Dublin Ireland
| | - M. Kilbane
- Metabolism Laboratory; St Vincent's University Hospital; Dublin Ireland
| | - S. Curran
- Department of Dietetics; National Maternity Hospital; Dublin Ireland
| | - L. Harrington
- Department of Dietetics; Rotunda Hospital; Dublin Ireland
| | - O. Uduma
- Centre for Global Health; Trinity College; Dublin Ireland
| | - F. M. McAuliffe
- UCD Obstetrics and Gynaecology; School of Medicine and Medical Science; National Maternity Hospital; University College Dublin; Dublin Ireland
| |
Collapse
|
29
|
O’Sullivan ES, van der Kamp S, Kilbane M, McKenna M. Osteogenesis imperfecta in adults: phenotypic characteristics and response to treatment in an Irish cohort. Ir J Med Sci 2013; 183:225-30. [DOI: 10.1007/s11845-013-0995-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 07/29/2013] [Indexed: 12/01/2022]
|
30
|
McMenamin M, McKenna M. Effect of glacial acetic acid treatment of cervical ThinPrep specimens on HPV DNA detection with the cobas 4800 HPV test. Cytopathology 2013; 24:321-6. [PMID: 23445358 DOI: 10.1111/cyt.12052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cytology laboratories in the UK routinely treat unsatisfactory cervical liquid-based cytology (LBC) specimens with glacial acetic acid (GAA) to reduce the unsatisfactory rate. However, there is limited published data on the effect of GAA reprocessing on the molecular detection of human papillomavirus (HPV). The aim of this study was to assess the impact of GAA treatment of cervical ThinPrep(®) samples on HPV detection with the cobas(®) 4800 HPV Test (Roche Molecular Systems, Pleasanton, CA, USA). METHODS Residual ThinPrep samples (n = 121) were selected to provide a range of typical cytology results and enrich the study samples for HPV positivity. Specimens were equally split into two fractions: one part treated with 10% GAA and the other part left untreated. All samples were HPV tested using the cobas 4800 HPV Test, which simultaneously detects a total of 14 high-risk HPV (hrHPV) genotypes and individually identifies HPV16 and HPV18. The HPV positive/negative status of tested samples determined the level of agreement between treated and untreated fractions; one sample failed owing to detection of a clot by the instrument during pipetting, leaving 120 samples in the study. Statistical analysis was performed using an unweighted kappa. RESULTS Analysis of overall HPV positivity showed 97.5% (117/120) agreement between the treated and untreated fractions with a kappa value of 0.95. There were 63/65 (96.9%) concordant HPV positive and 54/55 (98.2%) concordant HPV negative results. In addition to the three discordant results for overall HPV positivity, there were three HPV type-specific discrepancies giving a total of 114/120 concordant HPV results (95% agreement). CONCLUSIONS Glacial acetic acid (GAA) treatment of cervical ThinPrep specimens does not have significant adverse affects on HPV detection with the cobas 4800 HPV Test.
Collapse
Affiliation(s)
- M McMenamin
- Cytopathology Department, Altnagelvin Hospital, Western Health and Social Care Trust, Derry, Northern Ireland, UK
| | | |
Collapse
|
31
|
Abstract
Increased ultraviolet light exposure and hypoxia at altitude along with the body's physiological adaptation to altitude can lead to problems with the visual system. The problems that occur can be at the time of the exposure or delayed. The article provides an overview of the ways which the different components of the visual system can be affected following such exposure.
Collapse
Affiliation(s)
- A Gibson
- James Cook University Hospital, Middlesbrough.
| | | |
Collapse
|
32
|
McKenna M, McCarthy R, Kilbane M, Molloy E. Vitamin D nutrient intake for all life stages. Ir Med J 2011; 104:102. [PMID: 21675089] [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: 05/30/2023]
|
33
|
Lonergan R, Kinsella K, Fitzpatrick P, Brady J, Murray B, Dunne C, Hagan R, Duggan M, Jordan S, McKenna M, Hutchinson M, Tubridy N. Multiple sclerosis prevalence in Ireland: relationship to vitamin D status and HLA genotype. J Neurol Neurosurg Psychiatry 2011; 82:317-22. [PMID: 21248317 DOI: 10.1136/jnnp.2010.220988] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The relationship between prevalence of multiple sclerosis (MS) and latitude may be due to both genetic and environmental factors. The hypothesis that, in Ireland, MS prevalence is increasing and that north-south differences relate to variation in serum 25-hydroxyvitamin D (25(OH)D) levels was tested in this study. PATIENTS AND METHODS Patients and matched control subjects were identified in counties Donegal, Wexford and South Dublin through multiple sources. Prevalence was determined. Blood samples were taken for serum 25(OH)D and serum intact parathyroid hormone measurement, and DNA was extracted. RESULTS Prevalence in 2007 was significantly greater in Donegal (northwest) (290.3/105, 95% CI 262.3 to 321.7) compared with 2001 (184.6/105; 162 to 209.5). In Wexford (southeast), there was a non-significant increase in prevalence in 2007 compared with 2001. Prevalence was significantly higher in Donegal than in Wexford (144.8/105; 126.7 to 167.8, p<0.0001) and South Dublin (127.8/105; 111.3 to 148.2, p<0.0001). Overall, mean 25(OH)D levels were low and did not differ between patients (38.6 nmol/l) and controls (36.4 nmol/l) However, significantly more patients than controls had 25(OH)D levels <25 nmol/l (deficiency) (p=0.004). Levels of 25(OH)D (mean 50.74 nmol/l) were significantly higher in South Dublin (area with lowest prevalence) (p<0.0001) than in Donegal or Wexford. HLA DRB1*15 occurred most frequently in Donegal (greatest MS prevalence) and least frequently in South Dublin. CONCLUSION Vitamin D deficiency is common in Ireland. Latitudinal variation in MS probably relates to an interaction between genetic factors and environment (25(OH)D levels), and MS risk may be modified by vitamin D in genetically susceptible individuals.
Collapse
Affiliation(s)
- R Lonergan
- Department of Neurology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Wyckelsma V, Aughey R, McKenna M. Physiological responses and movement demands of elite women playing Australian football in the midfield position. J Sci Med Sport 2010. [DOI: 10.1016/j.jsams.2010.10.493] [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: 10/18/2022]
|
35
|
Elias G, Varley M, Wyckelsma V, Minahan C, McKenna M, Stepto N, Aughey R. Cold water immersion is most effective for recovery of repeat sprint ability and reducing fatigue post an Australian football game. J Sci Med Sport 2010. [DOI: 10.1016/j.jsams.2010.10.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
36
|
Daley SK, Bernas MJ, Stea BD, Bracamonte F, McKenna M, Stejskal A, Hirleman ED, Witte MH. Radioprotection from radiation-induced lymphedema without tumor protection. Lymphology 2010; 43:48-58. [PMID: 20848992] [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: 05/29/2023]
Abstract
Lymphedema or tissue swelling from impaired lymph drainage commonly occurs after regional nodal dissection and/or radiation therapy for cancer control. Treatment options for this disabling and life-altering complication involve long-term labor-intensive commitments. Sentinel node biopsy can forestall removal of negative regional nodes, offering some protection against lymphedema, however, most preventive measures are elusive, ineffective, or unproven. Our goal was to determine whether the radioprotectant amifostine could prevent or retard the development of lymphedema in a rodent radiation therapy-dependent model yet not offer tumor protection from the therapeutic effects of radiation therapy. We pre-treated rats after unilateral radical groin dissection with the organic thiophosphate radioprotectant amifostine or placebo prior to single dose post-operative groin radiation therapy and monitored hindlimb volumes, wound scores, and tissue lymphostasis. In addition, we determined whether amifostine protected human MCF7 breast cancer cells exposed to a range of radiation therapy doses in an in vitro clonogenic assay and an in vivo MCF7 tumor xenograft model. Our findings indicate that amifostine markedly reduced the volume of limb lymphedema and dramatically improved wound healing and tissue lymphostasis in the rodent lymphedema model. The in vivo and in vitro studies further demonstrated that amifostine offered no MCF7 tumor protection from radiation therapy. These pre-clinical findings provide proof-of-principle to further delineate specific mechanisms underlying amifostine's beneficial effects, determine optimal amifostine-radiation therapy dosing regimens, and thereby expedite translation into clinical trials to reduce lymphedema incidence and severity in cancer patients at high lymphedema risk in whom radiation therapy is the recommended therapy.
Collapse
Affiliation(s)
- S K Daley
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona 85724-5200, USA
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Warren CW, Lea V, Lee J, Jones NR, Asma S, McKenna M. Resúmenes. Glob Health Promot 2009. [DOI: 10.1177/1757975909342917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
38
|
McKenna M, Arnold C, Catherwood MA, Humphreys MW, Cuthbert RJG, Bueso-Ramos C, McManus DT. Myeloid sarcoma of the small bowel associated with a CBF /MYH11 fusion and inv(16)(p13q22): a case report. J Clin Pathol 2009; 62:757-9. [DOI: 10.1136/jcp.2008.063669] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
39
|
|
40
|
Adams B, Fogarty P, McKenna M, McManus D. Superficial myofibroblastoma of the lower female genital tract: first case report of a pregnant patient. J OBSTET GYNAECOL 2009; 28:657-8. [PMID: 19003678 DOI: 10.1080/01443610802421668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- B Adams
- Ulster Hospital, Dundonald, UK.
| | | | | | | |
Collapse
|
41
|
Sostaric S, Goodman C, Gong X, Aw J, Steward C, Fraser S, Krum H, Snow R, Brown M, McKenna M. Effects of digoxin therapy on K+ release and fatigue during small muscle mass exercise in healthy humans. J Sci Med Sport 2009. [DOI: 10.1016/j.jsams.2008.12.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
42
|
Sostaric S, Pearce A, Gatt B, McKenna M, Stathis C, Goodman C. Mild electro-stimulation treatment accelerates recovery in healthy humans following exercise induced muscle damage. J Sci Med Sport 2009. [DOI: 10.1016/j.jsams.2008.12.061] [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: 10/21/2022]
|
43
|
McKenna M, McCluggage WG. Signet ring cells of stromal derivation in the uterine cervix secondary to cauterisation: report of a previously undescribed phenomenon. J Clin Pathol 2008; 61:648-51. [DOI: 10.1136/jcp.2007.054767] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
44
|
Tuthill A, Quinn A, McColgan D, McKenna M, O'Shea D, McKenna TJ. A prospective randomized controlled trial of lifestyle intervention on quality of life and cardiovascular risk score in patients with obesity and type 2 diabetes. Diabetes Obes Metab 2007; 9:917-9. [PMID: 17451423 DOI: 10.1111/j.1463-1326.2007.00731.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
45
|
Abstract
Conventionally motorized treadmills elicit different sprinting kinematics to the over-ground condition. Treadmills powered by a torque motor have been used to assess sprinting power; yet, the kinematics of sprinting on the torque treadmill are unknown. This study compares the sprinting kinematics, during the constant velocity phase, between a conventional treadmill, a torque treadmill and the over-ground condition to assess the suitability of each treadmill for sprinting studies and training. After familiarization, 13 recreationally active males performed multiple sprints at various experimental settings on each surface. Ninety sprints, which attained mean velocities over 7.0 m/s, had their lower-body sagittal plane joint angles during ground contact captured at 250 Hz. These data were low-pass filtered at 10 Hz, and compared with respect to surface, subject and velocity using an ANCOVA statistical model. Sprinting on the conventional treadmill elicited a longer ground contact time, a longer braking phase, a more extended knee at foot strike and a faster extending hip than the torque treadmill and over-ground (all P<0.05). The torque treadmill obtained an equivalent sprinting technique to the over-ground condition, with the exception of a less extended hip at toe-off, suggesting that it is more appropriate for laboratory sprinting analyses and training than the conventional treadmill.
Collapse
Affiliation(s)
- M McKenna
- Department of Applied Physiology, University of Strathclyde, Glasgow, UK
| | | |
Collapse
|
46
|
|
47
|
Kelleher FC, McKenna M, Collins C, Brady GM, Crown JP. Is bisphosphonate-induced osteonecrosis of the jaw (BONJ) an ischemic manifestation of pseudo-osteopetrosis?: Biochemical, densitometric, and imaging evidence. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.18621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
18621 Background: BONJ is an increasingly recognised but poorly understood complication of long-term B therapy. We hypothesise that the pathophysiology is ischaemic, and is due to an osteopetrosis (OP)-like lesion which causes progressive constriction of maxillo- mandibular perforating arterial foramina. Support for this comes from the observation that the osteoclast ruffled border is functionally impaired in osteopetrosis and structurally lost with B therapy. Cases of maxillomandibular osteomyelitis and avascular necrosis complicating OP exist. Additionally the blood supply of the jaw relies partly on small periosteal perforators. Methods: Bone mineral density (BMD) of 2 female patients (pt) with BONJ was investigated with dual energy x-ray absorbptiometry. Serum creatinine BB-isoenzyme (CK-BB) was determined. Serum acid phosphatase was assessed for patient 1. Bone biochemistry; (serum calcium, phosphate, parathyroid hormone, bone alkaline phosphatase, 25(OH) vitamin D, osteocalcin (intact), N. Ter.procoll1, CTX-1) was assessed. Multislice CT with orthoradial reconstruction was performed on pt 1. Results: CK-BB isoenzyme was increased at 21% and 20% in patients 1 and 2 (upper limit normal 2%). DEXA scan patient 1 results: BMD, lumbar spine; T score 4.9 (152%), Z score 5.4 (160%), femur; T score 2.2 (128%) Z score 2.5 (134%). DEXA scan patient 2 results: BMD lumbar spine; T score 0.2, Z score 1.2, femur; T score 1.2, Z score 1.8. Serum acid phosphatase in pt 1 was normal. Orthoradial reconstruction of the mandible in pt 1 showed absence of lateral lingual canals in affected hemi mandible.Mental foramen and inferior alveolar canal were not constricted. Conclusion: The increased BMD and CK BB isoenzyme seen in our pts are characteristic features of osteopetrosis. The normal acid phosphatase is explained by bisphosphonate-induced osteoclast apoptosis a phenomenon that does not occur in osteopetrosis. Orthoradial reconstruction of the mandible provided radiological correlation. The data was found to be consistent with the hypothesized disease process. No significant financial relationships to disclose.
Collapse
Affiliation(s)
| | - M. McKenna
- St. Vincent’s University Hospital, Dublin, Ireland
| | - C. Collins
- St. Vincent’s University Hospital, Dublin, Ireland
| | - G. M. Brady
- St. Vincent’s University Hospital, Dublin, Ireland
| | - J. P. Crown
- St. Vincent’s University Hospital, Dublin, Ireland
| |
Collapse
|
48
|
Millar J, Davidson A, McKenna M, Brunton C, Finlayson D, Labram EK. Cervical epidural abscess: an unusual case of persistent neck pain. Scott Med J 2005; 50:175-6. [PMID: 16374985 DOI: 10.1177/003693300505000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
49
|
McKenna M, Schousboe A. Workshop W04: Glycogen: a static or dynamic energy source? J Neurochem 2005. [DOI: 10.1111/j.1474-1644.2005.03229_9.x] [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: 11/30/2022]
|
50
|
McKenna M, Brodsky L. Extraesophageal acid reflux and recurrent respiratory papilloma in children. Int J Pediatr Otorhinolaryngol 2005; 69:597-605. [PMID: 15850681 DOI: 10.1016/j.ijporl.2004.11.021] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2004] [Revised: 11/08/2004] [Accepted: 11/23/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Recurrent respiratory papillomatosis (RRP) is a benign infectious disease which is caused by the human papilloma virus (HPV). When it infects the larynx, hoarseness and airway obstruction are often the presenting symptoms. Latent virus is found in the laryngeal mucosa of many more patients than exhibit the disease. The factors which lead to virus activation have not been identified, however, extra-esophageal acid reflux disease (EERD) has been suggested as one of these factors. METHODS This is a case series of four patients with RRP who had increase in severity of their disease with the recognition of concurrent extra-esophageal acid reflux. The clinical course of the papillomatosis and the diagnosis and treatment of reflux are compared over time. RESULTS In all four cases, with identification and treatment of the EERD, control of the RRP improved, and in at least two patients, was complete with resolution of the EERD. Lapses in compliance with medications or behavioral and dietary recommendations in three out of four patients led to a rebound in symptoms and signs of RRP, including worsening of vocal quality and the endoscopic appearance of the larynx. CONCLUSION The clinical course of these patients suggests a link between the presence of EERD and RRP. The inflammation induced by chronic acid exposure may result in the expression of HPV in susceptible tissues. Prompt diagnosis and effective treatment of EERD should be considered in all patients with difficult to control RRP or with clinical presentation or endoscopic signs of EERD.
Collapse
Affiliation(s)
- Margo McKenna
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
| | | |
Collapse
|