1
|
Busher A, Costello S, Culliton M, Fitzgerald J, Murphy MC. Review of the postnatal management of infants following positive direct antiglobulin test. Ir Med J 2023; 116:885. [PMID: 38259218] [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: 01/24/2024]
|
2
|
Scarton L, Nelson T, Jo A, O'Neal LJ, Yao Y, Huggins S, Legaspi AB, McClaren MJ, Cabassa JS, Burgos Melendez JM, Munoz-Pena JM, Markham MJ, Murphy MC, Chatzkel JA, Rogers S, George TJ. A nurse-led intervention in patients with newly diagnosed cancer and Type 2 diabetes: A pilot randomized controlled trial feasibility study. Cancer Med 2023. [PMID: 37212484 DOI: 10.1002/cam4.6118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/13/2023] [Accepted: 05/10/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Undiagnosed Type 2 diabetes (T2D) has been associated with advanced stage cancer at diagnosis, higher mortality, and lower long-term all-cause survival. This was a RCT pilot study to examine the feasibility of a nurse-led T2D intervention for adults with newly diagnosed cancer (≤3 months), and T2D, undiagnosed or untreated with medication, conducted at an outpatient oncology clinic affiliated with a large academic institution. METHODS Participants needed to meet the eligibility criteria including a HbA1c level between 6.5% and 9.9%. Randomization was 1:1 to a 3-month intervention that consisted of nursing-led diabetes education and immediate initiation of metformin versus referral to primary care for usual care (control). RESULTS Three hundred and seventy nine patients were screened using EHR, 55 agreed to participate, and 3 had eligible HbA1c levels and were randomized in the study. Primary reasons for study exclusion included life expectancy ≤2 years (16.9%), current use or inability to tolerate metformin (14.8%), and abnormal labs that contraindicated metformin use (13.9%). CONCLUSION This study was not feasible due to recruitment inefficiencies, but acceptable to all who qualified.
Collapse
Affiliation(s)
- Lisa Scarton
- College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Tarah Nelson
- College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Ara Jo
- College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - LaToya J O'Neal
- College of Agricultural and Life Sciences, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, Florida, USA
| | - Yingwei Yao
- College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Shavondra Huggins
- College of Nursing, University of Florida, Gainesville, Florida, USA
| | | | - Mariah J McClaren
- College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Jake S Cabassa
- College of Nursing, University of Florida, Gainesville, Florida, USA
| | | | - Juan M Munoz-Pena
- Division of Endocrinology, Diabetes and Metabolism, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Merry J Markham
- Division of Hematology and Oncology, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Martina C Murphy
- Division of Hematology and Oncology, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Jonathan A Chatzkel
- Division of Hematology and Oncology, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Sherise Rogers
- Division of Hematology and Oncology, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Thomas J George
- Division of Hematology and Oncology, University of Florida, College of Medicine, Gainesville, Florida, USA
| |
Collapse
|
3
|
Graff SL, Wildes T, Duma N, Dizon DS, LoConte NK, Mitchell E, Murphy MC, Perez EA, Temkin SM, Kunz PL, Winkfield KM. Understanding Modern Medical Centers: Beyond Simone-Intersectional Maxims for a New Era. J Clin Oncol 2023; 41:1350-1358. [PMID: 36166718 DOI: 10.1200/jco.22.01060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Stephanie L Graff
- Division of Medical Oncology, Lifespan Cancer Institute, Brown University, Providence, RI
| | | | - Narjust Duma
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Don S Dizon
- Division of Medical Oncology, Lifespan Cancer Institute, Brown University, Providence, RI
| | - Noelle K LoConte
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Edith Mitchell
- Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Martina C Murphy
- Division of Hematology and Oncology, Department of Medicine, University of Florida College of Medicine, Gainesville, FL
| | - Edith A Perez
- Department of Hematology/Oncology and Cancer Biology, Mayo Clinic Jacksonville, Jacksonville, FL
| | | | - Pamela L Kunz
- Department of Medicine, Yale School of Medicine, New Haven, CT
| | - Karen M Winkfield
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
4
|
Velazquez AI, Durani U, Weeks LD, Major A, Reynolds R, Kumbamu A, Das DG, Murphy MC, Henry E, Lee AI, Marshall AL. Impact of COVID-19 on Hematology-Oncology Fellowship Programs: A Quantitative and Qualitative Survey Assessment of Fellowship Program Directors. JCO Oncol Pract 2022; 18:e551-e563. [PMID: 35015586 PMCID: PMC9014421 DOI: 10.1200/op.21.00634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/27/2021] [Accepted: 11/30/2021] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The COVID-19 pandemic led to unprecedented challenges in medical training, and we sought to assess the specific impact of COVID-19 on hematology-oncology (HO) fellowship programs. METHODS We conducted a cross-sectional anonymous online survey of 103 HO program directors (PDs) in conjunction with the American Society of Hematology (ASH) and ASCO. We sought to assess the specific impact of COVID-19 on HO fellowship programs' clinical, educational, and research activities, evaluate perceptions regarding PD and trainee emotional and mental health, and identify ways to support programs. Data were analyzed using descriptive statistics, parametric and nonparametric tests, and multivariable logistic regression models. Responses to open-ended questions were analyzed with thematic analysis. RESULTS Significant changes to fellowship activities included transitioning fellow training from outpatient clinics to telehealth (77.7%), shifting to virtual education (94.2%), and moving to remote research work (63.1%). A minority (21.4%) of PDs reported that their fellows were redeployed to cover non-HO services. Most PDs (54.4%) believed COVID-19 had a slight negative impact on fellowship training. PD self-reported burnout increased significantly from 15.5% prepandemic to 44.7% during the pandemic, and most PDs witnessed minor signs of fellow burnout (52.4%). Common PD concerns included inadequate supervision for telehealth activities, reduced opportunities for fellow advancement and promotion, lack of professional development activities, limited research operations and funding, program financial constraints, and virtual recruitment. CONCLUSION We encourage institutions and national societies to allocate resources and develop programs that can support fellowships and mitigate the potential negative effects of COVID-19 on trainee and PD career development.
Collapse
Affiliation(s)
- Ana I. Velazquez
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA
- National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA
| | - Urshila Durani
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Ajay Major
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | | | - Ashok Kumbamu
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Devika G. Das
- Division of Hematology and Oncology, University of Alabama Medical Center, Birmingham, AL
| | - Martina C. Murphy
- Division of Hematology and Oncology, University of Florida, Gainesville, FL
| | - Elizabeth Henry
- Department of Medical Education, Loyola University Medical Center, Maywood, IL
- Division of Hematology and Oncology, Loyola University Medical Center, Maywood, IL
| | - Alfred I. Lee
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Ariela L. Marshall
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| |
Collapse
|
5
|
Durani U, Major A, Velazquez AI, May J, Nelson M, Zheng Z, Hall AG, Alam ST, Reynolds R, Thompson JC, Kumbamu A, Das DG, Murphy MC, Henry E, Lee AI, Marshall AL, Wun T, Weeks LD. Impact of COVID-19 on Hematology-Oncology Trainees: A Quantitative and Qualitative Assessment. JCO Oncol Pract 2022; 18:e586-e599. [PMID: 34990292 PMCID: PMC9014488 DOI: 10.1200/op.21.00630] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Graduate medical and research training has drastically changed during the COVID-19 pandemic, with widespread implementation of virtual learning, redeployment from core rotations to the care of patients with COVID-19, and significant emotional and physical stressors. The specific experience of hematology-oncology (HO) fellows during the COVID-19 pandemic is not known. METHODS We conducted a mixed-methods study using a survey of Likert-style and open-ended questions to assess the training experience and well-being of HO fellows, including both clinical and postdoctoral trainee members of the American Society of Hematology and ASCO. RESULTS A total of 2,306 surveys were distributed by e-mail; 548 (23.8%) fellows completed the survey. Nearly 40% of fellows felt that they had not received adequate mental health support during the pandemic, and 22% reported new symptoms of burnout. Pre-existing burnout before the pandemic, COVID-19-related clinical work, and working in a primary research or nonclinical setting were associated with increased burnout on multivariable logistic regression. Qualitative thematic analysis of open-ended responses revealed significant concerns about employment after training completion, perceived variable quality of virtual education and board preparation, loss of clinical opportunities to prepare for independent clinical practice, inadequate grant funding opportunities in part because of shifting research priorities, variable productivity, and mental health or stress during the pandemic. CONCLUSION HO fellows have been profoundly affected by the pandemic, and our data illustrate multiple avenues for fellowship programs and national organizations to support both clinical and postdoctoral trainees.
Collapse
Affiliation(s)
- Urshila Durani
- Department of Hematology and HCT, City of Hope, Duarte, CA
| | - Ajay Major
- Section of Hematology-Oncology, Department of Medicine, The University of Chicago, Chicago, IL
| | - Ana I Velazquez
- Division of Hematology-Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA.,National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA
| | - Jori May
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham Medical Center, Birmingham, AL
| | - Marquita Nelson
- Division of Hematology and Oncology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Ze Zheng
- Division of Endocrinology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.,Blood Research Institute, Versiti Blood Center of Wisconsin, Milwaukee, WI
| | - Anurekha G Hall
- Division of Hematology and Oncology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Sara Taveras Alam
- Division of Hematology and Oncology, Baylor College of Medicine, Houston, TX
| | | | | | - Ashok Kumbamu
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Devika G Das
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham Medical Center, Birmingham, AL
| | - Martina C Murphy
- Division of Hematology and Oncology, University of Florida, Gainesville, FL
| | - Elizabeth Henry
- Department of Medical Education, Loyola University Medical Center, Maywood, IL.,Division of Hematology and Oncology, Loyola University Medical Center, Maywood, IL
| | - Alfred Ian Lee
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT
| | - Ariela L Marshall
- Division of Hematology, Mayo Clinic, Rochester, MN.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Ted Wun
- Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Lachelle Dawn Weeks
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| |
Collapse
|
6
|
Murphy MC, Gibney B, Walsh J, Orpen G, Kenny E, Bolster F, MacMahon PJ. Ultra-low-dose cone-beam CT compared to standard dose in the assessment for acute fractures. Skeletal Radiol 2022; 51:153-159. [PMID: 34132888 DOI: 10.1007/s00256-021-03825-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Multi-detector computed tomography (MDCT) is superior in fracture detection than conventional radiography; however, dose is increased. Cone-beam computed tomography (CBCT) offers higher spatial resolution and lower dose than MDCT. Manufacturers offer an ultra-low-dose algorithm. This study compares the diagnostic accuracy of the ultra-low-dose CBCT (ULDCBCT) with that of the standard-dose CBCT (SDCBCT). MATERIALS AND METHODS In total, 64 patients were scanned with both the SDCBCT and the ULDCBCT protocols. Both studies were reported by two consultant radiologists with fellowship training in emergency radiology separated in time. The reporter recorded a diagnosis of fracture or normal and diagnostic confidence using a 5-point Likert scale. The gold standard was taken as the SDCBCT. Reporters were blinded to the indication and the SDCBCT report. Cases of discrepancy were resolved by consensus. RESULTS There were 34 fractures and 30 cases had no fracture. Several fractures were missed using the UDCBCT, and there were also several cases of overdiagnosis. ULD was inferior to SD for fracture diagnosis (p < 0.00001). The diagnostic accuracy of ULDCBCT was 82.8% (75.1-88.9 CI). The diagnostic accuracy of plain radiograph was 64% (55.1-75.7% CI). Diagnostic confidence was reduced; the mean confidence for SDCBCT was 4.68 vs 4.12 for ULDCBCT (p < 0.001). The Kappa for interobserver agreement was 0.6. CONCLUSION ULDCBCT is inferior to SDCBCT in fracture detection and confidence is reduced. For diagnostic studies, the standard dose should be used.
Collapse
Affiliation(s)
- M C Murphy
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland.
| | - B Gibney
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - J Walsh
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - G Orpen
- Department of Radiography, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - E Kenny
- Department of Medical Physics, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - F Bolster
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - P J MacMahon
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| |
Collapse
|
7
|
Cogswell PM, Murphy MC, Senjem ML, Botha H, Gunter JL, Elder BD, Graff-Radford J, Jones DT, Cutsforth-Gregory JK, Schwarz CG, Meyer FB, Huston J, Jack CR. Changes in Ventricular and Cortical Volumes following Shunt Placement in Patients with Idiopathic Normal Pressure Hydrocephalus. AJNR Am J Neuroradiol 2021; 42:2165-2171. [PMID: 34674997 DOI: 10.3174/ajnr.a7323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/18/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE While changes in ventricular and extraventricular CSF spaces have been studied following shunt placement in patients with idiopathic normal pressure hydrocephalus, regional changes in cortical volumes have not. These changes are important to better inform disease pathophysiology and evaluation for copathology. The purpose of this work is to investigate changes in ventricular and cortical volumes in patients with idiopathic normal pressure hydrocephalus following ventriculoperitoneal shunt placement. MATERIALS AND METHODS This is a retrospective cohort study of patients with idiopathic normal pressure hydrocephalus who underwent 3D T1-weighted MR imaging before and after ventriculoperitoneal shunt placement. Images were analyzed using tensor-based morphometry with symmetric normalization to determine the percentage change in ventricular and regional cortical volumes. Ventricular volume changes were assessed using the Wilcoxon signed rank test, and cortical volume changes, using a linear mixed-effects model (P < .05). RESULTS The study included 22 patients (5 women/17 men; mean age, 73 [SD, 6] years). Ventricular volume decreased after shunt placement with a mean change of -15.4% (P < .001). Measured cortical volume across all participants and cortical ROIs showed a mean percentage increase of 1.4% (P < .001). ROIs near the vertex showed the greatest percentage increase in volume after shunt placement, with smaller decreases in volume in the medial temporal lobes. CONCLUSIONS Overall, cortical volumes mildly increased after shunt placement in patients with idiopathic normal pressure hydrocephalus with the greatest increases in regions near the vertex, indicating postshunt decompression of the cortex and sulci. Ventricular volumes showed an expected decrease after shunt placement.
Collapse
Affiliation(s)
- P M Cogswell
- From the Departments of Radiology (P.M.C., M.C.M., J.L.G., C.G.S., J.H., C.R.J.)
| | - M C Murphy
- From the Departments of Radiology (P.M.C., M.C.M., J.L.G., C.G.S., J.H., C.R.J.)
| | | | - H Botha
- Neurology (H.B., J.G.-R., D.T.J., J.K.C.-G.)
| | - J L Gunter
- From the Departments of Radiology (P.M.C., M.C.M., J.L.G., C.G.S., J.H., C.R.J.)
| | - B D Elder
- Neurosurgery (B.D.E., F.B.M.)
- Biomedical Engineering (B.D.E.), Mayo Clinic, Rochester, Minnesota
| | | | - D T Jones
- Neurology (H.B., J.G.-R., D.T.J., J.K.C.-G.)
| | | | - C G Schwarz
- From the Departments of Radiology (P.M.C., M.C.M., J.L.G., C.G.S., J.H., C.R.J.)
| | | | - J Huston
- From the Departments of Radiology (P.M.C., M.C.M., J.L.G., C.G.S., J.H., C.R.J.)
| | - C R Jack
- From the Departments of Radiology (P.M.C., M.C.M., J.L.G., C.G.S., J.H., C.R.J.)
| |
Collapse
|
8
|
Murphy MC, Gibney B, Gillespie C, Hynes J, Bolster F. Gallstones top to toe: what the radiologist needs to know. Insights Imaging 2020; 11:13. [PMID: 32026025 PMCID: PMC7002643 DOI: 10.1186/s13244-019-0825-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/05/2019] [Indexed: 01/11/2023] Open
Abstract
Gallstone-related disease can have significant associated morbidity and mortality worldwide. The incidence of gallstone-related disease in the Western world is on the increase. There are multiple different pathological manifestations of gallstone disease: the presentation, diagnosis and associated complications of which vary significantly depending on anatomical location. The role of imaging in gallstone-related disease is broad with radiology playing an essential role in the diagnosis, management and follow-up of gallstone-related pathologies. This paper distills the broad range of gallstone-related pathologies into an anatomical map, discussing the disease processes involved at each point along the biliary tree and reviewing the strengths and weaknesses of different imaging modalities for each distinct disease process.
Collapse
Affiliation(s)
- M C Murphy
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - B Gibney
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - C Gillespie
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - J Hynes
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - F Bolster
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| |
Collapse
|
9
|
Duma N, Durani U, Woods CB, Kankeu Fonkoua LA, Cook JM, Wee C, Fuentes HE, Gonzalez-Velez M, Murphy MC, Jain S, Marshall AL, Graff SL, Knoll MA. Evaluating Unconscious Bias: Speaker Introductions at an International Oncology Conference. J Clin Oncol 2019; 37:3538-3545. [PMID: 31603705 DOI: 10.1200/jco.19.01608] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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
PURPOSE In a professional setting, the introduction of female speakers without their professional title may have an impact on the public's perception of the female speaker. We examined how professional titles were used during speakers' introductions at the ASCO Annual Meeting. METHODS We conducted a retrospective, observational study of video-archived speaker introductions at the 2017 and 2018 ASCO Annual Meetings. A "professional address" was defined as the professional title followed by the speaker's full name or last name. Multivariable logistic regressions were used to identify factors associated with the form of address. RESULTS Of 2,511 videos reviewed, 781 met inclusion criteria. Female speakers were addressed less often by their professional title compared with male speakers (62% v 81%; P < .001). Males were less likely to use a professional address when introducing female speakers compared with females when introducing male speakers (53% v 80%; P < .01). When women performed speaker introductions, no gender differences in professional address were observed (75% v 82%; P = .13). Female speakers were more likely to be introduced by first name only (17% v 3%; P < .001). Male introducers were more likely to address female speakers by first name only compared with female introducers (24% v 7%; P < .01). In a multivariable regression including gender, degree, academic rank, and geographic location of the speaker's institution, male speakers were more likely to receive a professional address compared with female speakers (odds ratio, 2.43; 95% CI, 1.71 to 3.47; P < .01). CONCLUSION When introduced by men, female speakers were less likely to receive a professional address and more likely to be introduced by first name only compared with their male peers.
Collapse
Affiliation(s)
- Narjust Duma
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Murphy MC, O’Donnell CPF. Pneumothorax in Newborns: Needle, Less Damage Done? Ir Med J 2018; 111:832. [PMID: 30558405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- M C Murphy
- National Maternity Hospital, Holles Street, Dublin 2
- National Children’s Research Centre, Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland
- School of Medicine, University College Dublin, Ireland
| | - C P F O’Donnell
- National Maternity Hospital, Holles Street, Dublin 2
- National Children’s Research Centre, Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland
- School of Medicine, University College Dublin, Ireland
| |
Collapse
|
11
|
Murphy MC, Markham MJ. Rare Case of Syndrome of Inappropriate Antidiuretic Hormone As the Initial Presentation of Ovarian Cancer Recurrence. J Clin Oncol 2015; 33:e48-9. [DOI: 10.1200/jco.2013.49.8089] [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: 11/20/2022] Open
|
12
|
Abstract
AIMS The aim of this study was to use general practice data to estimate the prevalence of diabetic nephropathy within the registered diabetes patients and examine variation in practice prevalence and management performance since introduction of this initiative. METHODS Reported quality indicators from the Northern Ireland General Practice Quality and Outcomes Framework were analysed for diabetes and diabetic nephropathy prevalence and management in the period 2004-2008. Variation in prevalence at practice level was assessed using multiple linear regression adjusting for age, practice size, deprivation and glycaemic control. RESULTS In 2006-2007, 57,454 (4.1%) adult diabetic patients were registered in the denominator population of 1.4 million compared with 51,923 (3.8%) in 2004-2005 (mean practice range 0.5-7.7%). Diabetic nephropathy prevalence was 15.1 and 11.5%, respectively (8688 and 5955 patients). Documented diabetic nephropathy prevalence showed marked variation across practices (range 0-100%) and was significantly negatively correlated with diabetes list size, albumin creatinine ratio testing rates and renin-angiotensin-aldosterone system blockade use and positively correlated with exception reporting rates. Specifically, for every increase in 100 diabetic patients to a register, documented diabetic nephropathy prevalence reduced by 40% (P=0.003). On the positive side, median albumin-creatinine ratio testing rates doubled to 82% compared with figures in the pre-Framework era. CONCLUSIONS Implementation of the Northern Ireland General Practice Quality and Outcomes Framework has positively benefitted testing for diabetic nephropathy and increased numbers of detected patients in a short space of time. Large variation in diabetic nephropathy prevalence remains and is associated with diabetes registry size, screening and treatment practices, suggesting that understanding this variation may help detect and better manage diabetic nephropathy.
Collapse
Affiliation(s)
- G M Magee
- Regional Centre for Diabetes and Endocrinology, Royal Victoria Hospital, Belfast, Co Antrim, UK.
| | | | | | | | | | | | | |
Collapse
|
13
|
Murphy MC, Steele JL, Daly C, McKay LL. Concomitant conjugal transfer of reduced-bacteriophage-sensitivity mechanisms with lactose- and sucrose-fermenting ability in lactic streptococci. Appl Environ Microbiol 2010; 54:1951-6. [PMID: 16347707 PMCID: PMC202785 DOI: 10.1128/aem.54.8.1951-1956.1988] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Ten previously reported lactose-positive (Lac) transconjugants from Streptococcus lactis, S. cremoris, and S. lactis subsp. diacetylactis and one sucrose-positive (Suc) transconjugant from S. lactis were examined for their sensitivity to prolate- and small isometric-headed bacteriophages. Four of the Lac transconjugants showed a 10- to 100-fold reduction in the efficiency of plating (EOP) as well as a reduced plaque size for the prolate phage c2 and were insensitive to the small isometric phage 712. A fifth Lac transconjugant demonstrated a similar reduced sensitivity to phage c2; however, this transconjugant was able to plaque phage 712, but with a reduced plaque size and EOP. The other five Lac transconjugants were sensitive to both c2 and 712 phages. The Suc transconjugant plaqued phage 712 with a reduced plaque size and EOP, but no reduction in plaque size or EOP was observed for phage c2. The Lac and reduced bacteriophage sensitivity (Rbs) phenotypes were correlated with specific plasmids in the Lac transconjugants. As four of the Lac transconjugants exhibited a phenotypically indistinguishable Rbs, one (AB001) was selected for further study. The Rbs in AB001 for both small isometric- and prolate-headed phages was not related to adsorption, and the reduced EOP for phage c2 was not related to the presence of a restriction and modification system. The latent period for phage c2 was unchanged, but the burst size was reduced 80%. The presence of the plasmid coding for Rbs retarded the lysis of a mitomycin C-induced prophage-containing strain. The Rbs mechanism appears to be abortive phage infection. This study supports previous observations that Rbs and conjugal transfer ability are physically linked among some group N streptococci. The results presented have implications in the identification of plasmids coding for Rbs and may also aid in explaining the dissemination of Rbs genes among lactic streptococci.
Collapse
Affiliation(s)
- M C Murphy
- Department of Food Science and Nutrition, University of Minnesota, 1334 Eckles Avenue, St. Paul, Minnesota 55108, and Department of Dairy and Food Microbiology, University College, Cork, Ireland
| | | | | | | |
Collapse
|
14
|
Park DSW, Hupert ML, Witek MA, You BH, Datta P, Guy J, Lee JB, Soper SA, Nikitopoulos DE, Murphy MC. A titer plate-based polymer microfluidic platform for high throughput nucleic acid purification. Biomed Microdevices 2008; 10:21-33. [PMID: 17659445 DOI: 10.1007/s10544-007-9106-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [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: 10/23/2022]
Abstract
A 96-well solid-phase reversible immobilization (SPRI) reactor plate was designed to demonstrate functional titer plate-based microfluidic platforms. Nickel, large area mold inserts were fabricated using an SU-8 based, UV-LIGA technique on 150 mm diameter silicon substrates. Prior to UV exposure, the prebaked SU-8 resist was flycut to reduce the total thickness variation to less than 5 mum. Excellent UV lithography results, with highly vertical sidewalls, were obtained in the SU-8 by using an UV filter to remove high absorbance wavelengths below 350 nm. Overplating of nickel in the SU-8 patterns produced high quality, high precision, metal mold inserts, which were used to replicate titer plate-based SPRI reactors using hot embossing of polycarbonate (PC). Optimized molding conditions yielded good feature replication fidelity and feature location integrity over the entire surface area. Thermal fusion bonding of the molded PC chips at 150 degrees C resulted in leak-free sealing, which was verified in leakage tests using a fluorescent dye. The assembled SPRI reactor was used for simple, fast purification of genomic DNA from whole cell lysates of several bacterial species, which was verified by PCR amplification of the purified genomic DNA.
Collapse
Affiliation(s)
- D S-W Park
- Center for Bio-Modular Multi-Scale Systems, Louisiana State University, Baton Rouge, LA 70803, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Jordan SN, Mullen GJ, Murphy MC. Composition variability of spent mushroom compost in Ireland. Bioresour Technol 2008; 99:411-8. [PMID: 17306529 DOI: 10.1016/j.biortech.2006.12.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Revised: 12/01/2006] [Accepted: 12/01/2006] [Indexed: 05/14/2023]
Abstract
Spent mushroom compost (SMC) has proven to be an attractive material for improving soil structure in tilled soils and increasing dry matter production in grassland soils, owing to its high organic matter content and availability of essential plant nutrients. Because of this, it is important to identify the variability in composition of SMC in order to evaluate its merit as a fertilizer/soil conditioner. For this reason, a study was carried out involving the analysis of SMC samples obtained from five mushroom growers using compost from each of the 13 mushroom composting yards currently operating in both Northern Ireland (5 yd) and the Republic of Ireland (8 yd). The selected parameters measured include dry matter, organic matter, total N, P and K, C/N ratio; plant-available P and K, pH, EC, total Ca, Mg, Na, Cu, Zn, Fe, Mn, Cd, Cr, Ni, Pb; and cellulose, hemicellulose and lignin constituents. Yield of mushroom data were also collected from the selected growers. There were significant differences (P<0.05) within two compost production yards for some parameters, therefore, for the most part, the uniformity of SMC within each yard is relatively consistent. However, significant differences (P<0.05) were evident when comparing SMC obtained from growers supplied with compost from Northern Ireland and the Republic of Ireland independently, particularly among total and available phosphorus and potassium values. The results obtained show that, while SMC has fertilizer merit, its variability of composition must be taken into account when assessing this value. The variability of composition is also of particular interest in the context of recent emphasis on plant nutrient management in agriculture.
Collapse
Affiliation(s)
- S N Jordan
- National Centre for Freshwater Studies, Department of Applied Science, Dundalk Institute of Technology, Co Louth, Ireland.
| | | | | |
Collapse
|
16
|
Harvey PA, Murphy MC, Dornom E, Berlowitz DJ, Lim WK, Jackson B. Implementing evidence-based guidelines: inpatient management of chronic obstructive pulmonary disease. Intern Med J 2005; 35:151-5. [PMID: 15737134 DOI: 10.1111/j.1445-5994.2004.00754.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [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: 11/29/2022]
Abstract
BACKGROUND Evidence-based guidelines exist to guide inpatient management of chronic obstructive pulmonary disease (COPD) exacerbations, but we do not know how well these recommendations are adhered to. AIMS The aims of this study were: (i) to examine concordance with evidence based guidelines for inpatient management of COPD and (ii)to address deficiencies in compliance with guidelines by feedback of audit results and distribution of an education package. METHODS Retrospective chart reviews were performed using a data collection tool based on current guidelines. Forty-nine consecutive COPD admissions were audited, and results presented to medical staff. An education package was distributed directly after the presentation. One month later,35 consecutive separations were reviewed. Concordance with recommendations supported by the highest level of evidence was calculated. RESULTS Data were complete for 84 cases. Concordance rates ranged from 0 to 100%. Apart from initiation of systemic steroids (80-83%)and avoidance of intravenous aminophylline (100%),concordance rates were less than 60%. The only significant improvement post-intervention was for steroid duration (10 vs 29%,95% confidence interval for difference (-36.2, -1.8)). CONCLUSION Recommendations for steroid initiation and avoidance of aminophylline are well adhered to. Concordance rates for other recommendations were generally less than 60%. Concordance with recommendations for steroid duration was significantly improved by our intervention. The findings suggest that to facilitate evidence-based practice, alternative interventions should be evaluated.
Collapse
Affiliation(s)
- P A Harvey
- TheNorthern Clinical Research Centre, The Northern Hospital, NorthernHealth, Melbourne, Victoria, Australia.
| | | | | | | | | | | |
Collapse
|
17
|
Abstract
Single-stranded DNA (ssDNA) is an essential intermediate in various DNA metabolic processes and interacts with a large number of proteins. Due to its flexibility, the conformations of ssDNA in solution can only be described using statistical approaches, such as flexibly jointed or worm-like chain models. However, there is limited data available to assess such models quantitatively, especially for describing the flexibility of short ssDNA and RNA. To address this issue, we performed FRET studies of a series of oligodeoxythymidylates, (dT)N, over a wide range of salt concentrations and chain lengths (10 < or = N < or = 70 nucleotides), which provide systematic constraints for testing theoretical models. Unlike in mechanical studies where available ssDNA conformations are averaged out during the time it takes to perform measurements, fluorescence lifetimes may act here as an internal clock that influences fluorescence signals depending on how fast the ssDNA conformations fluctuate. A reasonably good agreement could be obtained between our data and the worm-like chain model provided that limited relaxations of the ssDNA conformations occur within the fluorescence lifetime of the donor. The persistence length thus estimated ranges from 1.5 nm in 2 M NaCl to 3 nm in 25 mM NaCl.
Collapse
Affiliation(s)
- M C Murphy
- Physics Department, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | | | | | | | | |
Collapse
|
18
|
Lumbers M, New SA, Gibson S, Murphy MC. Nutritional status in elderly female hip fracture patients: comparison with an age-matched home living group attending day centres. Br J Nutr 2001; 85:733-40. [PMID: 11430778 DOI: 10.1079/bjn2001350] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.7] [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: 11/11/2022]
Abstract
Fractured neck of femur occurs mostly in the older female population and is generally caused by falls. Malnutrition has been postulated as a factor that increases the tendency to suffer falls. Nutritional status of older female hospital patients admitted for emergency surgery for fractured neck of femur recruited (n 75), was compared with an age-matched independent-living group of females attending one of three local day centres (n 50). Dietary assessment was undertaken using three consecutive 24 h dietary recalls and, in the hip fracture group, completed menu cards were used as memory prompts. Data concerning key lifestyle characteristics were obtained using a face-to-face administered questionnaire. Blood samples were taken to determine levels of plasma albumin, transferrin, C-reactive protein (CRP), cholesterol, vitamin C, Se, Zn and total antioxidant status. Haemolysate samples were analysed for Se-dependent glutathione peroxidase activity. There were no significant differences in age between the two groups, but the hip fracture patients had lower mean values for body weight (59.6 v. 67.5 kg; mindex (weight/demispan) (83.1 v. 94.4 kg/m; calculated BMI (24.1 v. 27.5 kg/m2 mid-upper arm circumference; 27.1 v. 31.3 cm, and triceps skinfold thickness; 17.0 v. 18.9 mm, than the home-living group. The hip fracture patients had lower intakes of energy (4.3 v. 5.4 MJ, fat carbohydrate protein thiamine vitamin B6 calcium K Mg P Fe Se and NSP Mean intakes of both groups were below the estimated average requirement for energy and below the reference nutrient intakes for folate, Ca, vitamin D, Mg, K, Se and Zn. In a high percentage of the hip fracture group the dietary intake of particular nutrients fell below the lower reference nutrient intake for Se (73 %), Mg (54 %) and Fe (19 %). As expected, the fracture patients had reduced plasma albumin and increased CRP values. They had higher plasma vitamin C levels and lower cholesterol levels than the day centre attendees. There were no significant differences in plasma levels of Se, Zn, transferrin or haemolysate glutathione peroxidase activity between the two groups. However, there was evidence of under-nutrition in both groups as key anthropometric values were low, plasma nutrient and metabolite levels were below the standard reference ranges and many individuals had low dietary intakes for specified nutrients.
Collapse
Affiliation(s)
- M Lumbers
- Food and Health Care Management Research Group, School of Management Studies for the Service Sector, University of Surrey, UK
| | | | | | | |
Collapse
|
19
|
Minihane AM, Khan S, Talmud PJ, Williams DL, Wright JW, Murphy MC, Griffin BA, Williams CM. Lack of association between lipaemia and central adiposity in subjects with an atherogenic lipoprotein phenotype (ALP). Int J Obes (Lond) 2000; 24:1097-106. [PMID: 11033977 DOI: 10.1038/sj.ijo.0801372] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the associations between indices of adiposity and cardiovascular risk factors in individuals with an atherogenic lipoprotein phenotype (ALP). SUBJECTS Fifty-five men, aged 34-69 y, body mass index (BMI) 22-35 kg/m2, with an ALP lipid profile (triglycerides (TG) 1.5-4.0 mmol/l, HDL<1.1 mmol/l; %LDL-3>40% total LDL). DESIGN Each participant provided a fasting blood sample and underwent an 8 h postprandial assessment and had anthropometric measurements taken. OUTCOME MEASURES BMI, waist circumference (W), waist-to-hip ratio (W/H), sum of skinfolds (SSK), fasting and postprandial concentrations of glucose, insulin and plasma lipids, post-heparin lipase activity, and apoE genotype. RESULTS The expected positive associations between BMI, W and SSK and fasting and postprandial insulin were observed (r=0.42-0.65). Little association between glucose responses and any measures of adiposity was evident. Unexpectedly, there were no positive associations between measures of central adiposity (W and W/H) and fasting and postprandial TG responses, with a trend towards negative associations in this study group (TG AUC vs W, r=-0.23, P=0.097; TG IAUC vs W/H, r=-0.26, P=0.068). Subgroup analysis indicated that lack of a positive association between central adiposity and postprandial TG values was more evident in those with one E4 allele (r=-0.42, P=0.077) relative to non-E4 carriers (r=-0.16, P=0.430). The expected positive associations between insulin and TG responses were not observed (r=-0.03 to -0.36). CONCLUSION In this ALP group the expected positive association between TG responses and a centralized distribution of body fat was not observed, particularly in individuals with an apoE4 genotype. Our findings are not in line with the view that there is a clear causal relationship between insulin resistance and the lipid abnormalities associated with ALP.
Collapse
Affiliation(s)
- A M Minihane
- Department of Food Science and Technology, University of Reading, Whiteknights, UK.
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Minihane AM, Khan S, Leigh-Firbank EC, Talmud P, Wright JW, Murphy MC, Griffin BA, Williams CM. ApoE polymorphism and fish oil supplementation in subjects with an atherogenic lipoprotein phenotype. Arterioscler Thromb Vasc Biol 2000; 20:1990-7. [PMID: 10938022 DOI: 10.1161/01.atv.20.8.1990] [Citation(s) in RCA: 181] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The study assessed the efficacy of fish oil supplementation in counteracting the classic dyslipidemia of the atherogenic lipoprotein phenotype (ALP). In addition, the impact of the common apolipoprotein E (apoE) polymorphism on the fasting and postprandial lipid profile and on responsiveness to the dietary intervention was established. Fifty-five ALP males (aged 34 to 69 years, body mass index 22 to 35 kg/m(2), triglyceride [TG] levels 1.5 to 4.0 mmol/L, high density lipoprotein cholesterol [HDL-C] <1.1 mmol/l, and percent low density lipoprotein [LDL]-3 >40% total LDL) completed a randomized placebo-controlled crossover trial of fish oil (3.0 g eicosapentaenoic acid/docosahexaenoic acid per day) and placebo (olive oil) capsules with the 6-week treatment arms separated by a 12-week washout period. In addition to fasting blood samples, at the end of each intervention arm, a postprandial assessment of lipid metabolism was carried out. Fish oil supplementation resulted in a reduction in fasting TG level of 35% (P<0.001), in postprandial TG response of 26% (TG area under the curve, P<0.001), and in percent LDL-3 of 26% (P<0.05). However, no change in HDL-C levels was evident (P=0.752). ANCOVA showed that baseline HDL-C levels were significantly lower in apoE4 carriers (P=0.035). The apoE genotype also had a striking impact on lipid responses to fish oil intervention. Individuals with an apoE2 allele displayed a marked reduction in postprandial incremental TG response (TG incremental area under the curve, P=0.023) and a trend toward an increase in lipoprotein lipase activity relative to non-E2 carriers. In apoE4 individuals, a significant increase in total cholesterol and a trend toward a reduction in HDL-C relative to the common homozygous E3/E3 profile was evident. Our data demonstrate the efficacy of fish oil fatty acids in counteracting the proatherogenic lipid profile of the ALP but also that the apoE genotype influences responsiveness to this dietary treatment.
Collapse
Affiliation(s)
- A M Minihane
- Hugh Sinclair Unit of Human Nutrition, Department of Food Science and Technology, University of Reading, Reading, UK.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
OBJECTIVE To assess the use of the Mini-Nutritional Assessment (MNA) in elderly orthopaedic patients. DESIGN An observation study assessing the nutritional status of female orthopaedic patients. SETTING The orthopaedic wards of the Royal Surrey County Hospital. SUBJECTS Forty-nine female patients aged 60-103 y; dietary records were obtained for 41 subjects and 36 subjects gave a blood sample for biochemical analysis. MAJOR OUTCOME METHODS: MNA questionnaire, anthropometry, plasma albumin, transferrin, C-reactive protein (CRP) levels and dietary analyses. RESULTS The group as a whole had low mean values for body weight, albumin and transferrin and high CRP levels. In addition, the group had mean energy intakes well below the estimated average requirement (EAR) and mean intakes of vitamin D, magnesium, potassium, selenium and non-starch polysaccharides (NSP) were below the lower reference nutrient intakes (LRNI). The MNA screening section categorized 69% of the patients as requiring a full assessment (scored 11 or below), but for the purposes of the study the MNA was completed on all patients. The MNA assessment categorized 16% of the group as 'malnourished' (scored<17 points), 47% as 'at risk' (scored 17.5-23.5) and 37% as 'well nourished' (scored>23.5). Significant differences were found between the malnourished and well nourished groups for body weight (P<0.001), body mass index (BMI) (P<0.001), demiquet (P<0.001) and mindex (P<0. 001). Mean values for energy and nutrient intakes showed a clear stepwise increase across the three groups for all nutrients except sodium, with significant differences for protein (P<0.05), carbohydrate (P<0.05), riboflavin (P<0.05) niacin (P<0.05), pyridoxine (P<0.05), folate (P<0.05), calcium (P<0.05), selenium (P<0.05), iron (P<0.05) and NSP (P<0.05) intakes. Stepwise multiple regression analysis indicated that anthropometric assessments were the most predictive factors in the total MNA score. The sensitivity and specificity of the MNA was assessed in comparison with albumin levels, energy intake and mindex. The sensitivity of the MNA classification of those scoring less than 17 points in comparison with albumin levels, energy intake and mindex varied from 27 to 57% and the specificity was 66-100%. This was compared with the sensitivity and specificity of using a score of less than 23.5 on the MNA to predict malnourished individuals. Using this cut-off the sensitivity ranged from 75 to 100%, but the specificity declined to between 37 and 50%. CONCLUSIONS The results suggest that the MNA is a useful diagnostic tool in the identification of elderly patients at risk from malnutrition and those who are malnourished in this hospital setting. SPONSORSHIP Nestlé Clinical Nutrition, Croydon, Surrey.
Collapse
Affiliation(s)
- M C Murphy
- European Institute of Health and Medical Sciences, University of Surrey, Guildford, UK.
| | | | | | | |
Collapse
|
22
|
Fuchimoto Y, Huang CA, Yamada K, Shimizu A, Kitamura H, Colvin RB, Ferrara V, Murphy MC, Sykes M, White-Scharf M, Neville DM, Sachs DH. Mixed chimerism and tolerance without whole body irradiation in a large animal model. J Clin Invest 2000; 105:1779-89. [PMID: 10862793 PMCID: PMC378506 DOI: 10.1172/jci8721] [Citation(s) in RCA: 169] [Impact Index Per Article: 7.0] [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: 11/17/2022] Open
Abstract
Mixed hematopoietic chimerism may provide a treatment for patients with nonmalignant hematologic diseases, and may tolerize patients to organ allografts without requiring chronic immunosuppression. However, the toxicity of the usual conditioning regimens has limited the clinical applicability of this approach. These regimens generally include some level of whole body irradiation (WBI), which is thought to facilitate engraftment either by making room for donor hematopoietic stem cells or by providing sufficient host immunosuppression to enable donor cells to engraft. Here, we have established mixed chimerism across both minor and major histocompatibility barriers in swine, by using high doses of peripheral blood stem cells in the absence of WBI. After mixed chimerism was established, swine leukocyte antigen-matched (SLA-matched) donor skin grafts were tolerated and maintained for a prolonged period, whereas third-party SLA-matched skin was rejected promptly. Donor-matched kidney allografts were also accepted without additional immunosuppression. Because of its low toxicity, this approach has potential for a wide range of clinical applications. Our data may indicate that niches for engrafting stem cells are filled by mass action and that WBI, which serves to empty some of these niches, can be omitted if the donor inoculum is sufficiently large and if adequate host T-cell depletion is achieved before transplant.
Collapse
Affiliation(s)
- Y Fuchimoto
- Transplantation Biology Research Center, and. Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA. Laboratory of Molecular Bi
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Abstract
Over the last decade, much evidence has emerged to suggest that alterations in maternal nutrition during pregnancy may irreversibly affect aspects of physiological and biochemical functions in the fetus. This study was designed to determine the mechanisms involved in these alterations. Our hypothesis was that the type of maternal dietary fat received in early life could determine the level of lipoprotein lipase (LPL; EC 3.1.1.34) activity and gene expression which would be maintained into later life. A diet high in (n-3) polyunsaturated fatty acids was predicted to be associated with higher levels of lipoprotein lipase (LPL) activity and expression and lower levels of plasma triglyceride after a high fat meal challenge. Using a 2x2 factorial design, Wistar Albino rats were pair-fed either a fish oil diet (50 g/kg) or a mixed oil diet (50 g/kg) for the last 2 wk of gestation, during lactation and pups were fed these diets until 5 wk of age. After 5 wk, the rats were fed nonpurified diet. The rats were killed at 5 wk (young) or 10 wk (adult) of age after a mixed oil (50 g/kg) test meal. There were significant age effects on plasma triglyceride (P<0.02), cholesterol (P<0.001), glucose-dependent insulinotrophic polypeptide (GIP) (P<0.001) and liver glutathione reductase activity (P<0.05) which were all higher in the young rats compared to the adults. There were significant effects of diet on triglyceride (P<0.001), cholesterol (P<0.001) and LPL mRNA levels (P<0.001). GIP and triglyceride levels were significantly correlated (r = 0.66; P<0.001). Omental adipose tissue LPL activity as significantly higher in the fish-oil fed groups compared to the other groups (P<0.001), whereas Epididymal adipose tissue LPL mRNA was significantly higher in the mixed oil-fed adults compared to the other groups (P<0.001). The latter result suggested an imprinting effect of fatty acid composition in early life on LPL gene expression. Liver superoxide dismutase activity was affected by age and diet and was higher in the young than in the adults and higher in the fish oil-fed young than in those fed the mixed oil-fed (P<0.005). Catalase activity was also affected by age (P<0.001) and diet (P<0.001), and there was a significant interaction between age and diet (P<0.001). Catalase activity was higher in rats fed fish oils at both stages of development, suggesting that feeding fish oils to rats in early life raises oxidative stress throughout life. The majority of the significant differences shown were between the age groups and not between the two dietary groups, suggesting that postprandial handling of a standard fat meal is affected more by age than by early dietary fatty acid composition. However, the mechanisms of biological imprinting of fatty acids on LPL expression and on enzymes related to oxidative stress requires more investigation.
Collapse
Affiliation(s)
- C Chapman
- Centre for Nutrition and Food Safety School of Biological Sciences, University of Surrey, Guildford, United Kingdom
| | | | | |
Collapse
|
24
|
Huang CA, Fuchimoto Y, Scheier-Dolberg R, Murphy MC, Neville DM, Sachs DH. Stable mixed chimerism and tolerance using a nonmyeloablative preparative regimen in a large-animal model. J Clin Invest 2000; 105:173-81. [PMID: 10642595 PMCID: PMC377429 DOI: 10.1172/jci7913] [Citation(s) in RCA: 186] [Impact Index Per Article: 7.8] [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: 11/17/2022] Open
Abstract
Bone marrow transplantation (BMT) has considerable potential for the treatment of malignancies, hemoglobinopathies, and autoimmune diseases, as well as the induction of transplantation allograft tolerance. Toxicities associated with standard preparative regimens for bone marrow transplantation, however, make this approach unacceptable for all but the most severe of these clinical situations. Here, we demonstrate that stable mixed hematopoietic cell chimerism and donor-specific tolerance can be established in miniature swine, using a relatively mild, non-myeloablative preparative regimen. We conditioned recipient swine with whole-body and thymic irradiation, and we depleted their T-cells by CD3 immunotoxin-treatment. Infusion of either bone marrow cells or cytokine-mobilized peripheral blood stem cells from leukocyte antigen-matched animals resulted in stable mixed chimerism, as detected by flow cytometry in the peripheral blood, thymus, and bone marrow, without any clinical evidence of graft-versus-host disease (GvHD). Long-term acceptance of donor skin and consistent rejection of third-party skin indicated that the recipients had developed donor-specific tolerance.
Collapse
Affiliation(s)
- C A Huang
- Transplantation Biology Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts 02129, USA
| | | | | | | | | | | |
Collapse
|
25
|
Abstract
The hemodynamic effect of severe contralateral internal carotid (ICA) disease may result in overestimation of ipsilateral stenosis by duplex ultrasound (DU). This study examines the role of the vertebral artery system (VAS) on duplex results in patients with severe carotid disease. A retrospective study of 110 patients who underwent carotid endarterectomy (CEA) between January 1, 1995 and January 31, 1998 was performed. All patients had a preoperative and postoperative DU within 6.5 months of each other and a preoperative magnetic resonance angiogram or conventional angiogram. Duplex categories of stenosis were mild (0-49%), moderate (50-79%), and severe (80-99%). Pre- and postoperative values for ICA peak systolic velocity (PSV), end diastolic velocity (EDV), and ICA-to-common carotid artery (CCA) ratio were recorded. Paired t-tests were used to assess significant changes within groups and independent t-tests were used to compare changes between groups. Sixty-seven patients had a normal VAS and 43 patients had an abnormal VAS. Patients with an abnormal VAS had significantly greater decreases in EDV after contralateral CEA. In the abnormal VAS group, there was a higher incidence (23.2% vs. 16.4%) of ipsilateral overestimation of stenosis by duplex and a greater incidence (20.9% vs. 10.4%) of postoperative decrease in stenosis following contralateral CEA than in the normal VAS group. Patients who underwent CEA for severe stenosis versus moderate stenosis had significant postoperative decreases in ipsilateral PSV, EDV, and ICA/CCA ratio. Severe contralateral stenosis patients with an abnormal VAS had a significant decrease in EDV compared to patients with a normal VAS. Vertebral artery blood flow contributes significantly to the "hemodynamic effect" of carotid disease identified by duplex.
Collapse
Affiliation(s)
- H J Welch
- Department of Vascular Surgery, Lahey Clinic, Burlington, MA 01805, USA
| | | | | | | |
Collapse
|
26
|
Huang CA, Yamada K, Murphy MC, Shimizu A, Colvin RB, Neville DM, Sachs DH. In vivo T cell depletion in miniature swine using the swine CD3 immunotoxin, pCD3-CRM9. Transplantation 1999; 68:855-60. [PMID: 10515387 DOI: 10.1097/00007890-199909270-00019] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [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: 11/25/2022]
Abstract
BACKGROUND Partially inbred miniature swine developed in this laboratory provide a unique preclinical large animal model for studying transplant tolerance. The importance of in vivo T cell depletion for establishing stable mixed hematopoietic cell chimerism using a clinically relevant sublethal regimen has been well documented in murine studies (1). Until now, the lack of an effective in vivo T cell-depleting reagent in swine has limited the progress of studies involving hematopoietic cell transplants. METHODS The swine CD3 immunotoxin, pCD3-CRM9, was prepared by conjugating our porcine-specific CD3 monoclonal antibody 898H2-6-15 to the diphtheria toxin derivative, CRM9. The resultant immunotoxin was administered i.v. to several miniature swine at doses ranging from 0.15-0.2 mg/kg either in a single dose or two doses 2 days apart. T-cell depletion was monitored in the peripheral blood, mesenteric lymph node, and thymus by flow cytometric analysis and histological examination. RESULTS T cells were depleted to less than 1% of their pretreatment levels based on absolute numbers in the peripheral blood. Fluorescence activated cell sorter analysis and histological examination of serial lymph node biopsies confirmed depletion of the CD3+ T cells rather than down modulation or masking of the surface CD3 expression. Depletion of the CD3 bright medullary thymocytes could also be detected by flow cytometry and histological examination after immunotoxin treatment. CONCLUSIONS Administration of the immunotoxin i.v. drastically depletes mature T cells from the peripheral blood, lymph node, and thymus compartments of the pig. This first description of an effective in vivo T-cell depleting reagent for the pig provides a valuable tool for studies of transplant tolerance in this large animal model. It also makes possible preclinical studies of T cell depletion with anti-CD3 immunotoxin in this large animal model.
Collapse
Affiliation(s)
- C A Huang
- Transplantation Biology Research Center, Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston 02129, USA
| | | | | | | | | | | | | |
Collapse
|
27
|
Murphy MC, Brooks CN, Rockett JC, Chapman C, Lovegrove JA, Gould BJ, Wright JW, Williams CM. The quantitation of lipoprotein lipase mRNA in biopsies of human adipose tissue, using the polymerase chain reaction, and the effect of increased consumption of n-3 polyunsaturated fatty acids. Eur J Clin Nutr 1999; 53:441-7. [PMID: 10403579 DOI: 10.1038/sj.ejcn.1600774] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the effects of the consumption of fish oils on the gene expression of lipoprotein lipase (LPL, EC 3.1.1.34) in human adipose tissue. In order to measure LPL mRNA in adipose tissue samples obtained by needle biopsy from human volunteers a competitive, reverse transcriptase PCR (RT-PCR) protocol was developed. DESIGN A randomised controlled, single blind cross over dietary study which compared the effects of a low level n-3 polyunsaturated fatty acids (PUFA) using normal foods enriched with eicosapentaenoic (EPA) and docosahexaenoic (DHA) (test diet), with non-enriched but otherwise identical foods (control). The diets were consumed for a period of 22 d with a wash out period of 5 months between the diets. SETTING Free-living individuals associated with the University of Surrey. SUBJECTS Six male subjects with a mean (+/- sd) age of 51.2+/-3.6 y were recruited. MAJOR OUTCOME MEASURES Pre- and postprandial blood samples were taken for the measurement of triacylglycerol (TAG), postheparin LPL activity and adipose tissue samples for the measurement of LPL mRNA levels. RESULTS Mean LPL expression values were 4.12 x 10(5) molecules of LPL mRNA per ng total RNA on the control diet and 4.60 x 10(5) molecules of LPL mRNA per ng total RNA on the n-3 PUFA enriched (test) diet. There was no significant difference between the levels of LPL expression following each diet, consistent with the lack of change in TAG levels in response to increased dietary n-3 PUFA intake. However, the change in LPL expression (Test-Control diet) correlated significantly with the change in fasting TAG levels (P = 0.03, R = -0.87 and R2 = 0.75) and with the total area under the TAG-time response curve (P = 0.003, R = -0.96 and R2 = 0.92) in individuals. CONCLUSIONS These findings, although based on a small number of subjects, suggest that LPL expression may be a determinant of plasma TAG levels. The development of this methodology should allow further elucidation of the effects of dietary manipulation and disease processes on lipid clearance and regulation in human subjects.
Collapse
Affiliation(s)
- M C Murphy
- Centre for Nutrition and Food Safety, School of Biological Sciences, University of Surrey, Guildford, UK
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Lovegrove JA, Jackson KG, Murphy MC, Brooks CN, Zampelas A, Knapper JM, Wright JW, Gould BJ, Williams CM. Markers of intestinally-derived lipoproteins: application to studies of altered diet and meal fatty acid compositions. Nutr Metab Cardiovasc Dis 1999; 9:9-18. [PMID: 10726104] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND AND AIM The atherogenic potential of dietary derived lipids, chylomicrons (CM) and their remnants (CMr) is now becoming more widely recognised. To investigate factors effecting levels of CM and CMr and their importance in coronary heart disease risk it is essential to use a specific method of quantification. Two studies were carried out to investigate: (i) effects of increased daily intake of long chain n-3 polyunsaturated fatty acid (LC n-3 PUFA), and (ii) effects of increasing meal monounsaturated fatty acid (MUFA) content on the postprandial response of intestinally-derived lipoproteins. The contribution of the intestinally-derived lipoproteins to total lipaemia was assessed by triacylglycerol-rich lipoprotein (TRL) apolipoprotein B-48 (apo B-48) and retinyl ester (RE) concentrations. METHODS AND RESULTS In a randomised controlled crossover trial (placebo vs LC n-3 PUFA) a mean daily intake of 1.4 g/day of LC n-3 PUFA failed to reduce fasting and postprandial triacylglycerol (TAG) response in 9 healthy male volunteers. Although the pattern and nature of the apo B-48 response was consistent with the TAG response following the two diets, the postprandial RE response differed on the LC n-3 PUFA diet with a lower early RE response and a delayed and more marked increase in RE in the late postprandial period compared with the control diet, but the differences did not reach levels of statistical significance. In the meal study there was no effect of MUFA/SFA content on the total lipaemic response to the meals nor on the contribution of intestinally derived lipoproteins evaluated as TAG, apo B-48 and RE responses in the TRL fraction. In both studies, the RE and apo B-48 measurements provided broadly similar information with respect to lack of effects of dietary or meal fatty acid composition and the presence of single or multiple peak responses. However the apo B-48 and RE measurements differed with respect to the timing of their peak response times, with a delayed RE peak, relalive to apo B-48, of approximately 2-3 hours for the LC n-3 PUFA diet (p = 0.002) study and 1-1.5 hours for the meal MUFA/SFA study. CONCLUSIONS It was concluded that there are limitations of using RE as a specific CM marker, apo B-48 quantitation was found to be a more appropriate method for CM and CMr quantitation. However it was still considered of value to measure RE as it provided additional information regarding the incorporation of other constituents into the CM particle.
Collapse
Affiliation(s)
- J A Lovegrove
- Hugh Sinclair Unit of Human Nutrition, Department of Food Science and Technology, University of Reading, Whiteknights, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Lovegrove JA, Brooks CN, Murphy MC, Gould BJ, Williams CM. Use of manufactured foods enriched with fish oils as a means of increasing long-chain n-3 polyunsaturated fatty acid intake. Br J Nutr 1997; 78:223-36. [PMID: 9301413 DOI: 10.1079/bjn19970142] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The objectives of the present study were to determine the feasibility of using manufactured foods, enriched with eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) as a means of increasing the intake of these n-3 polyunsaturated fatty acids (PUFA), and to determine the effect of the consumption of these foods on postprandial lipaemia and other metabolic responses to a high-fat mixed test meal. Nine healthy, normotriacylglycerolaemic, free-living male volunteers (aged 35-60 years) completed the randomized, controlled, single-blind, crossover study. The study consisted of two periods (each of 22 d) of dietary intervention, separated by a 5-month washout period. During these two periods the subjects were provided with the manufactured foods enriched with EPA and DHA (n-3 enriched) or identical but unenriched foods (control). A mixed test meal containing 82 g fat was given to the fasted subjects on day 22 of each dietary intervention period. Two fasting, and thereafter hourly, blood samples were collected from the subjects for an 8 h period postprandially. Plasma triacylglycerol, total and HDL-cholesterol, non-esterified fatty acids (NEFA), glucose and immunoreactive insulin levels, post-heparin lipoprotein lipase (EC 3.1.1.34) activity and the plasma free fatty acid and phospholipid fatty acid compositions were measured. A mean daily intake of 1.4 g EPA+DHA (0.9 g EPA, 0.5 g DHA) was ingested during the n-3-enriched dietary period, which was significantly higher than the intake during the habitual and control periods (P < 0.001) assessed by a 3 d weighed food intake. A significantly higher level of EPA+DHA enrichment of the plasma fatty acids and phospholipids (P < 0.001) after the n-3-enriched compared with the control intervention periods was also found. The energy intake on both of the dietary intervention periods was found to be significantly higher than on the habitual diet (P < 0.001), with an increase in body weight of the subjects, which reached significance during the n-3 PUFA-enriched dietary intervention period (P < 0.04). The palatability of the enriched foods was not significantly different from that of the control foods. Significantly higher fasting plasma HDL-cholesterol and glucose concentrations were found after the n-3 PUFA-enriched compared with the control intervention period (P < 0.02 and P < 0.05 respectively). No significant differences were found for the postprandial lipid and hormone measurements, except for significantly lower levels of NEFA at 60 min after the n-3-enriched intervention period (P < 0.04). Enriched manufactured foods were a feasible vehicle for increasing n-3 PUFA intake. However the nature of the foods provided as the n-3 vehicle may have contributed to the increased body weight and higher energy intakes which were adverse consequences of the intervention. These factors, together with the short duration of the study may have been responsible for the failure to observe significant plasma triacylglycerol reductions in response to daily intakes of 1.4 g EPA+DHA.
Collapse
Affiliation(s)
- J A Lovegrove
- Hugh Sinclair Unit of Human Nutrition, Department of Food Science and Technology, University of Reading, Whiteknights
| | | | | | | | | |
Collapse
|
30
|
|
31
|
Murphy MC. Healthcare reform must not compromise patient care. Oncol Nurs Forum 1996; 23:1373-4. [PMID: 8899753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
32
|
Murphy MC, Chapman C, Lovegrove JA, Isherwood SG, Morgan LM, Wright JW, Williams CM. Meal frequency; does it determine postprandial lipaemia? Eur J Clin Nutr 1996; 50:491-7. [PMID: 8863008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the effect of altering meal frequency on postprandial lipaemia and associated parameters. DESIGN A randomized open cross over study to examine the programming effects of altering meal frequency. A standard test meal was given on three occasions following: (i) the normal diet; (ii) a period of two weeks on a nibbling and (iii) a period of two weeks on a gorging diet. SETTING Free living subjects associated with the University of Surrey. SUBJECTS Eleven female volunteers (age 22 +/- 0.89 y) were recruited. INTERVENTIONS The subjects were requested to consume the same foods on either a nibbling diet (12 meals per day) or a gorging diet (three meals per day) for a period of two weeks. The standard test meal containing 80 g fat, 63 g carbohydrate and 20 g protein was administered on the day prior to the dietary intervention and on the day following each period of intervention. MAJOR OUTCOME MEASURES Fasting and postprandial blood samples were taken for the analysis of plasma triacylglycerol, non-esterified fatty acids, glucose, immunoreactive insulin, glucose-dependent insulinotropic polypeptide levels (GIP) and glucagon-like peptide (GLP-1), fasting total, low density lipoprotein (LDL)- and high density lipoprotein (HDL)-cholesterol concentrations and postheparin lipoprotein lipase (LPL) activity measurements. Plasma paracetamol was measured following administration of a 1.5 g paracetamol load with the meal as an index of gastric emptying. RESULTS The compliance to the two dietary regimes was high and there were no significant differences between the nutrient intakes on the two intervention diets. There were no significant differences in fasting or postprandial plasma concentrations of triacylglycerol, non-esterified fatty acids, glucose, immunoreactive insulin, GIP and GLP-1 levels, in response to the standard test meal following the nibbling or gorging dietary regimes. There were no significant differences in fasting total or LDL-cholesterol concentrations, or in the 15 min postheparin lipoprotein lipase activity measurements. There was a significant increase in HDL-cholesterol in the subjects following the gorging diet compared to the nibbling diet. DISCUSSION The results suggest that previous meal frequency for a period of two weeks in young healthy women does not alter the fasting or postprandial lipid or hormonal response to a standard high fat meal. CONCLUSIONS The findings of this study did not confirm the previous studies which suggested that nibbling is beneficial in reducing the concentrations of lipid and hormones. The rigorous control of diet content and composition in the present study compared with others, suggest reported effects of meal frequency may be due to unintentional alteration in nutrient and energy intake in previous studies.
Collapse
Affiliation(s)
- M C Murphy
- Nutrition Research Group, School of Biological Sciences, University of Surrey, Guildford, UK
| | | | | | | | | | | | | |
Collapse
|
33
|
Murphy MC, Isherwood SG, Sethi S, Gould BJ, Wright JW, Knapper JA, Williams CM. Postprandial lipid and hormone responses to meals of varying fat contents: modulatory role of lipoprotein lipase? Eur J Clin Nutr 1995; 49:578-88. [PMID: 7588508] [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: 01/26/2023]
Abstract
OBJECTIVE Substrate and hormone responses to meals of differing fat content were evaluated in normal subjects in order to investigate mechanisms underlying the regulation of postprandial lipoprotein concentration. DESIGN A randomised cross-over study with three different meals on three occasions. SETTING Free-living subjects associated with Surrey University. SUBJECTS Ten male volunteers (aged 18-23 years) were recruited. INTERVENTIONS Three test meals containing 20, 40 or 80 g fat but identical carbohydrate and protein content were randomly allocated to volunteers. MAJOR OUTCOME MEASURES Pre- and postprandial blood samples were taken for the analysis of plasma triacylglycerol, non-esterified fatty acids, glucose, immunoreactive insulin and glucose-dependent insulinotrophic polypeptide levels and postheparin lipoprotein lipase activity measurements. RESULTS Peak triacylglycerol concentrations and lipoprotein lipase activity measurements were significantly higher following the 80 g than the 20 g fat meal (P = 0.009 and P = 0.049 respectively). Areas under the glucose-dependent insulinotrophic polypeptide time-response concentration curves were significantly higher following the 80 g compared with the 20 g fat meal (P = 0.04), but no differences in insulin response to the meals were seen. The 30-360 min decrease in the non-esterified fatty acid concentration was less following the 80 g than the 20 g meal (P = 0.001). CONCLUSIONS The results suggest that glucose-dependent insulinotrophic polypeptide may mediate increased lipoprotein lipase activity in response to fat-containing meals and may play a role in circulating lipoprotein homeostasis. This mechanism may be overloaded with high fat meals with adverse consequences on circulating triacylglycerol and NEFA concentrations.
Collapse
Affiliation(s)
- M C Murphy
- Nutrition Research Centre, School of Biological Sciences, University of Surrey, Guildford, UK
| | | | | | | | | | | | | |
Collapse
|
34
|
Stertzer SH, Pomerantsev EV, Shaw RE, Boucher RA, Millhouse F, Zipkin RE, Hidalgo BO, Murphy MC, Hansell HN, Myler RK. Comparative study of the angiographic morphology of coronary artery lesions treated with PTCA, directional coronary atherectomy, or high-speed rotational ablation. Cathet Cardiovasc Diagn 1994; 33:1-9. [PMID: 8001093 DOI: 10.1002/ccd.1810330102] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To evaluate trends in morphology-based intervention selection, series of 110 consecutive procedures of each of three devices, percutaneous transluminal balloon coronary angioplasty (PTCA), directional coronary atherectomy (DCA), or high-speed rotational ablation (HSRA), were reviewed. PTCA was used mainly in discrete, concentric, smooth, ACC/AHA type A and B1 lesions. PTCA was used less frequently on a bend, branching points or in calcified lesions. Using PTCA as a reference, DCA was used more often for the treatment of discrete, proximal, eccentric, and noncalcified lesions, often complicated with thrombus and located on straight segments. HSRA was used more frequently in diffuse, calcified multiple complicated and B2+C type lesions with frequent side branches and bend points. These results suggest that directional atherectomy and rotational ablation may be helpful in expanding the capacity of the operator to approach prognostically unfavorable lesions.
Collapse
Affiliation(s)
- S H Stertzer
- San Francisco Heart Institute, Seton Medical Center, Daly City, California 94015
| | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Murphy MC, Conley J, Hernandez MA. Group remotivation therapy for the 90s. Perspect Psychiatr Care 1994; 30:9-12. [PMID: 7862520 DOI: 10.1111/j.1744-6163.1994.tb00433.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The authors assert that some of the most regressed, treatment-resistant clients with persistent mental illness will show a favorable response to a group approach called remotivation therapy. The remotivation therapy techniques of the 1950s have been updated by psychiatric nurses and a social work clinician in one VA setting. The authors assert that remotivation therapy approaches are easy to implement, personally rewarding, and effective in promoting interaction in such clients.
Collapse
|
36
|
Myler RK, Shaw RE, Stertzer SH, Zapolanski A, Zipkin R, Murphy MC, Hecht H, Chan J, Mengarelli L, Cumberland DC. Triple vessel revascularization: coronary angioplasty versus coronary artery bypass surgery: initial results and five-year follow-up. Comparative costs and loss of working days and wages. J Invasive Cardiol 1994; 6:125-35. [PMID: 10147165] [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: 02/11/2023]
Abstract
OBJECTIVES The purpose of this study was to compare early and late outcomes in patients undergoing PTCA or CABG for triple vessel disease. BACKGROUND Although early results of PTCA/CABG randomized trials have recently become available, at present little data exists on long-term medical and socioeconomic effects of these treatment modalities in patients with triple vessel revascularization. METHODS During 1986-87, 76 patients undergoing triple vessel PTCA and 85 patients having triple vessel CABG were selected from a consecutive series of patients having multivessel revascularization. Initial results and 5 year outcome, hospital stay and charges and out-of-work time were assessed from prospectively collected data. RESULTS Clinical and morphological factors were similar in the PTCA and CABG groups. Hospital success and complications were also similar, except for higher mortality in the CABG cohort (0 vs. 3.5%). Five year follow-up showed no differences in survival, nonfatal infarction and angina-free status; however, there was a difference in need for repeat revascularization (PTCA 55.4% vs. CABG 6.3%, p less than 0.001). Repeat PTCA accounted for 49% of the revascularization in the PTCA cohort. Crossovers were similar (PTCA[CABG 6.8%; CABG[PTCA 6.3%, pNS). Predictors of late death in the entire population were female gender (p less than 0.0001), diabetes (p<0.05) and depressed LVEF (p less than 0.05). The choice of revascularization procedure (PTCA vs. CABG) was not an independent predictor of late death or MI. Analysis of initial hospital charges showed a 2:1 advantage in favor of PTCA but this advantage was lost in late followup due to the need for repeat revascularization in the PTCA group. However, the PTCA cohort lost fewer working days than CABG patients (3017 vs 5874 days) and therefore, lost less wages ($7,022 vs. $14,685). CONCLUSIONS The study shows that for selected triple vessel disease patients, PTCA and CABG results are comparable after 5 years, though repeat revascularization (mainly due to restenosis) was necessary in the PTCA group to maintain these favorable results. After 5 years, hospital charges are similar in the 2 groups, though out-of-work time and lost wages were 2:1 in favor of PTCA.
Collapse
Affiliation(s)
- R K Myler
- San Francisco Heart Institute, Seton Medical Center, Daly City, California 94015
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Anwar A, Stertzer SH, Hidalgo BO, de la Fuente L, Morales MC, Fischer EI, Shaw RE, Murphy MC, Myler RK. Coronary stenting with a new ultra-short balloon expandable device: early and late animal results. Cathet Cardiovasc Diagn 1994; 31:85-9. [PMID: 8118865 DOI: 10.1002/ccd.1810310117] [Citation(s) in RCA: 7] [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: 01/28/2023]
Abstract
The early and late effects of a new balloon-expandable coronary stent (Boneau II) were studied in 16 adult mongrel dogs. Thirty-three balloon-expandable stents were deployed using standard transfemoral coronary angioplasty technique. Single stents were placed in eight dogs and multiple (two to four) stents were placed in eight dogs. Intravenous heparin (3,000 units) was administered at the beginning of the procedure. Aspirin, dipyridamole, dextran, and warfarin were not administered before or after the procedure. All stent deployments were successful. Angiographic or pathologic examinations were performed within 24 hr of deployment on two of the dogs, at 2 weeks on two of the dogs, at 2 months on three of the dogs, at 6 months on six of the dogs, and at 1 year on three of the dogs. All successfully deployed stents were noted to be widely patent. There was no evidence of side-branch vessel occlusion. There was no evidence of acute or late vessel thrombosis. Histologic examination at 2 months showed a mean intimal thickness of 153 microns. The stainless steel Boneau II coronary stent is relatively short and easily deployed. This balloon-expandable coronary stent was successfully deployed in normal canine arteries without the use of anticoagulation or antiplatelet therapy before or after the procedure. The Boneau II intracoronary stent has a very low thrombogenic potential in dogs.
Collapse
Affiliation(s)
- A Anwar
- San Francisco Heart Institute, Seton Medical Center, Daly City, California
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Murphy MC, Zampelas A, Puddicombe SM, Furlonger NP, Morgan LM, Williams CM. Pretranslational regulation of the expression of the lipoprotein lipase (EC 3.1.1.34) gene by dietary fatty acids in the rat. Br J Nutr 1993; 70:727-36. [PMID: 8297911 DOI: 10.1079/bjn19930168] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Although there have been a number of studies of effects of diet and hormones on lipoprotein lipase (EC 3.1.1.34; LPL) activity and levels of LPL mRNA (Raynolds et al. 1990), there have been no studies which have investigated effects of different dietary fatty acids on LPL gene expression. In the present study male Wistar Albino rats were pair-fed diets containing 50 g fat/kg of different fatty acid composition for 2 weeks. The diets fed were (1) a mixed oil (450 g saturated fatty acids, 420 g monounsaturated fatty acids, 130 g polyunsaturated fatty acids/kg; n 8), (2) maize oil (n 8), or (3) fish oil (n 8). Animals were killed, RNA was extracted from liver and perirenal and epididymal fat pads, and analysed by 'Northern methodology'. Samples were hybridized to a human cDNA probe for LPL (Gotoda et al. 1989). Two transcripts were identified in epididymal and perirenal adipose tissue which were approximately 3.7 and 1.7 kb in size. The results suggested that (1) fish oil-fed animals had significantly greater production of LPL mRNA in epididymal adipose tissue compared with maize oil-fed animals (P < 0.05), (2) maize oil-fed animals had significantly greater production of LPL mRNA in perirenal fat compared with the other dietary groups (P < 0.05), (3) expression in the liver was not significant. Rats fed on a fish oil diet had significantly reduced plasma triacylglycerol concentrations compared with the mixed-oil group (P < 0.05), but there were no significant differences in plasma cholesterol. The differences in LPL could not be explained directly by the changes in plasma immunoreactive-insulin and glucose-dependent insulinotrophic polypeptide levels in the three groups.
Collapse
Affiliation(s)
- M C Murphy
- Nutritional Metabolism Research Group, School of Biological Sciences, University of Surrey, Guildford
| | | | | | | | | | | |
Collapse
|
39
|
Baciewicz PA, Shaw RE, Rosenblum J, Myler RK, Zapolanski A, Anwar A, Stertzer SH, Murphy MC, Hansell HN, Chan J. Late outcome of multivessel coronary artery disease after angioplasty or bypass surgery. J Invasive Cardiol 1993; 5:179-87. [PMID: 10146581] [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: 02/11/2023]
Abstract
Background. Results from randomized trials to determine optimal treatment for patients with multivessel coronary disease are not yet available. Thus, the early and late outcomes of 191 PTCA and 221 CABG patients done in 1985-86 were evaluated. Methods and Results. CABG patients selected had more coronary risk factors and more severe coronary artery disease compared to PTCA patients. Comparison of the initial outcome showed that clinical success without major cardiovascular events was similar (93.7% for PTCA vs. 90.0% for CABG; p=n.s.). Five year followup was obtained in 99.0% of PTCA patients and 94.4% of CABG patients. In the PTCA group, 89.8% were alive, 4.8% had sustained an MI, and repeat revascularization was required in 46.8%. In the CABG group, 87.1% were alive, 3.2% had had a MI, and 3.5% required repeat revascularization. Statistical comparison demonstrated no difference between the groups in survival or late cardiac events, but rate of repeat revascularization was significantly higher for PTCA patients (p less than 0.0001). Incompleteness of revascularization (p<0.01) was independently associated with an increased need for repeat revascularization in the PTCA group. In the CABG group, depressed left ventricular function (p less than 0.001) and female sex (p<0.01) were associated with lower survival rates. An analysis of cost per patient showed that the strategies were comparable. Conclusions. PTCA and CABG in multivessel disease patients have similar early results and comparable rates of survival and late cardiac events. Significantly more repeat revascularization is required in PTCA patients to maintain these results.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- P A Baciewicz
- San Francisco Heart Institute at Seton Medical Center, Daly City, California
| | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Murphy MC, Zampelas A, Puddicombe SM, Furlonger NP, Morgan LM, Williams CM. Adipose tissue site specificity of lipoprotein lipase mRNA expression in rats fed diets containing different fatty acid compositions. Biochem Soc Trans 1993; 21:145S. [PMID: 8359399 DOI: 10.1042/bst021145s] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- M C Murphy
- Nutritional Metabolism Research Group, School of Biological Sciences, University of Surrey, Guildford, U.K
| | | | | | | | | | | |
Collapse
|
41
|
Shaw RE, Myler RK, Murphy MC, Mooney J, Hansell HN, Stertzer SH. The evolution of a clinical database to evaluate the treatment of coronary artery disease. J Invasive Cardiol 1993; 5:162-9. [PMID: 10146579] [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: 02/11/2023]
Abstract
BACKGROUND The field of invasive cardiology has evolved rapidly since the initial use of catheters for treatment of coronary artery disease in the late 1970's. The pace of this change coupled with the complexity of the clinical setting and proliferation of devices and drugs used for therapy have made it extremely difficult to construct and maintain a viable clinical database. METHODS Using a standard hardware and software system with the direct clinical input from a multidisciplinary team of physicians, nurses and biostatisticians, a clinical database was developed that is capable of tracking complex in-hospital and longterm follow-up data in patients undergoing treatment of coronary artery disease. RESULTS The database has provided the basis for in-depth analysis of angioplasty results in patients with vessels and lesions of varying morphology, showing greater than 90% success in most complex lesion morphology using contemporary balloon technology and/or new devices. Longterm analysis (14 years) of patients after angioplasty has demonstrated that 76% survived without major cardiac events. Other analyses of various clinical and morphologic subsets have shown favorable results with angioplasty. The databases for angioplasty and coronary bypass surgery have been combined, showing comparable survival and freedom from cardiac events in multivessel disease patients treated with these procedures. CONCLUSIONS The development of a dynamic and clinically relevant database that has evolved has contributed valuable information to the understanding and effective management of patients with coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- R E Shaw
- San Francisco Heart Institute, Seton Medical Center, Daly City, California 94015
| | | | | | | | | | | |
Collapse
|
42
|
Stertzer SH, Rosenblum J, Shaw RE, Sugeng I, Hidalgo B, Ryan C, Hansell HN, Murphy MC, Myler RK. Coronary rotational ablation: initial experience in 302 procedures. J Am Coll Cardiol 1993; 21:287-95. [PMID: 8425988 DOI: 10.1016/0735-1097(93)90665-n] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES The aim of this study was to assess the utility of percutaneous transluminal coronary rotational ablation in the treatment of coronary artery disease. BACKGROUND Although numerous advances have been made in the treatment of coronary artery disease, there are lesions with complex morphology that are not amenable to current intravascular therapy. METHODS A consecutive series of 242 patients having 302 coronary rotational ablation procedures was analyzed. One hundred nineteen (49%) of the patients had previously undergone attempted coronary angioplasty, which was unsuccessful in 31 patients (13%). The left ventricular ejection fraction was normal in 196 patients (81%). The ablation procedure was attempted in 308 vessels and 346 lesions. Of the 346 lesions treated, 26 (7.5%) were classified as American College of Cardiology/American Heart Association type A, and 320 (92.5%) as either type B or type C. RESULTS Procedural success was achieved in 284 (94%) of the 302 procedures and 330 (95.4%) of the 346 lesions in which ablation was attempted. Five procedures (1.7%) were unsuccessful, but no cardiac event occurred during the hospital stay. A major cardiac event occurred in 13 cases (4.3%); 9 (3%) of these complications were due to the ablation procedure. Six patients sustained a Q wave myocardial infarction alone, two had a Q wave infarction and required emergency surgery and one needed emergency surgery but did not have a Q wave infarction. No procedural deaths were attributed to the ablation procedure. Follow-up has been obtained in 182 of the 242 patients at a mean interval of 9 +/- 5 months. Of the 182 patients, 174 (95.6%) were alive and free of myocardial infarction. Angiographic follow-up is available thus far in 87 patients. By combining angiographic and clinical outcome, an overall estimated restenosis rate of 37.4% (68 of 182) was calculated. CONCLUSIONS These data suggest that coronary rotational ablation can be performed on lesions with a variety of morphologic features with high initial success rates. The overall rate of restenosis is similar to that of balloon angioplasty.
Collapse
Affiliation(s)
- S H Stertzer
- San Francisco Heart Institute, Seton Medical Center, Daly City, California 94015
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
DeFeyter N, Kent D, Murphy MC, Vaughn E, Wilcox R. Psych/mental health nurses care patients as a team. Am Nurse 1993; 25:20. [PMID: 8439059] [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: 01/30/2023]
|
44
|
Rosenblum J, Stertzer SH, Shaw RE, Hidalgo B, Hansell HN, Murphy MC, Myler RK. Rotational ablation of balloon angioplasty failures. J Invasive Cardiol 1992; 4:312-8. [PMID: 10147818] [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: 02/11/2023]
Abstract
In this series, we evaluated the use of rotational ablation in stenoses that were previously refractory to balloon angioplasty. Forty-one stenoses were treated; in 26, the balloon did not adequately expand within the lesion and in 15 the balloon could not be delivered to the stenosis. Rotational ablation was technically successful in 40 of 41 (97.6%) of the lesions attempted. Twenty-four patients have been followed (mean time = 9 +/- 5 months) and the restenosis rate was similar to that of balloon angioplasty. Rotational ablation appears well suited and may be the treatment of choice for heavily calcified, severely angulated, and diffusely diseased vessels.
Collapse
Affiliation(s)
- J Rosenblum
- San Francisco Heart Institute, Seton Medical Center, Daly City, California 94015
| | | | | | | | | | | | | |
Collapse
|
45
|
Baciewicz PA, Rosenblum J, Murphy MC, Hansell HN. Directional atherectomy. J Invasive Cardiol 1992; 4:213-28. [PMID: 10147813] [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: 02/11/2023]
|
46
|
Myler RK, Shaw RE, Stertzer SH, Hecht HS, Ryan C, Rosenblum J, Cumberland DC, Murphy MC, Hansell HN, Hidalgo B. Lesion morphology and coronary angioplasty: current experience and analysis. J Am Coll Cardiol 1992; 19:1641-52. [PMID: 1593061 DOI: 10.1016/0735-1097(92)90631-v] [Citation(s) in RCA: 217] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
From July 1, 1990 to February 28, 1991, 533 consecutive patients with 764 target vessels and 1,000 lesions underwent coronary angioplasty. Procedural success was achieved in 92.3%, untoward (major cardiac) events occurred in 3% (0.8% myocardial infarction, 1.3% emergency coronary bypass grafting and 0.9% both; there were no deaths). An unsuccessful uncomplicated outcome occurred in 4.7%. Lesion analysis using a modified American College of Cardiology/American Heart Association classification system showed that 8% were type A, 47.5% were type B and 44.5% were type C (36% of type B and 11% of type C were occlusions). Angioplasty success was achieved in 99% of type A, 92% of type B and 90% of type C lesions (A vs. B, p less than 0.05; B vs. C, p = NS; A vs. C, p less than 0.01). Untoward events occurred in 1.2% of type A, 1.9% of type B and 2% of type C lesions (p = NS). An unsuccessful uncomplicated outcome occurred in 0% of type A, 6% of type B and 7% of type C lesions (A vs. B, p less than 0.05; B vs. C, p = NS; A vs. C, p less than 0.05). Among the unsuccessful uncomplicated outcome group, occlusion occurred in 49%: 38% of type B and 59% of type C lesions. With B1 and B2 subtypes, success was obtained in 95% and 89.5% and untoward events occurred in 1.5% and 2.3% and an unsuccessful uncomplicated outcome in 3.7% and 8%, respectively. C1 and C2 subtyping showed success in 91% and 86%, untoward events in 1.3% and 6% and an unsuccessful uncomplicated outcome in 7.5% and 8.5%, respectively. Among the 764 vessels, success was obtained in 89.5% and untoward events occurred in 2.5% and an unsuccessful uncomplicated outcome in 8%. Assessment of lesion-vessel combinations showed a less favorable outcome with type C lesions and combinations of A-B, B-C and multiple (more than three lesions) type B and C vessels. Statistical analysis of morphologic factors associated with angioplasty success included absence of (old) occlusion (p less than 0.0001) and unprotected bifurcation lesion (p less than 0.001), decreasing lesion length (p less than 0.003) and no thrombus (p less than 0.03). The only significant factor associated with untoward events was the presence of thrombus (p less than 0.003). Predictors of an unsuccessful uncomplicated outcome included old occlusion (p less than 0.0001) and increasing lesion length (greater than 20 mm) (p less than 0.001), unprotected bifurcation lesion (p less than 0.05) and thrombus (p less than 0.03).
Collapse
Affiliation(s)
- R K Myler
- San Francisco Heart Institute, Seton Medical Center, Daly City, California
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Schechtmann NS, Murphy MC, Hansell HN. Laser/thermal ablation. J Invasive Cardiol 1992; 4:266-81. [PMID: 10147816] [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: 02/11/2023]
|
48
|
Rosenblum J, Hansell HN, Murphy MC. Stents. J Invasive Cardiol 1992; 4:229-53. [PMID: 10147814] [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: 02/11/2023]
|
49
|
Baciewicz PA, Rosenblum J, Murphy MC, Hansell HN. Rotational/mechanical ablation. J Invasive Cardiol 1992; 4:254-65. [PMID: 10147815] [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: 02/11/2023]
|
50
|
Abstract
Bentall's technique for repair of annuloaortic ectasia has been associated with postoperative bleeding and with false aneurysms at the anastomotic site between the coronary orifices and valve-containing graft. To reduce the incidence of these complications, we modified the Bentall procedure, using a simplified technique to implant the graft and to create a fistula between the closed perigraft space and right atrium to control bleeding. A continuous suture of monofilament polypropylene was used to implant the prosthetic valve ring and to anastomose the coronary orifices to the Dacron fabric. In some instances, a brief period of hypothermic circulatory arrest was needed to perform the distal aortic anastomosis. Among 562 patients undergoing operation for aneurysm of the ascending aorta between January 1, 1980, and February 28, 1990, 280 underwent graft replacement with a valve-containing composite conduit. Most (82%) had annuloaortic ectasia. In 267, we performed a classic Bentall procedure with direct anastomosis between the coronary orifices and fabric graft. The remaining 13 patients underwent other procedures for coronary connection. Early mortality was 5.0%. Reoperation for bleeding was needed in 13.2% of patients who underwent operation before we used the right atrial fistula technique and in 4.4% after we began to use the technique (p = 0.044). Actuarial survival was 71% at 5 years and 65% at 7 years. For hospital survivors, it was 76% at 5 years and 70% at 7 years. During follow-up, only 9 patients have required reoperation. A false aneurysm at the coronary anastomosis, which was associated with prosthetic valve endocarditis, developed in 1 patient. No permanent fistulas have developed.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- C T Lewis
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston
| | | | | | | | | |
Collapse
|