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Sengokmen-Ozsoz N, Boston R, Claeyssens F. Correction to "Investigating the Potential of Electroless Nickel Plating for Fabricating Ultra-Porous Metal-Based Lattice Structures Using PolyHIPE Templates". ACS Appl Mater Interfaces 2023; 15. [PMID: 38038653 PMCID: PMC10726303 DOI: 10.1021/acsami.3c16884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Indexed: 12/02/2023]
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Sengokmen-Ozsoz N, Boston R, Claeyssens F. Investigating the Potential of Electroless Nickel Plating for Fabricating Ultra-Porous Metal-Based Lattice Structures Using PolyHIPE Templates. ACS Appl Mater Interfaces 2023; 15:30769-30779. [PMID: 37310213 PMCID: PMC10316321 DOI: 10.1021/acsami.3c04637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/31/2023] [Indexed: 06/14/2023]
Abstract
The use of polymerized high internal phase emulsions (polyHIPEs) as templates for electroless nickel plating is a promising method for producing ultra-porous metallic lattice structures with consistent wall thickness. These structures have desirable properties such as low density, high specific strength, resilience, and absorbency, making them suitable for various applications including battery electrodes, catalyst supports, and acoustic or vibration damping. This study aimed to optimize and investigate the electroless nickel plating process on polyHIPEs. Initially, a surfactant (Hypermer)-stabilized water-in-oil emulsion based on 2-ethylhexyl-acrylate and isobornyl-acrylate was used as a 3D printing resin to create polyHIPE structures. Then, the electroless nickel plating process was optimized using polyHIPE discs. The study also examined the effects of air, argon, and reducing atmospheres during the heating process to remove the polyHIPE template using metallized 3D-printed polyHIPE lattice structures. The findings indicated that different atmospheres led to the formation of distinct compounds. While nickel-coated polyHIPEs were fully oxidized in an air atmosphere, nickel phosphide (Ni3P) structures occurred in argon and reducing atmospheres along Ni metal. Moreover, in argon and reducing atmospheres, the porous structure of the polyHIPEs was retained as the internal structure was completely carbonized. Overall, the study demonstrated that intricate polyHIPE structures can be used as templates to create ultra-porous metal-based lattices for a wide range of applications.
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Affiliation(s)
- Nihan Sengokmen-Ozsoz
- Kroto
Research Institute, Department of Materials Science and Engineering, The University of Sheffield, Sheffield S3 7HQ, United Kingdom
| | - R. Boston
- Department
of Materials Science and Engineering, The
University of Sheffield, Mappin Street, Sheffield S1 3JD, United Kingdom
| | - Frederik Claeyssens
- Kroto
Research Institute, Department of Materials Science and Engineering, The University of Sheffield, Sheffield S3 7HQ, United Kingdom
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Duncan AJ, Peric I, Boston R, Seneviratne U. Predictive semiology of psychogenic non-epileptic seizures in an epilepsy monitoring unit. J Neurol 2021; 269:2172-2178. [PMID: 34550469 PMCID: PMC8456070 DOI: 10.1007/s00415-021-10805-1] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 11/25/2022]
Abstract
Introduction The diagnosis of psychogenic nonepileptic seizures (PNES) is a common clinical dilemma. We sought to assess the diagnostic value of four ictal signs commonly used in differentiating PNES from epileptic seizures (ES). Methods We retrospectively reviewed consecutive adult video-electroencephalogram (VEM) studies conducted at a single tertiary epilepsy center between May 2009 and August 2016. Each event was assessed by a blinded rater for the presence of four signs: fluctuating course, head shaking, hip thrusting, and back arching. The final diagnosis of PNES or ES was established for each event based on clinical and VEM characteristics. All ES were pooled regardless of focal or generalized onset. We analyzed the odds ratio of each sign in PNES in comparison to ES with adjustment for repeated measures using logistic regression. Additionally, we calculated the sensitivity, specificity, predictive values, and likelihood ratios of each sign to diagnose PNES. Results A total of 742 events from 140 VEM studies were assessed. Fluctuating course (odds ratio (OR) 37.37, 95% confidence interval (CI) 13.56–102.96, P < 0.0001), head shaking (OR 2.95, 95% CI 1.26–6.79, P = 0.012), and hip thrusting (OR 4.28, 95% CI 1.21–15.18, P = 0.02) were each significantly predictive of PNES. Fluctuating course had the highest sensitivity (76.16%). Back arching (OR 1.06, 95% CI 0.35–3.20, P = 0.92) was not significantly associated with PNES. Conclusion Fluctuating course, head shaking, and hip thrusting are semiological features significantly more common in PNES than ES. Fluctuating course is the most reliable sign. Back arching does not appear to differentiate PNES from ES.
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Affiliation(s)
- Andrew J Duncan
- Department of Clinical Neurosciences, St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia.
| | - Ivana Peric
- Department of Neurology, Monash Medical Centre, Melbourne, VIC, Australia
| | - Ray Boston
- Department of Clinical Neurosciences, St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, USA
| | - Udaya Seneviratne
- Department of Clinical Neurosciences, St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Neurology, Monash Medical Centre, Melbourne, VIC, Australia
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Li R, Plummer C, Vogrin SJ, Woods WP, Kuhlmann L, Boston R, Liley DTJ, Cook MJ, Grayden DB. Interictal spike localization for epilepsy surgery using magnetoencephalography beamforming. Clin Neurophysiol 2021; 132:928-937. [PMID: 33636608 DOI: 10.1016/j.clinph.2020.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/25/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Magnetoencephalography (MEG) kurtosis beamforming is an automated localization method for focal epilepsy. Visual examination of virtual sensors, which are source activities reconstructed by beamforming, can improve performance but can be time-consuming for neurophysiologists. We propose a framework to automate the method and evaluate its effectiveness against surgical resections and outcomes. METHODS We retrospectively analyzed MEG recordings of 13 epilepsy surgery patients who had one-year minimum post-operative follow-up. Kurtosis beamforming was applied and manual inspection was confined to morphological clusters. The region with the Maximum Interictal Spike Frequency (MISF) was validated against prospectively modelled sLORETA solutions and surgical resections linked to outcome. RESULTS Our approach localized spikes in 12 out of 13 patients. In eight patients with Engel I surgical outcomes, beamforming MISF regions were concordant with surgical resection at overlap level for five patients and at lobar level for three patients. The MISF regions localized to spike onset and propagation modelled by sLORETA in two and six patients, respectively. CONCLUSIONS Automated beamforming using MEG can predict postoperative seizure freedom at the lobar level but tends to localize propagated MEG spikes. SIGNIFICANCE MEG beamforming may contribute to non-invasive procedures to predict surgical outcome for patients with drug-refractory focal epilepsy.
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Affiliation(s)
- Rui Li
- Department of Biomedical Engineering, The University of Melbourne, Parkville, VIC, Australia.
| | - Chris Plummer
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Department of Neurology, St. Vincent's Hospital, Fitzroy, VIC, Australia; School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Simon J Vogrin
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Department of Neurology, St. Vincent's Hospital, Fitzroy, VIC, Australia; School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - William P Woods
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Levin Kuhlmann
- Faculty of Information Technology, Monash University, Clayton, VIC 3168, Australia
| | - Ray Boston
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Department of Clinical Studies, New Bolton Centre, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, USA
| | - David T J Liley
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Mark J Cook
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Department of Neurology, St. Vincent's Hospital, Fitzroy, VIC, Australia; Graeme Clark Institute for Biomedical Engineering, The University of Melbourne, Parkville, VIC, Australia
| | - David B Grayden
- Department of Biomedical Engineering, The University of Melbourne, Parkville, VIC, Australia; Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Graeme Clark Institute for Biomedical Engineering, The University of Melbourne, Parkville, VIC, Australia
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Wang S, Boston R, Lawn N, Seneviratne U. Temporal patterns in the first unprovoked seizure. Epilepsy Behav 2021; 115:107625. [PMID: 33421854 DOI: 10.1016/j.yebeh.2020.107625] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 11/02/2020] [Accepted: 11/06/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Cyclic phenomena in epilepsy are well recognized. We investigated a multicenter cohort of unprovoked first seizure presentations to determine whether seizures have a preponderance to occur in: a particular time of the day, a particular day of the week, a particular month of the year, day time versus night time, and wakefulness versus sleep. METHODS We retrospectively studied adults who presented with a first-ever unprovoked seizure to the First Seizure Clinic at two tertiary centers in Australia. Seizure onset time was obtained from the emergency department and ambulance documentations. Electro-clinical and neuroimaging findings were reviewed. We used histograms and Poisson regression modeling to determine whether seizures have a preponderance to occur at a particular time and calculated incidence rate ratios (IRR). We performed further analysis on patients with "first seizure epilepsy" and "first seizure not epilepsy" based on the ILAE criteria for a diagnosis of epilepsy after a single unprovoked seizure, as well as comparing patients that could be categorized as having a generalized-onset seizure versus those with focal-onset seizures. RESULTS We analyzed 1724 patients (38% females; age range 14-97 yr, median 39 yr), of whom 18% had epileptiform abnormalities on EEG and potentially epileptogenic lesions were detected on neuroimaging in 28%. Whole cohort analysis shows the incidence rate ratios (IRR) of seizures varied significantly across the 24-hour clock-time of the day (p < 0.001), peaking at hour 12 (IRR 3.18). The first unprovoked seizure was significantly less likely to be reported during the night (IRR 0.61, p < 0.001) and during sleep (IRR 0.29, p < 0.001). Both the "first seizure epilepsy" and "first seizure not epilepsy" subgroups' analysis demonstrated similar patterns. An infraradian pattern was also noted with seizures most likely to occur in May (IRR 1.29, p = 0.02). Both "first seizure epilepsy - generalized" and "first seizure epilepsy - focal" groups had a preponderance for seizures to occur during the day versus night and wakefulness as opposed to sleep, but the association was more robust for generalized seizures. CONCLUSIONS Our results suggest that temporal patterns are seen in patients with first-ever unprovoked seizures, including those that meet contemporary criteria for epilepsy. These results raise the possibility that first unprovoked seizures have intrinsic rhythmicity similar to epileptic seizures.
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Affiliation(s)
- Shuyu Wang
- Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.
| | - Ray Boston
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia; Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, USA
| | - Nicholas Lawn
- Western Australia Adult Epilepsy Service, Perth, Australia.
| | - Udaya Seneviratne
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia; Department of Neuroscience, Monash Medical Centre, Melbourne, Australia; School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Melbourne, Australia.
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Wang S, Boston R, Lawn N, Seneviratne U. Revisiting an ancient legend: Influence of the lunar cycle on occurrence of first-ever unprovoked seizures. Intern Med J 2020; 52:1057-1060. [PMID: 33197117 DOI: 10.1111/imj.15135] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/01/2020] [Accepted: 11/01/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The mythical effect of the lunar cycle on seizures has been debated over time. Previously healthy individuals presenting with first-ever seizures in whom investigations are negative often invoke questions about potential reasons including a full moon. AIMS To determine whether there is a temporal relationship between the occurrence of the first-ever unprovoked seizure and the lunar cycle. METHODS We studied adults who presented with a first-ever unprovoked seizure to two tertiary centres in Australia. Seizure onset time was obtained from the emergency department and ambulance documentations. We used Poisson regression modelling and incidence rate ratios (IRR) to determine whether seizures have a preponderance for a particular lunar phase. We performed further analysis on "first seizure epilepsy" and "first seizure not epilepsy" subgroups based on the International League Against Epilepsy criteria for a diagnosis of epilepsy after a single unprovoked seizure. RESULTS We analysed 1710 patients (38% females; median 39 yr), of whom 18% had epileptiform abnormalities on EEG and potentially epileptogenic lesions were detected on neuroimaging in 28%. Based on the EEG and imaging findings, 684 (40%) patients were categorized as "first seizure epilepsy" and 1026 (60%) "first seizure not epilepsy". The whole cohort and subgroup analysis demonstrated no significant difference in the seizure occurrence among the four lunar quarters. CONCLUSIONS First unprovoked seizures are not influenced by the lunar cycle. Patients pondering the cause of their first-ever unprovoked seizure can be reassured that the full moon was not responsible. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Shuyu Wang
- Alfred Health, Melbourne, Australia, 3004.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia, 3004
| | - Ray Boston
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Australia, 3065.,Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, USA, 19384
| | - Nicholas Lawn
- Western Australia Adult Epilepsy Service, Perth, Australia
| | - Udaya Seneviratne
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Australia, 3065.,Department of Neuroscience, Monash Medical Centre, Melbourne, Australia.,School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Melbourne, Australia
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MacIsaac RJ, Farag M, Obeyesekere V, Clarke M, Boston R, Ward GM, Jerums G, Ekinci EI. Changes in soluble tumor necrosis factor receptor type 1 levels and early renal function decline in patients with diabetes. J Diabetes Investig 2019; 10:1537-1542. [PMID: 30989829 PMCID: PMC6825941 DOI: 10.1111/jdi.13061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/01/2019] [Accepted: 04/14/2019] [Indexed: 12/19/2022] Open
Abstract
The relationship between serial changes in soluble tumor necrosis factor receptor type 1 (TNFR1) levels and an early decline in estimated glomerular filtration rate (eGFR) decline remains to be defined. We found that in patients with an early decline in renal function (n = 30), soluble TNFR1 values increased (2,595 ± 683 vs 3,596 ± 1,203 pg/mL, P < 0.001) as eGFR decreased (89 ± 1 vs 51 ± 2 mL/min/1.73m2 , P < 0.001) over an 8-year period. In contrast, there were no significant changes in soluble TNFR1 levels in patients with stable renal function (n = 17). In a multilevel mixed effects regression model, changes in soluble TNFR1 levels were found to be independently associated with eGFR decline (Z = -4.31, P < 0.001). An early decline in eGFR is associated with an increase in soluble TNFR levels; however, the factors driving this increase and the possible pathological role that soluble TNFR1 plays in progressive diabetic kidney disease remain to be determined.
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Affiliation(s)
- Richard J MacIsaac
- Department of Endocrinology and DiabetesSt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
- Department of MedicineUniversity of MelbourneMelbourneVictoriaAustralia
| | - Matthew Farag
- Department of Endocrinology and DiabetesSt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
- Department of MedicineUniversity of MelbourneMelbourneVictoriaAustralia
| | - Varuni Obeyesekere
- Department of Endocrinology and DiabetesSt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Michele Clarke
- Department of MedicineUniversity of MelbourneMelbourneVictoriaAustralia
- Endocrine CenterAustin HealthMelbourneVictoriaAustralia
| | - Ray Boston
- Department of Endocrinology and DiabetesSt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
- Department of MedicineUniversity of MelbourneMelbourneVictoriaAustralia
| | - Glenn M Ward
- Department of Endocrinology and DiabetesSt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
- Department of MedicineUniversity of MelbourneMelbourneVictoriaAustralia
- Clinical ChemistrySt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - George Jerums
- Department of MedicineUniversity of MelbourneMelbourneVictoriaAustralia
- Endocrine CenterAustin HealthMelbourneVictoriaAustralia
| | - Elif I Ekinci
- Department of MedicineUniversity of MelbourneMelbourneVictoriaAustralia
- Endocrine CenterAustin HealthMelbourneVictoriaAustralia
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Chen JW, Stefanovski D, Haughan J, Jiang Z, Boston R, Soma LR, Robinson MA. Inflammatory mediators are potential biomarkers for extracorporeal shockwave therapy in horses. Equine Vet J 2019; 52:449-454. [PMID: 31505057 DOI: 10.1111/evj.13183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/29/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Extracorporeal shockwave therapy (ESWT) can potentially mask painful injuries in equine athletes. Tests to detect whether a horse has received ESWT prior to competition are needed. Extracorporeal shockwave therapy is known to affect inflammatory mediators in other species, and if these mediators are altered in the horse, these could serve as biomarkers of ESWT. OBJECTIVES To test the hypothesis that a single application of ESWT will alter the circulating protein concentrations of 10 inflammatory mediators in horse plasma. STUDY DESIGN Prospective repeated measures experimental study. METHODS Eleven healthy horses were administered a single dose of ESWT on the dorsal surface of proximal MCIII. Blood samples were collected at -168, -144, -120, -96, -72, -70, -68, -66, -48, -24, -6, -4, -2, 0 h before and 2, 4, 6, 24, 48, 72, 96, 168, 336 and 504 h after ESWT. Plasma concentrations of interleukin 1 beta (IL-1β), IL-1 receptor antagonist (IL-1RA), IL-2, IL-4, IL-6, IL-10, IL-15, interferon gamma (IFN-γ), soluble toll-like receptor 2 (sTLR2) and tumour necrosis factor alpha (TNF-α) were measured to assess the effects of ESWT on these mediators. RESULTS Baseline concentrations of inflammatory mediators did not change substantially during the week prior to ESWT. Plasma concentrations of five inflammatory factors changed following ESWT. IL-1β and IL-6 were significantly down-regulated (P<0.01), while TNF-α, IL-1RA and TLR2 were significantly up-regulated (P<0.01). The remaining cytokines were not significantly affected by ESWT. MAIN LIMITATIONS This study was performed in a small number of sedentary, healthy pasture-kept horses using a single dose of ESWT applied to a single location. Additional studies are necessary to determine the effect of ESWT on inflammatory mediators in athletic horses undergoing treatment for musculoskeletal injuries. CONCLUSIONS Plasma concentrations of TNF-α, IL-1β, IL-1RA, IL-6 and TLR2 were significantly affected by ESWT, and deserve further investigation as possible biomarkers of ESWT.
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Affiliation(s)
- J-W Chen
- Department of Clinical Studies- New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
| | - D Stefanovski
- Department of Clinical Studies- New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
| | - J Haughan
- Department of Clinical Studies- New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
| | - Z Jiang
- Department of Clinical Studies- New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
| | - R Boston
- Department of Clinical Studies- New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
| | - L R Soma
- Department of Clinical Studies- New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
| | - M A Robinson
- Department of Clinical Studies- New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, Pennsylvania, USA.,Pennsylvania Equine Toxicology and Research Laboratory, West Chester, Pennsylvania, USA
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Caramello V, Zarucco L, Foster D, Boston R, Stefanovski D, Orsini JA. Equine cheek tooth extraction: Comparison of outcomes for five extraction methods. Equine Vet J 2019; 52:181-186. [PMID: 31260572 DOI: 10.1111/evj.13150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 06/20/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Post-operative complications are reported for all methods of equine cheek tooth extraction but not all methods carry the same risks. An outcome comparison for commonly used methods is needed so that clinicians can make informed treatment decisions. OBJECTIVES We conducted a side-by-side comparison of five cheek tooth extraction methods, comparing types and incidence of complications among oral extraction, tooth repulsion (three surgical approaches) and lateral buccotomy techniques. STUDY DESIGN Retrospective clinical study using hospital medical records. METHODS Medical records of all horses undergoing cheek tooth extraction between 1997 and 2013 were reviewed. Logistic regression was used to determine the likelihood of various post-operative complications, comparing oral extraction, tooth repulsion by maxillary and mandibular trephination or maxillary sinus bone flap, and lateral buccotomy. RESULTS The study included 137 horses and 162 cheek teeth extractions. Oral extraction was successful in 71% of patients in which it was attempted. Oral extraction (n = 55) had the lowest incidence of complications (20%) and repulsion by sinus bone flap (n = 20) the highest (80%). Complication rates for repulsion by maxillary (n = 19) and mandibular trephination (n = 28), and extraction by lateral buccotomy (n = 15) were 42, 54 and 53%, respectively. Cheek tooth repulsion by sinus bone flap significantly increased the odds of damage to adjacent teeth, post-operative sinusitis, damage to alveolar bone, delayed alveolar granulation and orosinus fistulation. Repulsion by maxillary trephination significantly increased the odds of superficial incisional surgical site infection; and extraction by lateral buccotomy significantly increased the odds of facial nerve neuropraxia. Post-operative pyrexia was more common in all repulsion methods. MAIN LIMITATIONS Some clinically relevant differences may have been missed due to small group numbers in several categories. CONCLUSIONS Oral extraction was associated with fewer post-operative complications than any other methods. Standing oral extraction remains the preferred choice, and recent surgical advances promise to further improve its success rate.
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Affiliation(s)
- V Caramello
- Department of Veterinary Science, Università degli Studi di Torino, Grugliasco, Torino, Italy
| | - L Zarucco
- Department of Veterinary Science, Università degli Studi di Torino, Grugliasco, Torino, Italy
| | - D Foster
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, New Bolton Center, Kennett Square, Pennsylvania, USA
| | - R Boston
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, New Bolton Center, Kennett Square, Pennsylvania, USA
| | - D Stefanovski
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, New Bolton Center, Kennett Square, Pennsylvania, USA
| | - J A Orsini
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, New Bolton Center, Kennett Square, Pennsylvania, USA
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Tan M, Boston R, Cook MJ, D'Souza WJ. Risk factors for injury in a community-treated cohort of patients with epilepsy in Australia. Epilepsia 2019; 60:518-526. [PMID: 30720862 DOI: 10.1111/epi.14659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 01/05/2019] [Accepted: 01/07/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE There remains a paucity of knowledge regarding specific epilepsy-related risk factors for accidents and injuries in people with epilepsy. Injury studies in people with epilepsy are overrepresented, with tertiary based populations that are prone to bias from severe disease. This study aims to assess the contribution of epilepsy-related risk factors to injuries in a community-based cohort. METHODS We performed a retrospective nested case-control study on patients recruited into the Tasmanian Epilepsy Register (TER) from July 1, 2001 to June 30, 2002. The TER is a community-based cohort of patients with epilepsy in Tasmania, Australia, recruited from the national prescription database and interviewed for epilepsy diagnosis, injuries, and risk factors using validated questionnaires with diagnosis made by an epilepsy specialist. The primary outcome measures were lifetime and recent 12-month injury. Multivariate logistic regression with multiple imputation modeling responder nondisclosure was performed, adjusting for age, gender, region, socioeconomic status, seizure frequency, and epilepsy duration. RESULTS A total of 819 patients with epilepsy were included in this study. Ten percent of patients experienced an injury in the preceding year. Before adjusting for seizure frequency, any seizure over the past 12 months was associated with recent injury (adjusted odds ratio [OR] = 7.90, 95% confidence interval [CI] = 4.17-14.96). Impaired awareness, cluster seizures, sleep-only seizures, and convulsive seizure were characteristics found to significantly influence injuries irrespective of seizure frequency. Although a warning appeared initially protective for recent injuries (OR = 0.39, 95% CI = 0.22-0.69), this was entirely explained by seizure frequency, with the effect becoming nonsignificant. SIGNIFICANCE Likely due to their unpredictable nature, seizures expose patients with epilepsy to a high risk of life-threatening injury. These findings emphasize the importance of seizure freedom for maximizing the safety of patients with epilepsy.
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Affiliation(s)
- Michael Tan
- Department of Medicine, University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Ray Boston
- Department of Medicine, University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania
| | - Mark J Cook
- Department of Medicine, University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Wendyl J D'Souza
- Department of Medicine, University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia
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Samkani A, Skytte MJ, Anholm C, Astrup A, Deacon CF, Holst JJ, Madsbad S, Boston R, Krarup T, Haugaard SB. The acute effects of dietary carbohydrate reduction on postprandial responses of non-esterified fatty acids and triglycerides: a randomized trial. Lipids Health Dis 2018; 17:295. [PMID: 30591062 PMCID: PMC6309080 DOI: 10.1186/s12944-018-0953-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 12/18/2018] [Indexed: 02/08/2023] Open
Abstract
Background Postprandial non-esterified fatty acid (NEFA) and triglyceride (TG) responses are increased in subjects with type 2 diabetes mellitus (T2DM) and may impair insulin action and increase risk of cardiovascular disease and death. Dietary carbohydrate reduction has been suggested as non-pharmacological therapy for T2DM, but the acute effects on NEFA and TG during subsequent meals remain to be investigated. Methods Postprandial NEFA and TG responses were assessed in subjects with T2DM by comparing a carbohydrate-reduced high-protein (CRHP) diet with a conventional diabetes (CD) diet in an open-label, randomized, cross-over study. Each diet was consumed on two consecutive days, separated by a wash-out period. The iso-caloric CRHP/CD diets contained 31/54 E% from carbohydrate, 29/16 E% energy from protein and 40/30 E% from fat, respectively. Sixteen subjects with well-controlled T2DM (median HbA1c 47 mmol/mol, (37–67 mmol/mol) and BMI 30 ± 4.4 kg/m2) participated in the study. NEFA and TG were evaluated following breakfast and lunch. Results NEFA net area under curve (AUC) was increased by 97 ± 38 μmol/Lx270 min (p = 0.024) after breakfast but reduced by 141 ± 33 μmol/Lx180 min (p < 0.001) after lunch on the CRHP compared with CD diet. Likewise, TG net AUC was increased by 80 ± 28 μmol/Lx270 min (p = 0.012) after breakfast but reduced by 320 ± 60 μmol/Lx180 min (p < 0.001) after lunch on the CRHP compared with CD diet. Conclusions In well-controlled T2DM a modest reduction of dietary carbohydrate with a corresponding increase in protein and fat acutely reduced postprandial serum NEFA suppression and increased serum TG responses after a breakfast meal but had the opposite effect after a lunch meal. The mechanism behind this second-meal phenomenon of CRHP diet on important risk factors for aggravating T2DM and cardiovascular disease awaits further investigation. Trial registration The study was registered at clinicaltrials.gov ID: NCT02472951. https://clinicaltrials.gov/ct2/show/NCT02472951. Registered June 16, 2015.
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Affiliation(s)
- Amirsalar Samkani
- Department of Endocrinology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark.
| | - Mads J Skytte
- Department of Endocrinology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Christian Anholm
- Department of Internal Medicine, Copenhagen University Hospital, Glostrup, Denmark
| | - Arne Astrup
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Carolyn F Deacon
- Endocrinology Research Section, Department of Biomedical Sciences, Copenhagen, Denmark.,Section for Translational Physiology, Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Jens J Holst
- Endocrinology Research Section, Department of Biomedical Sciences, Copenhagen, Denmark.,Section for Translational Physiology, Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Sten Madsbad
- Department of Endocrinology, Copenhagen University Hospital, Amager Hvidovre, Copenhagen, Denmark
| | - Ray Boston
- School of Medicine, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Thure Krarup
- Department of Endocrinology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Steen B Haugaard
- Department of Endocrinology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark.,Department of Internal Medicine, Copenhagen University Hospital, Amager Hvidovre, Copenhagen, Denmark
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12
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Payne DE, Karoly PJ, Freestone DR, Boston R, D'Souza W, Nurse E, Kuhlmann L, Cook MJ, Grayden DB. Postictal suppression and seizure durations: A patient‐specific, long‐term
iEEG
analysis. Epilepsia 2018; 59:1027-1036. [DOI: 10.1111/epi.14065] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Daniel E. Payne
- Department of Biomedical Engineering Melbourne School of Engineering The University of Melbourne Parkville Vic. Australia
- Department of Medicine St Vincent's Hospital The University of Melbourne Fitzroy Vic. Australia
| | - Philippa J. Karoly
- Department of Biomedical Engineering Melbourne School of Engineering The University of Melbourne Parkville Vic. Australia
- Department of Medicine St Vincent's Hospital The University of Melbourne Fitzroy Vic. Australia
| | - Dean R. Freestone
- Department of Medicine St Vincent's Hospital The University of Melbourne Fitzroy Vic. Australia
| | - Ray Boston
- Department of Medicine St Vincent's Hospital The University of Melbourne Fitzroy Vic. Australia
| | - Wendyl D'Souza
- Department of Medicine St Vincent's Hospital The University of Melbourne Fitzroy Vic. Australia
| | - Ewan Nurse
- Department of Biomedical Engineering Melbourne School of Engineering The University of Melbourne Parkville Vic. Australia
- Department of Medicine St Vincent's Hospital The University of Melbourne Fitzroy Vic. Australia
| | - Levin Kuhlmann
- Department of Biomedical Engineering Melbourne School of Engineering The University of Melbourne Parkville Vic. Australia
- Department of Medicine St Vincent's Hospital The University of Melbourne Fitzroy Vic. Australia
- Brain Dynamics Unit Centre for Human Psychopharmacology Swinburne University of Technology Hawthorn Vic. Australia
| | - Mark J. Cook
- Department of Biomedical Engineering Melbourne School of Engineering The University of Melbourne Parkville Vic. Australia
- Department of Medicine St Vincent's Hospital The University of Melbourne Fitzroy Vic. Australia
| | - David B. Grayden
- Department of Biomedical Engineering Melbourne School of Engineering The University of Melbourne Parkville Vic. Australia
- Department of Medicine St Vincent's Hospital The University of Melbourne Fitzroy Vic. Australia
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13
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Boston R, Guo J, Funahashi S, Baker A, Reaney IM, Randall CA. Reactive intermediate phase cold sintering in strontium titanate. RSC Adv 2018; 8:20372-20378. [PMID: 35541645 PMCID: PMC9080801 DOI: 10.1039/c8ra03072c] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/26/2018] [Indexed: 11/21/2022] Open
Abstract
Dense (>96% theoretical) strontium titanate ceramics were fabricated at 950 °C (conventional sintering temperature > 1400 °C) using a reactive intermediate phase cold sintering process. An aqueous solution of SrCl2 mixed with TiO2 nanoparticles was added to SrTiO3 powders and pressed at 180 °C to obtain a highly compacted green body. During the post-press heating step at 950 °C, the TiO2 and SrCl2 create in-filling micro-reactions around each grain resulting in dense (>96%) SrTiO3 ceramics. Nano- and micron-sized starting powders were used, demonstrating that this reactive intermediate phase cold sintering route can densify a wide range of starting powder sizes, as it not reliant on an amorphous-to-crystalline precipitation through the terrace ledge kink mechanism, as has been identified repeatedly in previous cold sintering mechanisms. Moreover, this process has the potential to densify a wide variety of functional oxides, as a range of different low-temperature chemical synthesis routes could be used. Strontium titanate ceramics (>96% theoretical) have been fabricated using a reactive intermediate phase cold sintering process with a range of starting-powder sizes.![]()
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Affiliation(s)
- R. Boston
- Materials Science and Engineering
- University of Sheffield
- UK
| | - J. Guo
- Materials Research Institute and Department of Materials Science and Engineering
- The Pennsylvania State University
- USA
| | | | - A. L. Baker
- Materials Research Institute and Department of Materials Science and Engineering
- The Pennsylvania State University
- USA
| | - I. M. Reaney
- Materials Science and Engineering
- University of Sheffield
- UK
| | - C. A. Randall
- Materials Research Institute and Department of Materials Science and Engineering
- The Pennsylvania State University
- USA
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14
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Karoly PJ, Nurse ES, Freestone DR, Ung H, Cook MJ, Boston R. Bursts of seizures in long-term recordings of human focal epilepsy. Epilepsia 2017; 58:363-372. [PMID: 28084639 DOI: 10.1111/epi.13636] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We report on temporally clustered seizures detected from continuous long-term ambulatory human electroencephalographic data. The objective was to investigate short-term seizure clustering, which we have termed bursting, and consider implications for patient care, seizure prediction, and evaluating therapies. METHODS Chronic ambulatory intracranial electroencephalography (EEG) data collected for the purpose of seizure prediction were annotated to identify seizure events. A detection algorithm was used to identify bursts of events. Burst events were compared to nonburst events to evaluate event dispersion, duration and dynamics. RESULTS Bursts of seizures were present in 6 of 15 subjects, and detections were consistent over long-term monitoring (>2 years). Subjects with bursts of seizures had highly overdispersed seizure rates, compared to other subjects. There was a complicated relationship between bursts and clinical seizures, although bursts were associated with multimodal distributions of seizure duration, and poorer predictive outcomes. For three subjects, bursts demonstrated distinctive preictal dynamics compared to clinical seizures. SIGNIFICANCE We have previously hypothesized that there are distinct physiologic pathways underlying short- and long-duration seizures. Herein we show that burst seizures fall almost exclusively within the short population of seizure durations; however, a short duration event was not sufficient to induce or imply bursting. We can therefore conclude that in addition to distinct mechanisms underlying seizure duration, there are separate factors regulating bursts of seizures. We show that bursts were a robust phenomenon in our patient cohort, which were consistent with overdispersed seizure rates, suggesting long-memory dynamics.
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Affiliation(s)
- Philippa J Karoly
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia.,Department of Electrical and Electronic Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Ewan S Nurse
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia.,Department of Electrical and Electronic Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Dean R Freestone
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia
| | - Hoameng Ung
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Mark J Cook
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia
| | - Ray Boston
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia
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15
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Salz RO, Ahern BJ, Boston R, Begg LM. Association of tracheal mucus or blood and airway neutrophilia with racing performance in Thoroughbred horses in an Australian racing yard. Aust Vet J 2016; 94:96-100. [PMID: 26952960 DOI: 10.1111/avj.12422] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 03/07/2015] [Accepted: 06/10/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the variation of tracheal mucus scores, tracheal blood scores and transendoscopic tracheal wash (TW) cytology in a population of Thoroughbred (TB) racehorses and assess their association with racing performance. METHODS A total of 220 endoscopic examinations were performed and TWs obtained from 155 TB racehorses. Samples were collected 60-120 min following gallop work. Tracheal mucus score, tracheal blood score and TW cytology were analysed and their association with racing performance assessed. RESULTS Of the total examinations and samples, 194 from 135 horses fitted the criteria for inclusion. The overall prevalence of visible tracheal mucus was 2.5% (5/194) and of increased tracheal mucus was 0%. The prevalence of visible tracheal blood was 8.8% (17/194) and of increased tracheal blood was 4.6% (9/194). A total of 36% (70/194) of TWs contained elevated percentages of neutrophils and of these, 96% (67/70) occurred in the absence of any visible tracheal mucus. There was no significant association between tracheal mucus score or TW cytology and subsequent racing performance. There was a statistically significant association (P = 0.004) between increased tracheal blood scores and poor racing performance. CONCLUSIONS Visible tracheal blood seen after strenuous exercise in clinically normal TB racehorses was a risk factor for poor racing performance, but the presence of airway neutrophilia was not. No horses in this study were found to have increased tracheal mucus, so the association of increased tracheal mucus with racing performance could not be assessed.
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Affiliation(s)
- R O Salz
- Randwick Equine Centre, 3 Jane Street, Randwick, NSW, 2031, Australia.
| | - B J Ahern
- Randwick Equine Centre, 3 Jane Street, Randwick, NSW, 2031, Australia
| | - R Boston
- Randwick Equine Centre, 3 Jane Street, Randwick, NSW, 2031, Australia
| | - L M Begg
- Randwick Equine Centre, 3 Jane Street, Randwick, NSW, 2031, Australia
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16
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Karoly PJ, Freestone DR, Boston R, Grayden DB, Himes D, Leyde K, Seneviratne U, Berkovic S, O'Brien T, Cook MJ. Interictal spikes and epileptic seizures: their relationship and underlying rhythmicity. Brain 2016; 139:1066-78. [PMID: 26912639 DOI: 10.1093/brain/aww019] [Citation(s) in RCA: 195] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 01/07/2016] [Indexed: 12/18/2022] Open
Abstract
We report on a quantitative analysis of electrocorticography data from a study that acquired continuous ambulatory recordings in humans over extended periods of time. The objectives were to examine patterns of seizures and spontaneous interictal spikes, their relationship to each other, and the nature of periodic variation. The recorded data were originally acquired for the purpose of seizure prediction, and were subsequently analysed in further detail. A detection algorithm identified potential seizure activity and a template matched filter was used to locate spikes. Seizure events were confirmed manually and classified as either clinically correlated, electroencephalographically identical but not clinically correlated, or subclinical. We found that spike rate was significantly altered prior to seizure in 9 out of 15 subjects. Increased pre-ictal spike rate was linked to improved predictability; however, spike rate was also shown to decrease before seizure (in 6 out of the 9 subjects). The probability distribution of spikes and seizures were notably similar, i.e. at times of high seizure likelihood the probability of epileptic spiking also increased. Both spikes and seizures showed clear evidence of circadian regulation and, for some subjects, there were also longer term patterns visible over weeks to months. Patterns of spike and seizure occurrence were highly subject-specific. The pre-ictal decrease in spike rate is not consistent with spikes promoting seizures. However, the fact that spikes and seizures demonstrate similar probability distributions suggests they are not wholly independent processes. It is possible spikes actively inhibit seizures, or that a decreased spike rate is a secondary symptom of the brain approaching seizure. If spike rate is modulated by common regulatory factors as seizures then spikes may be useful biomarkers of cortical excitability.
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Affiliation(s)
- Philippa J Karoly
- Department of Medicine, The University of Melbourne, St. Vincent's Hospital, Fitzroy VIC 3065, Australia NeuroEngineering Research Laboratory, Department of Electrical and Electronic Engineering, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Dean R Freestone
- Department of Medicine, The University of Melbourne, St. Vincent's Hospital, Fitzroy VIC 3065, Australia NeuroEngineering Research Laboratory, Department of Electrical and Electronic Engineering, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Ray Boston
- Department of Medicine, The University of Melbourne, St. Vincent's Hospital, Fitzroy VIC 3065, Australia
| | - David B Grayden
- Department of Medicine, The University of Melbourne, St. Vincent's Hospital, Fitzroy VIC 3065, Australia NeuroEngineering Research Laboratory, Department of Electrical and Electronic Engineering, The University of Melbourne, Parkville, VIC, 3010, Australia Centre for Neural Engineering, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - David Himes
- NeuroVista Corporation, Seattle, WA 98109 USA
| | - Kent Leyde
- NeuroVista Corporation, Seattle, WA 98109 USA
| | - Udaya Seneviratne
- Department of Medicine, The University of Melbourne, St. Vincent's Hospital, Fitzroy VIC 3065, Australia
| | - Samuel Berkovic
- Department of Medicine, The University of Melbourne, Austin and Repatriation Medical Centre, Heidelberg VIC 3084, Australia
| | - Terence O'Brien
- Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, Parkville VIC 3010, Australia
| | - Mark J Cook
- Department of Medicine, The University of Melbourne, St. Vincent's Hospital, Fitzroy VIC 3065, Australia
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17
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Cook MJ, Karoly PJ, Freestone DR, Himes D, Leyde K, Berkovic S, O'Brien T, Grayden DB, Boston R. Human focal seizures are characterized by populations of fixed duration and interval. Epilepsia 2015; 57:359-68. [PMID: 26717880 DOI: 10.1111/epi.13291] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We report on a quantitative analysis of data from a study that acquired continuous long-term ambulatory human electroencephalography (EEG) data over extended periods. The objectives were to examine the seizure duration and interseizure interval (ISI), their relationship to each other, and the effect of these features on the clinical manifestation of events. METHODS Chronic ambulatory intracranial EEG data acquired for the purpose of seizure prediction were analyzed and annotated. A detection algorithm identified potential seizure activity, which was manually confirmed. Events were classified as clinically corroborated, electroencephalographically identical but not clinically corroborated, or subclinical. K-means cluster analysis supplemented by finite mixture modeling was used to locate groupings of seizure duration and ISI. RESULTS Quantitative analyses confirmed well-resolved groups of seizure duration and ISIs, which were either mono-modal or multimodal, and highly subject specific. Subjects with a single population of seizures were linked to improved seizure prediction outcomes. There was a complex relationship between clinically manifest seizures, seizure duration, and interval. SIGNIFICANCE These data represent the first opportunity to reliably investigate the statistics of seizure occurrence in a realistic, long-term setting. The presence of distinct duration groups implies that the evolution of seizures follows a predetermined course. Patterns of seizure activity showed considerable variation between individuals, but were highly predictable within individuals. This finding indicates seizure dynamics are characterized by subject-specific time scales; therefore, temporal distributions of seizures should also be interpreted on an individual level. Identification of duration and interval subgroups may provide a new avenue for improving seizure prediction.
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Affiliation(s)
- Mark J Cook
- Departments of Medicine, St. Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia
| | - Philippa J Karoly
- Departments of Medicine, St. Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia.,Department of Electrical and Electronic Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Dean R Freestone
- Departments of Medicine, St. Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia
| | - David Himes
- NeuroVista Corporation, Seattle, Washington, U.S.A
| | - Kent Leyde
- NeuroVista Corporation, Seattle, Washington, U.S.A
| | - Samuel Berkovic
- Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia
| | | | - David B Grayden
- Departments of Medicine, St. Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia.,Department of Electrical and Electronic Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Ray Boston
- Departments of Medicine, St. Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia
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18
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MacIsaac RJ, Ekinci EI, Premaratne E, Lu ZX, Seah JM, Li Y, Boston R, Ward GM, Jerums G. The Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation does not improve the underestimation of Glomerular Filtration Rate (GFR) in people with diabetes and preserved renal function. BMC Nephrol 2015. [PMID: 26630928 DOI: 10.186/s12882-015-0196-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Our hypothesis was that both the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations would underestimate directly measured GFR (mGFR) to a similar extent in people with diabetes and preserved renal function. METHODS In a cross-sectional study, bias (eGFR - mGFR) was compared for the CKD-EPI and MDRD equations, after stratification for mGFR levels. We also examined the ability of the CKD-EPI compared with the MDRD equation to correctly classify subjects to various CKD stages. In a longitudinal study of subjects with an early decline in GFR i.e., initial mGFR > 60 ml/min/1.73 m(2) and rate of decline in GFR (ΔmGFR) > 3.3 ml/min/1.73 m(2) per year, ΔmGFR (based on initial and final values) was compared with ΔeGFR by the CKD-EPI and MDRD equations over a mean of 9 years. RESULTS In the cross-sectional study, mGFR for the whole group was 80 ± 2.2 ml/min/1.73 m(2) (n = 199, 75 % type 2 diabetes). For subjects with mGFR >90 ml/min/1.73 m(2) (mGFR: 112 ± 2.0, n = 76), both equations significantly underestimated mGFR to a similar extent: bias for CKD-EPI: -12 ± 1.4 ml/min/1.73 m(2) (p < 0.001) and for MDRD: -11 ± 2.1 ml/min/1.73 m(2) (p < 0.001). Using the CKD-EPI compared with the MDRD equation did not improve the number of subjects that were correctly classified to a CKD-stage. No biochemical or clinical patient characteristics were identified to account for the under estimation of mGFR values in the normal to high range by the CKD-EPI equation. In the longitudinal study (n = 30, 66 % type 1 diabetes), initial and final mGFR values were 102.8 ± 6 and 54.6 ± 6.0 ml/min/1.73 m(2), respectively. Mean ΔGFR (ml/min/1.73 m(2) per year) was 6.0 by mGFR compared with only 3.0 by MDRD and 3.2 by CKD-EPI (both p < 0.05 vs mGFR) CONCLUSIONS: Both the CKD-EPI and MDRD equations underestimate reference GFR values > 90 ml/min/1.73 m(2) as well as an early decline in GFR to a similar extent in people with diabetes. There is scope to improve methods for estimating an early decline in GFR.
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Affiliation(s)
- Richard J MacIsaac
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, 4th Floor, Daly Wing, 35 Victoria Parade, PO Box 2900, Fitzroy, VIC, 3065, Australia. .,Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, 3065, Victoria, Australia.
| | - Elif I Ekinci
- Endocrine Centre, Austin Health, West Heidelberg, 3081, Victoria, Australia. .,Menzies School of Health Research, Casuarina, 0811, Northern Territory, Australia. .,Department of Medicine, Austin Health, University of Melbourne, Heidelberg, 3084, Victoria, Australia.
| | - Erosha Premaratne
- Endocrine Centre, Austin Health, West Heidelberg, 3081, Victoria, Australia.
| | - Zhong X Lu
- Melbourne Pathology, Collingwood, 3066, Victoria, Australia.
| | - Jas-Mine Seah
- Endocrine Centre, Austin Health, West Heidelberg, 3081, Victoria, Australia.
| | - Yue Li
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, 4th Floor, Daly Wing, 35 Victoria Parade, PO Box 2900, Fitzroy, VIC, 3065, Australia. .,Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, 3065, Victoria, Australia.
| | - Ray Boston
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, 4th Floor, Daly Wing, 35 Victoria Parade, PO Box 2900, Fitzroy, VIC, 3065, Australia. .,Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, 3065, Victoria, Australia.
| | - Glenn M Ward
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, 4th Floor, Daly Wing, 35 Victoria Parade, PO Box 2900, Fitzroy, VIC, 3065, Australia. .,Clinical Chemistry, St Vincent's Hospital Melbourne, Fitzroy, 3065, Victoria, Australia. .,Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, 3065, Victoria, Australia.
| | - George Jerums
- Endocrine Centre, Austin Health, West Heidelberg, 3081, Victoria, Australia. .,Department of Medicine, Austin Health, University of Melbourne, Heidelberg, 3084, Victoria, Australia.
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19
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MacIsaac RJ, Ekinci EI, Premaratne E, Lu ZX, Seah JM, Li Y, Boston R, Ward GM, Jerums G. The Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation does not improve the underestimation of Glomerular Filtration Rate (GFR) in people with diabetes and preserved renal function. BMC Nephrol 2015; 16:198. [PMID: 26630928 PMCID: PMC4668645 DOI: 10.1186/s12882-015-0196-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 11/25/2015] [Indexed: 12/18/2022] Open
Abstract
Background Our hypothesis was that both the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations would underestimate directly measured GFR (mGFR) to a similar extent in people with diabetes and preserved renal function. Methods In a cross-sectional study, bias (eGFR – mGFR) was compared for the CKD-EPI and MDRD equations, after stratification for mGFR levels. We also examined the ability of the CKD-EPI compared with the MDRD equation to correctly classify subjects to various CKD stages. In a longitudinal study of subjects with an early decline in GFR i.e., initial mGFR >60 ml/min/1.73 m2 and rate of decline in GFR (ΔmGFR) > 3.3 ml/min/1.73 m2 per year, ΔmGFR (based on initial and final values) was compared with ΔeGFR by the CKD-EPI and MDRD equations over a mean of 9 years. Results In the cross-sectional study, mGFR for the whole group was 80 ± 2.2 ml/min/1.73 m2 (n = 199, 75 % type 2 diabetes). For subjects with mGFR >90 ml/min/1.73 m2 (mGFR: 112 ± 2.0, n = 76), both equations significantly underestimated mGFR to a similar extent: bias for CKD-EPI: -12 ± 1.4 ml/min/1.73 m2 (p < 0.001) and for MDRD: -11 ± 2.1 ml/min/1.73 m2 (p < 0.001). Using the CKD-EPI compared with the MDRD equation did not improve the number of subjects that were correctly classified to a CKD-stage. No biochemical or clinical patient characteristics were identified to account for the under estimation of mGFR values in the normal to high range by the CKD-EPI equation. In the longitudinal study (n = 30, 66 % type 1 diabetes), initial and final mGFR values were 102.8 ± 6 and 54.6 ± 6.0 ml/min/1.73 m2, respectively. Mean ΔGFR (ml/min/1.73 m2 per year) was 6.0 by mGFR compared with only 3.0 by MDRD and 3.2 by CKD-EPI (both p < 0.05 vs mGFR) Conclusions Both the CKD-EPI and MDRD equations underestimate reference GFR values >90 ml/min/1.73 m2 as well as an early decline in GFR to a similar extent in people with diabetes. There is scope to improve methods for estimating an early decline in GFR.
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Affiliation(s)
- Richard J MacIsaac
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, 4th Floor, Daly Wing, 35 Victoria Parade, PO Box 2900, Fitzroy, VIC, 3065, Australia. .,Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, 3065, Victoria, Australia.
| | - Elif I Ekinci
- Endocrine Centre, Austin Health, West Heidelberg, 3081, Victoria, Australia. .,Menzies School of Health Research, Casuarina, 0811, Northern Territory, Australia. .,Department of Medicine, Austin Health, University of Melbourne, Heidelberg, 3084, Victoria, Australia.
| | - Erosha Premaratne
- Endocrine Centre, Austin Health, West Heidelberg, 3081, Victoria, Australia.
| | - Zhong X Lu
- Melbourne Pathology, Collingwood, 3066, Victoria, Australia.
| | - Jas-Mine Seah
- Endocrine Centre, Austin Health, West Heidelberg, 3081, Victoria, Australia.
| | - Yue Li
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, 4th Floor, Daly Wing, 35 Victoria Parade, PO Box 2900, Fitzroy, VIC, 3065, Australia. .,Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, 3065, Victoria, Australia.
| | - Ray Boston
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, 4th Floor, Daly Wing, 35 Victoria Parade, PO Box 2900, Fitzroy, VIC, 3065, Australia. .,Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, 3065, Victoria, Australia.
| | - Glenn M Ward
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, 4th Floor, Daly Wing, 35 Victoria Parade, PO Box 2900, Fitzroy, VIC, 3065, Australia. .,Clinical Chemistry, St Vincent's Hospital Melbourne, Fitzroy, 3065, Victoria, Australia. .,Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, 3065, Victoria, Australia.
| | - George Jerums
- Endocrine Centre, Austin Health, West Heidelberg, 3081, Victoria, Australia. .,Department of Medicine, Austin Health, University of Melbourne, Heidelberg, 3084, Victoria, Australia.
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Stewart S, Richardson D, Boston R, Schaer TP. Risk Factors Associated With Survival to Hospital Discharge of 54 Horses With Fractures of the Radius. Vet Surg 2015; 44:1036-41. [PMID: 26455917 DOI: 10.1111/vsu.12412] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine (1) survival to discharge of horses with radial fractures (excluding osteochondral fragmentation of the distal aspect of the radius and stress fractures); and (2) risk factors affecting survival to hospital discharge in conservative and surgically managed fractures. STUDY DESIGN Case series. ANIMALS Horses (n = 54). METHODS Medical records (1990-June 2012) and radiographs of horses admitted with radial fracture were reviewed. Horses with osteochondral fragmentation of the distal aspect of the radius or stress fractures were excluded. Evaluated risk factors were age, fracture configuration, surgical repair method, surgical duration, hospitalization time, implant failure rate, and surgical site infection (SSI) rate. RESULTS Of 54 horses, overall survival to discharge was 50%. Thirteen (24%) were euthanatized on admission because of (1) fracture severity; (2) presence of an open fracture; or (3) financial constraints. Fourteen (26%) horses with minimally displaced incomplete fractures were conservatively managed and 12 (86%) survived to discharge. Twenty-seven (50%) horses had surgical treatment by open reduction and internal fixation (ORIF) and 15 (56%) survived to hospital discharge. Open fractures were significantly more likely to develop SSI (P = .008), which also resulted in a 17-fold increase in implant failure (P < .005). Six of 8 surgically managed horses with an open fracture did not survive to discharge. Outcome was also adversely affected by age (P < .005) and surgical duration > 168 minutes (P < .027). Presence of SSI trended toward a decreased survival rate (P = .09). CONCLUSION Prognosis for survival to discharge with minimally displaced incomplete fractures is good. Young horses have a good prognosis survival to discharge for ORIF, whereas ORIF in adult horses has a poor prognosis and SSI strongly correlates with catastrophic implant failure.
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Affiliation(s)
- Suzanne Stewart
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania
| | - Dean Richardson
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania
| | - Ray Boston
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania
| | - Thomas P Schaer
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania
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Engiles JB, Galantino-Homer HL, Boston R, McDonald D, Dishowitz M, Hankenson KD. Osteopathology in the Equine Distal Phalanx Associated With the Development and Progression of Laminitis. Vet Pathol 2015; 52:928-44. [PMID: 26063172 DOI: 10.1177/0300985815588604] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Although the equine distal phalanx and hoof lamellae are biomechanically and physiologically integrated, bony changes in the distal phalanx are poorly described in laminitis. The aims of this study were (1) to establish a laminitis grading scheme that can be applied to the wide spectrum of lesions seen in naturally occurring cases and (2) to measure and describe changes in the distal phalanx associated with laminitis using micro-computed tomography (micro-CT) and histology. Thirty-six laminitic and normal feet from 15 performance and nonperformance horses were evaluated. A laminitis grading scheme based on radiographic, gross, histopathologic, and temporal parameters was developed. Laminitis severity grades generated by this scheme correlated well with clinical severity and coincided with decreased distal phalanx bone volume and density as measured by micro-CT. Laminitic hoof wall changes included progressive ventral rotation and distal displacement of the distal phalanx with increased thickness of the stratum internum-corium tissues with lamellar wedge formation. Histologically, there was epidermal lamellar necrosis with basement membrane separation and dysplastic regeneration, including acanthosis and hyperkeratosis, corresponding to the lamellar wedge. The changes detected by micro-CT corresponded to microscopic findings in the bone, including osteoclastic osteolysis of trabecular and osteonal bone with medullary inflammation and fibrosis. Bone changes were identified in horses with mild/early stages of laminitis as well as severe/chronic stages. The authors conclude that distal phalangeal pathology is a quantifiable and significant component of laminitis pathology and may have important implications for early detection or therapeutic intervention of equine laminitis.
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Affiliation(s)
- J B Engiles
- Department of Pathobiology, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, USA Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, USA
| | - H L Galantino-Homer
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, USA
| | - R Boston
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, USA
| | - D McDonald
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, USA
| | - M Dishowitz
- Department of Pathobiology, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, USA Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA, USA Department of Orthopedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - K D Hankenson
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, USA Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA, USA Department of Orthopedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
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Selim S, Elo K, Jaakkola S, Karikoski N, Boston R, Reilas T, Särkijärvi S, Saastamoinen M, Kokkonen T. Relationships among Body Condition, Insulin Resistance and Subcutaneous Adipose Tissue Gene Expression during the Grazing Season in Mares. PLoS One 2015; 10:e0125968. [PMID: 25938677 PMCID: PMC4418745 DOI: 10.1371/journal.pone.0125968] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/27/2015] [Indexed: 01/09/2023] Open
Abstract
Obesity and insulin resistance have been shown to be risk factors for laminitis in horses. The objective of the study was to determine the effect of changes in body condition during the grazing season on insulin resistance and the expression of genes associated with obesity and insulin resistance in subcutaneous adipose tissue (SAT). Sixteen Finnhorse mares were grazing either on cultivated high-yielding pasture (CG) or semi-natural grassland (NG) from the end of May to the beginning of September. Body measurements, intravenous glucose tolerance test (IVGTT), and neck and tailhead SAT gene expressions were measured in May and September. At the end of grazing, CG had higher median body condition score (7 vs. 5.4, interquartile range 0.25 vs. 0.43; P=0.05) and body weight (618 kg vs. 572 kg ± 10.21 (mean ± SEM); P=0.02), and larger waist circumference (P=0.03) than NG. Neck fat thickness was not different between treatments. However, tailhead fat thickness was smaller in CG compared to NG in May (P=0.04), but this difference disappeared in September. Greater basal and peak insulin concentrations, and faster glucose clearance rate (P=0.03) during IVGTT were observed in CG compared to NG in September. A greater decrease in plasma non-esterified fatty acids during IVGTT (P<0.05) was noticed in CG compared to NG after grazing. There was down-regulation of insulin receptor, retinol binding protein 4, leptin, and monocyte chemoattractant protein-1, and up-regulation of adiponectin (ADIPOQ), adiponectin receptor 1 and stearoyl-CoA desaturase (SCD) gene expressions in SAT of both groups during the grazing season (P<0.05). Positive correlations were observed between ADIPOQ and its receptors and between SCD and ADIPOQ in SAT (P<0.01). In conclusion, grazing on CG had a moderate effect on responses during IVGTT, but did not trigger insulin resistance. Significant temporal differences in gene expression profiles were observed during the grazing season.
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Affiliation(s)
- Shaimaa Selim
- Department of Agricultural Sciences, P.O. Box 28, FI-00014 University of Helsinki, Helsinki, Finland
| | - Kari Elo
- Department of Agricultural Sciences, P.O. Box 28, FI-00014 University of Helsinki, Helsinki, Finland
- * E-mail:
| | - Seija Jaakkola
- Department of Agricultural Sciences, P.O. Box 28, FI-00014 University of Helsinki, Helsinki, Finland
| | - Ninja Karikoski
- Department of Equine and Small Animal Medicine, P.O. Box 57, FI-00014 University of Helsinki, Helsinki, Finland
| | - Ray Boston
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States of America
| | - Tiina Reilas
- Department of Green Technology, Natural Resources Institute Finland (Luke), Opistontie 10 A 1, FI-32100 Ypäjä, Finland
| | - Susanna Särkijärvi
- Department of Green Technology, Natural Resources Institute Finland (Luke), Opistontie 10 A 1, FI-32100 Ypäjä, Finland
| | - Markku Saastamoinen
- Department of Green Technology, Natural Resources Institute Finland (Luke), Opistontie 10 A 1, FI-32100 Ypäjä, Finland
| | - Tuomo Kokkonen
- Department of Agricultural Sciences, P.O. Box 28, FI-00014 University of Helsinki, Helsinki, Finland
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Navas de Solis C, Dallap Schaer BL, Boston R, Slack J. Myocardial insult and arrhythmias after acute hemorrhage in horses. J Vet Emerg Crit Care (San Antonio) 2015; 25:248-55. [PMID: 25752472 DOI: 10.1111/vec.12295] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 01/08/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objectives of this investigation were to: (1) Determine if acute hemorrhage is associated with increased plasma cardiac troponin I (cTnI) concentration or cardiac arrhythmias, (2) to describe the types of arrhythmias and their clinical course in horses following acute hemorrhage, (3) to determine the ability of clinical or clinicopathological variables to predict an increase in cTnI concentration and the presence of arrhythmias, and (4) to determine the associations of cTnI and cardiac arrhythmias with outcome. DESIGN Prospective observational study. SETTING Large animal veterinary teaching hospital. ANIMALS Eleven client-owned adult horses admitted for treatment of acute hemorrhage (HG) and 4 adult horses undergoing controlled blood collection (BDG). METHODS Serial cTnI concentrations were measured and continuous ECGs were obtained from the HG and BDG groups. Statistical tests were used to determine associations among acute hemorrhage and plasma cTnI concentrations, the presence of cardiac arrhythmias, clinicopathologic data (heart rate [HR], packed cell volume [PCV], total plasma protein [TPP], plasma lactate, and plasma creatinine concentrations), and outcome. RESULTS Plasma cTnI concentration and ECG were within reference intervals at all time points in the BDG. All horses in the HG had increased cTnI (ranging from 0.1-29.9 ng/mL). Arrhythmias were detected in 8 of these horses. There was an association between acute hemorrhage and increased cTnI (P = 0.004, ρ = 0.77), and the presence of arrhythmias (P = 0.026, ρ = 0.64). There were associations among plasma cTnI concentration and the presence of arrhythmias (P = 0.005), arrhythmias requiring treatment (P = 0.036), and poor outcome (P = 0.024). CONCLUSIONS Acute hemorrhage results in myocardial injury that can be detected by measuring cTnI concentration. Arrhythmias were frequent in hospitalized horses following acute hemorrhage.
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Affiliation(s)
- Cristobal Navas de Solis
- Sections of Sports Medicine and Imaging, Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, PA, 19348; Universidad Autonoma de Barcelona, Bellaterra, Barcelona, Spain
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24
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Abstract
Graphene oxide monoliths of defined macromorphology are used to direct the structure of complex oxides for improved functionality.
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Affiliation(s)
- R. Boston
- Bristol Centre for Functional Nanomaterials
- Centre for Nanoscience and Quantum Information
- University of Bristol
- Tyndall Avenue
- Bristol BS8 1FD, UK
| | - A. Bell
- School of Chemistry
- University of Bristol
- Cantock's Close
- Bristol, UK
| | - V. P. Ting
- Department of Chemical Engineering
- University of Bath
- Bath, UK
| | - A. T. Rhead
- Department of Mechanical Engineering
- University of Bath
- Bath, UK
| | - T. Nakayama
- Department of Electrical Engineering Nagaoka University of Technology
- 1603 1 Kamitomioka
- Nagaoka, Japan
| | - C. F. J. Faul
- School of Chemistry
- University of Bristol
- Cantock's Close
- Bristol, UK
| | - S. R. Hall
- School of Chemistry
- University of Bristol
- Cantock's Close
- Bristol, UK
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25
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Boston R, Awaya K, Nakayama T, Ogasawara W, Hall SR. Formation of superconducting yttrium barium copper oxide using sulphur-containing templates. RSC Adv 2014. [DOI: 10.1039/c4ra04745a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Protein from the acorn barnacle used to template high temperature superconductors.
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Affiliation(s)
- R. Boston
- School of Chemistry
- Cantock's Close
- University of Bristol
- Bristol, UK
- Bristol Centre for Functional Nanomaterials
| | - K. Awaya
- Nagaoka University of Technology
- Nagaoka, Japan
| | - T. Nakayama
- Nagaoka University of Technology
- Nagaoka, Japan
| | | | - S. R. Hall
- School of Chemistry
- Cantock's Close
- University of Bristol
- Bristol, UK
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26
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Boston R, Frank N. Insulin dysregulation, diabetes mellitus, and equine metabolic syndrome: lessons learned from modeling glucose and insulin dynamics in the horse. J Equine Vet Sci 2013. [DOI: 10.1016/j.jevs.2013.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Norton JL, Jackson K, Chen JW, Boston R, Nolen-Walston RD. Effect of clenbuterol on tracheal mucociliary transport in horses undergoing simulated long-distance transportation. J Vet Intern Med 2013; 27:1523-7. [PMID: 24033504 DOI: 10.1111/jvim.12166] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 05/08/2013] [Accepted: 07/17/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Pneumonia is observed in horses after long-distance transportation in association with confinement of head position leading to reduction in tracheal mucociliary clearance rate (TMCR). HYPOTHESIS/OBJECTIVES Clenbuterol, a beta-2 agonist shown to increase TMCR in the horse, will ameliorate the effects of a fixed elevated head position on large airway contamination and inflammation in a model of long-distance transportation model. ANIMALS Six adult horses. METHODS A cross-over designed prospective study. Horses were maintained with a fixed elevated head position for 48 hours to simulate long-distance transport, and treated with clenbuterol (0.8 μg/kg PO q12h) or a placebo starting 12 hours before simulated transportation. TMCR was measured using a charcoal clearance technique. Data were collected at baseline and 48 hours, and included TMCR, tracheal wash cytology and quantitative culture, rectal temperature, CBC, fibrinogen, and serum TNFα, IL-10, and IL-2 levels. There was a 18-21 day washout between study arms, and data were analyzed using regression analysis and Wilcoxon rank-sum tests. RESULTS Tracheal mucociliary clearance rate was significantly decreased after transportation in both treatment (P = .002) and placebo (P = .03) groups. There was a significant effect of treatment on TMCR, with the treatment group showing half the reduction in TMCR compared with the placebo group (P = .002). Other significant differences between before- and after-transportation samples occurred for serum fibrinogen, peripheral eosinophil count, quantitative culture, tracheal bacteria, and degenerate neutrophils, though no treatment effect was found. CONCLUSIONS AND CLINICAL IMPORTANCE Treatment with clenbuterol modestly attenuates the deleterious effects of this long-distance transportation model on tracheal mucociliary clearance.
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Affiliation(s)
- J L Norton
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA
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Durward-Akhurst SA, Mair TS, Boston R, Dunkel B. Comparison of two antimicrobial regimens on the prevalence of incisional infections after colic surgery. Vet Rec 2013; 172:287. [PMID: 23268187 DOI: 10.1136/vr.101186] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- S. A. Durward-Akhurst
- Equine Referral Hospital; The Royal Veterinary College; Hatfield Hertfordshire AL9 7TA UK
| | - T. S. Mair
- Bell Equine Veterinary Clinic; Butchers Lane Mereworth Maidstone ME18 5GS UK
| | - R. Boston
- Department of Clinical Studies; Section of Biostatistics; University of Pennsylvania; School of Veterinary Medicine; George D. Widener Hospital for Large Animals; New Bolton Centre, Kennett Square West Chester Pennsylvania 19348 USA
| | - B. Dunkel
- Equine Referral Hospital; The Royal Veterinary College; Hatfield Hertfordshire AL9 7TA UK
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Dunkel B, Kapff JE, Naylor RJ, Boston R. Blood lactate concentrations in ponies and miniature horses with gastrointestinal disease. Equine Vet J 2013; 45:666-70. [PMID: 23451985 DOI: 10.1111/evj.12043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 12/28/2012] [Indexed: 11/28/2022]
Abstract
REASONS FOR PERFORMING STUDY Clinical impression suggested that pony and miniature breeds (collectively referred to as ponies) presenting to a referral hospital for investigation of gastrointestinal disease had higher blood lactate concentrations on admission than large breed horses. OBJECTIVES The study tested the hypothesis that ponies with gastrointestinal disease had higher blood lactate concentrations on admission than large breed horses with similar disease severity. STUDY DESIGN Retrospective case-control study. METHODS Medical records from September 2006 to July 2011 were reviewed for ponies with a primary presenting complaint of gastrointestinal disease. Two larger breed horses with gastrointestinal disease were selected as controls for each case. Data collected included case details, historical and clinicopathological findings, diagnosis and outcome. RESULTS Information was collected on 50 ponies and 100 horses. Ponies had higher mean ± s.d. respiratory rates (27 ± 13 vs. 21 ± 13 beats/min; P = 0.01) and rectal temperatures (37.9 ± 0.6 vs. 37.4 ± 0.6°C; P = 0.006) and a longer median duration of clinical signs prior to presentation (10 h [1-72 h] vs. 6 h [1-120]; P<0.001). Median blood lactate concentrations on admission were higher in ponies than in horses (2.8 mmol/l [0.7-18.0] vs. 1.6 mmol/l [0.4-8.1]; P = 0.001). All other parameters relating to colic severity were not significantly different between groups, although more horses underwent exploratory laparotomy (19/50 ponies and 55/100 horses; P = 0.05). Median blood lactate concentrations in ponies with large intestinal disease, nonstrangulating lesions, undergoing medical treatment and surviving ponies were significantly higher than in horses in the same category. In contrast to horses, no differences in blood lactate concentrations exist between ponies with medical vs. surgical treatment, strangulating and nonstrangulating lesions and surviving and nonsurviving ponies. CONCLUSION AND POTENTIAL RELEVANCE Ponies might present with higher blood lactate concentrations than horses and might falsely be suspected of having a surgical lesion or a poorer prognosis if veterinarians are not aware of breed differences.
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Affiliation(s)
- B Dunkel
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, UK
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Raidal S, Edwards S, Pippia J, Boston R, Noble G. Pharmacokinetics and Safety of Oral Administration of Meloxicam to Foals. J Vet Intern Med 2013; 27:300-7. [DOI: 10.1111/jvim.12045] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 11/01/2012] [Accepted: 01/03/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- S.L. Raidal
- School of Animal and Veterinary Sciences; Charles Sturt University; Wagga Wagga NSW Australia
| | - S. Edwards
- School of Animal and Veterinary Sciences; Charles Sturt University; Wagga Wagga NSW Australia
| | - J. Pippia
- Troy Laboratories Australia Pty Ltd; Glendenning NSW Australia
| | - R. Boston
- Department of Clinical Studies; New Bolton Center; University of Pennsylvania; Kennett Square PA
| | - G.K. Noble
- School of Animal and Veterinary Sciences; Charles Sturt University; Wagga Wagga NSW Australia
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McGree JM, Noble G, Schneiders F, Dunstan AJ, McKinney AR, Boston R, Sillence M. A Bayesian approach for estimating detection times in horses: exploring the pharmacokinetics of a urinary acepromazine metabolite. J Vet Pharmacol Ther 2013; 36:31-42. [PMID: 23317425 DOI: 10.1111/j.1365-2885.2013.01389.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 01/30/2012] [Indexed: 11/27/2022]
Abstract
We describe the population pharmacokinetics of an acepromazine (ACP) metabolite (2-(1-hydroxyethyl)promazine) (HEPS) in horses for the estimation of likely detection times in plasma and urine. ACP (30 mg) was administered to 12 horses, and blood and urine samples were taken at frequent intervals for chemical analysis. A bayesian hierarchical model was fitted to describe concentration-time data and cumulative urine amounts for HEPS. The metabolite HEPS was modelled separately from the parent ACP as the half-life of the parent was considerably less than that of the metabolite. The clearance (Cl/F(PM)) and volume of distribution (V/F(PM)), scaled by the fraction of parent converted to metabolite, were estimated as 769 L/h and 6874 L, respectively. For a typical horse in the study, after receiving 30 mg of ACP, the upper limit of the detection time was 35 h in plasma and 100 h in urine, assuming an arbitrary limit of detection of 1 lg/L and a small (≈0.01) probability of detection. The model derived allowed the probability of detection to be estimated at the population level. This analysis was conducted on data collected from only 12 horses, but we assume that this is representative of the wider population.
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Affiliation(s)
- J M McGree
- Mathematical Sciences, Queensland University of Technology, Brisbane, Qld, Australia.
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Ungru J, Schmengler U, Boston R, Coenen M, Vervuert I. Effects of body weight reduction on insulin-sensitivity in obese ponies. PFERDEHEILKUNDE 2013. [DOI: 10.21836/pem20130306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ungru J, Coenen M, Vervuert I, Blüher M, Raila J, Boston R. Effects of body weight reduction on blood adipokines and subcutaneous adipose tissue adipokine mRNA expression profiles in obese ponies. Vet Rec 2012; 171:528. [DOI: 10.1136/vr.100911] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- J. Ungru
- Nutrition Diseases & Dietetics; Institute of Animal Nutrition; University of Leipzig; Leipzig 04159 Germany
| | - M. Coenen
- Nutrition Diseases & Dietetics; Institute of Animal Nutrition; University of Leipzig; Leipzig 04159 Germany
| | - I. Vervuert
- Nutrition Diseases & Dietetics; Institute of Animal Nutrition; University of Leipzig; Leipzig 04159 Germany
| | - M. Blüher
- Medical Department; University of Leipzig; Leipzig 04103 Germany
| | - J. Raila
- Institute of Nutritional Science; University of Potsdam; Nuthetal 14558 Germany
| | - Ray Boston
- Department of Clinical Studies; University of Pennsylvania; West Chester Pennsylvania 19382 USA
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D'Arcy-Moskwa E, Noble G, Weston L, Boston R, Raidal S. Effects of Meloxicam and Phenylbutazone on Equine Gastric Mucosal Permeability. J Vet Intern Med 2012; 26:1494-9. [DOI: 10.1111/j.1939-1676.2012.01004.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 06/10/2012] [Accepted: 08/14/2012] [Indexed: 12/19/2022] Open
Affiliation(s)
- E. D'Arcy-Moskwa
- School of Animal and Veterinary Sciences; Charles Sturt University; Wagga Wagga; NSW; Australia
| | - G.K. Noble
- School of Animal and Veterinary Sciences; Charles Sturt University; Wagga Wagga; NSW; Australia
| | - L.A. Weston
- EH Graham Centre for Agricultural Innovation; Charles Sturt University; Wagga Wagga; NSW; Australia
| | - R. Boston
- Department of Clinical Studies, New Bolton Center; University of Pennsylvania; Kennett Square; PA
| | - S.L. Raidal
- School of Animal and Veterinary Sciences; Charles Sturt University; Wagga Wagga; NSW; Australia
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Noble G, Edwards S, Lievaart J, Pippia J, Boston R, Raidal S. Pharmacokinetics and Safety of Single and Multiple Oral Doses of Meloxicam in Adult Horses. J Vet Intern Med 2012; 26:1192-201. [DOI: 10.1111/j.1939-1676.2012.00976.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 02/24/2012] [Accepted: 06/15/2012] [Indexed: 01/28/2023] Open
Affiliation(s)
- G. Noble
- School of Animal and Veterinary Sciences; Charles Sturt University; Wagga Wagga; NSW; Australia
| | - S. Edwards
- School of Animal and Veterinary Sciences; Charles Sturt University; Wagga Wagga; NSW; Australia
| | - J. Lievaart
- School of Animal and Veterinary Sciences; Charles Sturt University; Wagga Wagga; NSW; Australia
| | - J. Pippia
- Troy Laboratories Australia Pty Ltd; Glendenning; NSW; Australia
| | - R. Boston
- Department of Clinical Studies, New Bolton Center; University of Pennsylvania; Kennett Square; PA
| | - S.L. Raidal
- School of Animal and Veterinary Sciences; Charles Sturt University; Wagga Wagga; NSW; Australia
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Salin S, Taponen J, Elo K, Simpura I, Vanhatalo A, Boston R, Kokkonen T. Effects of abomasal infusion of tallow or camelina oil on responses to glucose and insulin in dairy cows during late pregnancy. J Dairy Sci 2012; 95:3812-25. [DOI: 10.3168/jds.2011-5206] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 03/06/2012] [Indexed: 01/01/2023]
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Barrett A, Goedert K, Chen P, Boston R. Dissociated Response to Prism Adaptation: "Aiming" Spatial-Motor Bias, Not "Where" Perceptual-Attentional Bias, Is Key Predictor (S29.006). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s29.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Barrett A, Goedert K, Chen P, Boston R. Dissociated Response to Prism Adaptation: "Aiming" Spatial-Motor Bias, Not "Where" Perceptual-Attentional Bias, Is Key Predictor (IN4-2.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.in4-2.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Harris M, Nolen-Walston R, Ashton W, May M, Jackson K, Boston R. Effect of sample storage on blood crossmatching in horses. J Vet Intern Med 2012; 26:662-7. [PMID: 22458345 DOI: 10.1111/j.1939-1676.2012.00913.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 01/17/2012] [Accepted: 02/06/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Blood samples banked for up to 1 month are typically used to perform pretransfusion testing in humans and small animals, but this has not been validated using blood from horses. HYPOTHESIS Compatibility of equine blood samples is repeatable using fresh samples, and reproducible using donor blood samples stored for up to 4 weeks. ANIMALS Six healthy adult horses. METHODS Randomized, blinded experimental study. Immunologic compatibility of the blood of all horses was assessed using a major and minor saline agglutination and hemolysin crossmatch using blood samples refrigerated for 0-4 weeks and fresh blood from the same horses. Crossmatch results were scored and then compared to identify changes of compatibility in each of the 4 tests. In addition, repeatability of the crossmatch technique itself was assessed by performing 6 iterations of this procedure in immediate succession with fresh blood from 3 horses. RESULTS No significant difference in crossmatch results was found using fresh blood (P = .39-1.00). Reproducibility was poor using blood stored for 1-4 weeks, especially in tests using stored erythrocytes (major antigen crossmatches), with significant differences from baseline at all weeks (P < .05); 13 of these differences were positive, indicating poorer compatibility. CONCLUSIONS AND CLINICAL IMPORTANCE Equine blood crossmatching is repeatable using fresh blood, although decreased apparent compatibility after storage makes exclusion of compatible donors more likely than mistaken administration of incompatible blood. These data suggest that fresh samples should be collected from potential donors before crossmatching equine blood.
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Affiliation(s)
- M Harris
- School of Veterinary Medicine, University of Pennsylvania, New Bolton Center, Kennett Square, PA 19348, USA
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Beech J, Boston R, Lindborg S. Comparison of Cortisol and ACTH Responses after Administration of Thyrotropin Releasing Hormone in Normal Horses and Those with Pituitary Pars Intermedia Dysfunction. J Vet Intern Med 2011; 25:1431-8. [DOI: 10.1111/j.1939-1676.2011.00810.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 08/09/2011] [Accepted: 08/22/2011] [Indexed: 11/26/2022] Open
Affiliation(s)
- J. Beech
- Department of Clinical Studies; School of Veterinary Medicine; University of Pennsylvania; New Bolton Center; Kennett Square; PA
| | - R. Boston
- Department of Clinical Studies; School of Veterinary Medicine; University of Pennsylvania; New Bolton Center; Kennett Square; PA
| | - S. Lindborg
- Department of Clinical Studies; School of Veterinary Medicine; University of Pennsylvania; New Bolton Center; Kennett Square; PA
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Abstract
REASONS FOR PERFORMING THE STUDY Intestinal hyperammonaemia (HA) has been infrequently reported in individual horses; however, there have been no studies describing clinical and laboratory data as well as short- and long-term outcome in a larger number of cases. OBJECTIVES To describe clinical and laboratory data and short- and long-term outcome in a large group of horses with intestinal HA. METHODS Multi-centred, retrospective study; case records of horses with HA were reviewed and any horse with a clinical or post mortem diagnosis of intestinal HA was included. Hyperammonaemia was defined as a blood ammonium (NH(4) (+)) concentration ≥60 µmol/l and horses with a diagnosis of primary hepatic disease were excluded. Relevant data were recorded and, if appropriate, data from survivors were compared to nonsurvivors to identify potential prognostic indicators. RESULTS Thirty-six cases, 26 mature horses and 10 foals with intestinal HA were identified. Case histories included diarrhoea, colic and neurological signs and the most common clinical diagnosis was colitis and/or enteritis. The most common clinical and laboratory abnormalities included tachycardia, increased packed cell volume, hyperlactataemia and hyperglycaemia. Fourteen horses (39%) survived to discharge; NH(4) (+) concentration on admission was the only parameter significantly associated with survival. All surviving horses and foals for which follow-up information was available recovered completely and returned to their intended use without further complications. CONCLUSIONS AND POTENTIAL RELEVANCE Intestinal HA occurs in mature horses and foals and can be associated with severe clinical and laboratory abnormalities; further studies are required to investigate predisposing factors and delineate possible differences in aetiologies.
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Affiliation(s)
- B Dunkel
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hertfordshire, UK.
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Norton J, Nolen-Walston R, Underwood C, Boston R, Slack J, Dallap B. Repeatability, Reproducibility, and Effect of Head Position on Central Venous Pressure Measurement in Standing Adult Horses. J Vet Intern Med 2011; 25:575-8. [DOI: 10.1111/j.1939-1676.2011.0701.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Tyner GA, Nolen-Walston RD, Hall T, Palmero JP, Couëtil L, Javsicas L, Stack A, Schott H, Johnson A, Hardefeldt L, Gruntman A, Sommardahl C, Menzies-Gow N, dePedro P, Norman T, Fennell LC, Axon JE, Lindborg S, Aceto H, Boston R, Engiles J. A multicenter retrospective study of 151 renal biopsies in horses. J Vet Intern Med 2011; 25:532-9. [PMID: 21382083 DOI: 10.1111/j.1939-1676.2011.0700.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Renal biopsies are uncommonly performed in horses and little is known about their diagnostic utility and associated complication rate. OBJECTIVE To describe the techniques, the complication rate, risk factors, and histopathology results; as well as evaluate the safety and diagnostic utility of renal biopsy in the horse. ANIMALS One hundred and forty-six horses from which 151 renal biopsies were obtained. Animals ranged in age from 48 hours to 30 years. METHODS Multicenter retrospective study, with participation of 14 institutions (1983-2009). RESULTS Renal biopsy in horses was associated with a similar rate of complications (11.3%) to that occurring in humans and companion animals. Complications were generally associated with hemorrhage or signs of colic, and required treatment in 3% of cases. Fatality rate was low (1/151; 0.7%). Biopsy specimens yielded sufficient tissue for a histopathologic diagnosis in most cases (94%) but diagnoses had only fair (72%) agreement with postmortem findings. Risk factors for complications included biopsy specimens of the left kidney (P = .030), a diagnosis of neoplasia (P = .004), and low urine specific gravity (P = .030). No association with complications was found for age, sex, breed, institution, presenting complaint, other initial clinicopathologic data, biopsy instrument, needle size, or use of ultrasonographic guidance. CONCLUSIONS AND CLINICAL IMPORTANCE Renal biopsy in horses has low morbidity and results in a morphological histopathologic diagnosis in 94% of cases. However, this procedure might result in serious complications and should only be used when information obtained would be likely to impact decisions regarding patient management and prognosis.
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Affiliation(s)
- G A Tyner
- Large Animal Internal Medicine Center, New Bolton Center, University of Pennsylvania, Kennett Square, PA 19348, USA
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Norton JL, Nolen-Walston RD, Underwood C, Slack J, Boston R, Dallap BL. Comparison of water manometry to 2 commercial electronic pressure monitors for central venous pressure measurement in horses. J Vet Intern Med 2011; 25:303-6. [PMID: 21281354 DOI: 10.1111/j.1939-1676.2010.0670.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Central venous pressure (CVP) customarily has been measured in veterinary patients with water manometry. However, many institutions are now using stallside electronic monitors in both anesthesia and intensive care units for many aspects of patient monitoring. HYPOTHESIS Electronic stall side monitoring devices will agree with water manometry for measurement of CVP in horses. ANIMALS Ten healthy adult horses from the university research herd. METHODS Central venous catheters were placed routinely, and measurements were obtained in triplicate with each of the 3 methods every 12 hours for 3 days. Data were analyzed by a Lin concordance correlation coefficient and modified Bland-Altman limits of agreement, with all devices compared pairwise. RESULTS Compared with water manometry, agreement (bias) of the Passport was -1.94 cmH₂O (95% limits of agreement, -8.54 to 4.66 cmH₂O) and of the Medtronic was -1.83 cmH₂O (95% limits of agreement, -8.60 to 4.94 cmH₂O). When compared with the Passport, agreement of the data obtained with the Medtronic was 0.27 cmH₂O (95% limits of agreement, -4.39 to 4.93 cmH₂O). CONCLUSIONS AND CLINICAL IMPORTANCE These data show that both electronic monitors systematically provide measurements that are approximately 2 cmH₂O lower than water manometry, but differences between the 2 electronic devices are small enough (< 0.5 cmH₂O) to be considered clinically unimportant. This discrepancy should be taken into account when interpreting data obtained with these monitoring devices.
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Affiliation(s)
- J L Norton
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, PA, USA
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Nolen-Walston RD, Norton JL, Navas de Solis C, Underwood C, Boston R, Slack J, Dallap BL. The effects of hypohydration on central venous pressure and splenic volume in adult horses. J Vet Intern Med 2010; 25:570-4. [PMID: 21092009 DOI: 10.1111/j.1939-1676.2010.0641.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Central venous pressure (CVP) is used in many species to monitor right-sided intravascular volume status, especially in critical care medicine. HYPOTHESIS That hypohydration in adult horses is associated with a proportional reduction in CVP. ANIMALS Ten healthy adult horses from the university teaching herd. METHODS In this experimental study, horses underwent central venous catheter placement and CVP readings were obtained by water manometry. The horses were then deprived of water and administered furosemide (1 mg/kg IV q6h) for up to 36 hours. Weight, CVP, vital signs, PCV, total protein (TP), and serum lactate were monitored at baseline and every 6 hours until a target of 5% decrease in body weight loss was achieved. The spleen volume was estimated sonographically at baseline and peak volume depletion. Linear regression analysis was used to assess the association of CVP and other clinical parameters with degree of body weight loss over time. RESULTS There was a significant association between CVP and decline in body weight (P < .001), with a decrease in CVP of 2.2 cmH(2)O for every percentage point decrease in body weight. Other significant associations between volume depletion and parameters measured included increased TP (P = .007), increased serum lactate concentration (P = .048), and decreased splenic volume (P = .046). There was no significant association between CVP and vital signs or PCV. CONCLUSIONS AND CLINICAL IMPORTANCE These findings suggest that CVP monitoring might be a useful addition to the clinical evaluation of hydration status in adult horses.
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Affiliation(s)
- R D Nolen-Walston
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, PA 19348, USA.
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Dunkel B, Chan D, Boston R, Monreal L. Association between Hypercoagulability and Decreased Survival in Horses with Ischemic or Inflammatory Gastrointestinal Disease. J Vet Intern Med 2010; 24:1467-74. [DOI: 10.1111/j.1939-1676.2010.0620.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Underwood C, Norton J, Nolen-Walston R, Dallap-Schaer B, Boston R, Slack J. Echocardiographic Changes in Heart Size in Hypohydrated Horses. J Vet Intern Med 2010; 25:563-9. [DOI: 10.1111/j.1939-1676.2010.0612.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Henriksen JE, Alford F, Ward G, Thye-Rønn P, Levin K, Hother-Nielsen O, Rantzau C, Boston R, Beck-Nielsen H. Glucose effectiveness and insulin sensitivity measurements derived from the non-insulin-assisted minimal model and the clamp techniques are concordant. Diabetes Metab Res Rev 2010; 26:569-78. [PMID: 20830736 DOI: 10.1002/dmrr.1127] [Citation(s) in RCA: 7] [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: 11/07/2022]
Abstract
BACKGROUND We investigated the concordance between glucose effectiveness (SG) and insulin sensitivity (SI), derived from the unmodified dynamic non-insulin-assisted intravenous glucose tolerance test (IVGTT) implemented by SG(MM) and SI(MM); simulation analysis and modelling/conversational interaction (SAAM/CONSAM) versus the eu/hyperglycaemic basal insulinaemic and the euglycaemic hyperinsulinaemic clamp (SG(CLAMP) and SI(CLAMP)). METHODS Twenty-seven of 30 normoglycaemic subjects completed a (1) euglycaemic hyperinsulinaemic clamp, (2) 6-h eu/hyperglycaemic near-normoinsulinaemic pancreatic clamp with hyperglycaemia present over the final 2 h of the clamp (Day 2 study), (3) identical clamp to (2) but with euglycaemia maintained over the entire 6 h (Day 3 study) and (4) IVGTT. SG(CLAMP) was calculated in two ways based on data from study (2) alone (Day 2 SG(CLAMP210-240')) or from data from study day (2) and (3) (Day 2-3 SG(CLAMP330-360')). RESULTS SG(MM) was unrelated to the magnitude of endogenous insulin release (AIR). The single-day (Day 2) and two-day (Day 2 and 3) SG(CLAMP) protocols correlated (r = 0.72, p = 0.003), but SG(CLAMP210-240') was significantly (p = 0.001) higher than SG(CLAMP330-360'). Employing the Day 2 and 3 SG(CLAMP) protocol, the whole body SG(CLAMP330-360') was similar to SG(MM) (1.80 ± 0.82 versus 1.73 ± 0.58 dL/min) and correlated (r = 0.45, p < 0.02). SG(CLAMP210-240') did not correlate with SG(MM) (r = 0.24). SI(MM) and SI(CLAMP) were similar (0.093 ± 0.060 versus 0.087 ± 0.029 dL/min per mU/L) and correlated (r = 0.76, p < 0.001). CONCLUSIONS The time-dependent increase in glucose disposal observed during a prolonged 6-h clamp significantly influences the estimation of SG(CLAMP), and significant concordance coefficients are observed between SG(MM), and SG(CLAMP330-360'), and SI(MM) and SI(CLAMP).
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Affiliation(s)
- Jan Erik Henriksen
- Department of Endocrinology M, Diabetes Research Centre, Odense University Hospital, Odense C, Denmark.
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Abstract
REASONS FOR PERFORMING STUDY The period between the onset of dystocia and its resolution has an important bearing on fetal outcome. There are few published data on which to base decisions regarding optimum management of cases in practice. OBJECTIVES To evaluate and compare the effects of a coordinated dystocia management protocol (CDMP) with that of a previous protocol of random management on time to resolution and outcome in both an emergency dystocia referral population of mares (referred emergency cases: EM) and in a population of mares residing in hospital due to high risk pregnancy (HRP) concerns that then experience dystocia at parturition. METHODS Retrospective study performed at a university hospital referral centre of cases presenting from 1991-2004 divided into Group 1 (pre-CDMP) and Group 2 (CDMP). RESULTS Medical records of 71 cases with dystocia were retrieved and data recorded. For referred emergency cases (EM), time from hospital presentation to resolution decreased significantly by 32 min (P = 0.03) after institution of CDMP. Survival rate of mares at discharge was 86%. Survival of EM foals was low, with 10% in Group 1 and 13% in Group 2, surviving to discharge. For EM foals delivered alive, survival to discharge was 30% and 43% in Groups 1 and 2, respectively. Median Stage II was significantly (P < 0.001) different at 71 and 282 min for EM foals delivered alive vs. those not alive at delivery, respectively. Median duration of Stage II was also significantly (P < 0.001) different between EM foals surviving and not surviving to discharge, at 44 and 249 min, respectively. Survival of HRP dystocia foals to discharge was 79%. CONCLUSIONS Although CDMP reduced the time from presentation at the hospital to resolution significantly for EM, total duration of Stage II for EM was unchanged, as was foal outcome. POTENTIAL RELEVANCE Very early referral of mares with dystocia to referral centres with dystocia management protocols may improve fetal outcome as increased duration of Stage II in the horse affects fetal outcome negatively.
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Affiliation(s)
- J Lynch Norton
- Department of Clinical Studies, Section of Large Animal Medicine, University of Pennsylvania, School of Veterinary Medicine, George D. Widener Hospital for Large Animals, New Bolton Center, Kennett Square, Pennsylvania 19348, USA
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