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Faingold R, Prempunpong C, Garfinkle J, St Martin C, Menegotto F, Boyle R, Donoso JMA, Nguyen KA, Sant'Anna GM. Association between Early Basal Ganglia and Thalami Perfusion Assessed by Color Doppler Ultrasonography and Brain Injury in Infants with Hypoxic-Ischemic Encephalopathy: A Prospective Cohort Study. J Pediatr 2024:114086. [PMID: 38705232 DOI: 10.1016/j.jpeds.2024.114086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/23/2024] [Accepted: 04/28/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE To evaluate associations between neurologic outcomes and early measurements of basal ganglia (BG) and thalamic (Th) perfusion using color Doppler ultrasonography (CDUS) in infants with hypoxic-ischemic encephalopathy (HIE). STUDY DESIGN Prospective study of infants with mild (n=18), moderate (n=17), and severe HIE (n=14) and controls (n=17). Infants with moderate-severe HIE received therapeutic hypothermia (TH). CDUS was performed at 24-36h and brain magnetic resonance imaging (MRI) at a median of 10 days. Development was followed through 2.5 to 5 years. The primary outcome was the association between BG and Th perfusion and brain MRI injury. Secondary analyses focused on associations between perfusion measurements and admission neurologic examinations, MRI scores in infants treated with TH, and motor and sensory disability, or death. An exploratory analysis assessed the accuracy of BG and Th perfusion to predict brain MRI injury in infants treated with TH. RESULTS Increased BG and Th perfusion on CDUS was observed in infants with severe MRI scores and those with significant motor and neurosensory disability or death through 2.5 to 5 years (p<0.05). Infants with severe HIE showed increased BG and Th perfusion (p< .005) compared with infants with moderate HIE. No differences were identified between the between the control and mild HIE groups. Th perfusion ≥ 0.237 cm/sec (AUC of 0.824) correctly classified 80% of infants with severe MRI scores. CONCLUSION Early dynamic CDUS of the BG and Th is a potential biomarker of severe brain injury in infants with HIE and may be a useful adjunct to currently used assessments.
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Affiliation(s)
- R Faingold
- Associate Professor of Pediatric Radiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - C Prempunpong
- Associate Professor of Pediatrics, Neonatal Division, Mahidol University, Bangkok, Thailand
| | - J Garfinkle
- Assistant Professor of Pediatrics, Neonatal Division, McGill University Health Center, Montreal, Canada
| | - C St Martin
- Associate Professor of Pediatric Radiology, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - F Menegotto
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, UK
| | - R Boyle
- Neonatal Nurse Practitioner, Neonatal Division, Edmonton, Canada
| | - J M A Donoso
- Masters Student of Experimental Surgery, McGill University, Montreal, Canada
| | - K A Nguyen
- Assistant Professor of Pediatrics, Neonatal Follow-up Division, Jewish General Hospital, McGill University Health Center, Montreal, Canada
| | - G M Sant'Anna
- Full Professor of Pediatrics, Neonatal Division, Senior Scientist of the Research Institute and Member of the Experimental Medicine Department, McGill University Health Center, Montreal, Canada.
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Broekhuis D, Meurs WMH, Kaptein BL, Karunaratne S, Carey Smith RL, Sommerville S, Boyle R, Nelissen RGHH. High accuracy of positioning custom triflange acetabular components in tumour and total hip arthroplasty revision surgery. Bone Jt Open 2024; 5:260-268. [PMID: 38555947 PMCID: PMC10981996 DOI: 10.1302/2633-1462.54.bjo-2023-0185.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Abstract
Aims Custom triflange acetabular components (CTACs) play an important role in reconstructive orthopaedic surgery, particularly in revision total hip arthroplasty (rTHA) and pelvic tumour resection procedures. Accurate CTAC positioning is essential to successful surgical outcomes. While prior studies have explored CTAC positioning in rTHA, research focusing on tumour cases and implant flange positioning precision remains limited. Additionally, the impact of intraoperative navigation on positioning accuracy warrants further investigation. This study assesses CTAC positioning accuracy in tumour resection and rTHA cases, focusing on the differences between preoperative planning and postoperative implant positions. Methods A multicentre observational cohort study in Australia between February 2017 and March 2021 included consecutive patients undergoing acetabular reconstruction with CTACs in rTHA (Paprosky 3A/3B defects) or tumour resection (including Enneking P2 peri-acetabular area). Of 103 eligible patients (104 hips), 34 patients (35 hips) were analyzed. Results CTAC positioning was generally accurate, with minor deviations in cup inclination (mean 2.7°; SD 2.84°), anteversion (mean 3.6°; SD 5.04°), and rotation (mean 2.1°; SD 2.47°). Deviation of the hip centre of rotation (COR) showed a mean vector length of 5.9 mm (SD 7.24). Flange positions showed small deviations, with the ischial flange exhibiting the largest deviation (mean vector length of 7.0 mm; SD 8.65). Overall, 83% of the implants were accurately positioned, with 17% exceeding malpositioning thresholds. CTACs used in tumour resections exhibited higher positioning accuracy than rTHA cases, with significant differences in inclination (1.5° for tumour vs 3.4° for rTHA) and rotation (1.3° for tumour vs 2.4° for rTHA). The use of intraoperative navigation appeared to enhance positioning accuracy, but this did not reach statistical significance. Conclusion This study demonstrates favourable CTAC positioning accuracy, with potential for improved accuracy through intraoperative navigation. Further research is needed to understand the implications of positioning accuracy on implant performance and long-term survival.
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Affiliation(s)
- Demien Broekhuis
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Willemijne M. H. Meurs
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Bart L. Kaptein
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Scott Sommerville
- Department of Orthopaedic Surgery, Princess Alexandra Hospital, Brisbane, Australia
| | - Richard Boyle
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Rob G. H. H. Nelissen
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, Netherlands
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3
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Favaloro J, Bryant CE, Abadir E, Gardiner S, Yang S, King T, Nassif N, Sedger LM, Boyle R, Joshua DE, Ho PJ. Single-cell analysis of the CD8 + T-cell compartment in multiple myeloma reveals disease specific changes are chiefly restricted to a CD69 - subset suggesting potent cytotoxic effectors exist within the tumor bed. Haematologica 2024; 109:1220-1232. [PMID: 37794800 PMCID: PMC10985429 DOI: 10.3324/haematol.2023.283062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023] Open
Abstract
Multiple myeloma (MM) is an incurable disease of the bone marrow (BM) characterized by the uncontrolled proliferation of neoplastic plasma cells. While CD8+ T cells have an established role in disease control, few studies have focused on these cells within the MM tumor microenvironment (TME). We analyzed CD8+ T cells in the BM and peripheral blood (PB) of untreated patients with MM and non-myeloma controls using flow cytometry, mass cytometry and single-cell RNA sequencing, using several novel bioinformatics workflows. Inter-tissue differences were most evident in the differential expression of Granzymes B and K, which were strongly associated with two distinct subsets of CD8+ T cells delineated by the expression of CD69, accounting for roughly 50% of BM-CD8+ T cells of all assessed cohorts. While few differences were observable between health and disease in the BM-restricted CD8CD69+ T-cell subset, the CD8+CD69- T-cell subset in the BM of untreated MM patients demonstrated increased representation of highly differentiated effector cells and evident compositional parallels between the PB, absent in age-matched controls, where a marked reduction of effector cells was observed. We demonstrate the transcriptional signature of BM-CD8+ T cells from patients with MM more closely resembles TCR-activated CD8+ T cells from age-matched controls than their resting counterparts.
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Affiliation(s)
- James Favaloro
- Institute of Haematology, Multiple Myeloma Research Laboratory, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; School of Life Sciences, University of Technology Sydney, Ultimo, NSW.
| | - Christian E Bryant
- Institute of Haematology, Multiple Myeloma Research Laboratory, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW.
| | - Edward Abadir
- Institute of Haematology, Multiple Myeloma Research Laboratory, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW
| | - Samuel Gardiner
- Sydney Local Health District Clinical Research Institute, Royal Prince Alfred Hospital, Camperdown, NSW
| | - Shihong Yang
- Institute of Haematology, Multiple Myeloma Research Laboratory, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW
| | - Tracy King
- Institute of Haematology, Multiple Myeloma Research Laboratory, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW
| | - Najah Nassif
- School of Life Sciences, University of Technology Sydney, Ultimo, NSW
| | - Lisa M Sedger
- Institute for Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital. Westmead NSW, Sydney, Australia; Centre for Virus research, Westmead Institute for Medical research. Westmead NSW, Sydney
| | - Richard Boyle
- Orthopaedics Department, Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, NSW
| | - Douglas E Joshua
- Institute of Haematology, Multiple Myeloma Research Laboratory, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW
| | - P Joy Ho
- Institute of Haematology, Multiple Myeloma Research Laboratory, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; School of Life Sciences, University of Technology Sydney, Ultimo, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW
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Murphy GT, Le M, Frangos Young A, Le M, Guzman MS, Franks D, Boyle R, Stalley P. Unique case of a broken axle in a GMRS tumour prosthesis: insights and challenges. ANZ J Surg 2024. [PMID: 38475966 DOI: 10.1111/ans.18940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Geoffrey T Murphy
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Matthew Le
- South West Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Annamaria Frangos Young
- Department of Hand Surgery and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Michael Le
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Maurice S Guzman
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Daniel Franks
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Richard Boyle
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Paul Stalley
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Boyle R, Gunga HC. Editorial: Insights in Environmental, Aviation and Space Physiology: 2022. Front Physiol 2023; 14:1278192. [PMID: 37731539 PMCID: PMC10507385 DOI: 10.3389/fphys.2023.1278192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/25/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
| | - Hanns-Christian Gunga
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany
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Broekhuis D, Boyle R, Karunaratne S, Chua A, Stalley P. Custom designed and 3D-printed titanium pelvic implants for acetabular reconstruction after tumour resection. Hip Int 2023; 33:905-915. [PMID: 36408844 PMCID: PMC10486168 DOI: 10.1177/11207000221135068] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 07/26/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Reconstructive procedure following resection of large pelvic tumours around the hip joint remains a complex challenge. METHODS This study presents a retrospective case series of patients presenting with benign or malignant pelvic tumour for which an internal hemipelvectomy including the hip joint and subsequent reconstruction with a custom designed 3-dimensional printed titanium pelvic implant (3DPPI) has been performed between August 2013 and January 2018. RESULTS 15 consecutive patients with a median age of 33.9 years (IQR 26.4-72.2) and a median BMI of 20.7 kg/m2 (IQR 19.0-33.3) were reviewed after median follow-up of 33.8 months (IQR 24.0-78.1). The majority of patients presented with a malignant tumour as their principal diagnosis (n = 13, 86.7%). The median surgical time was 5.5 hours (IQR 4.5-8.5) and median peri-operative blood loss was 5000 ml (IQR 2000-10000). The median MSTS score at follow-up was 63.3% (IQR 51.7-86.7%). The median NRS in rest was 0.0 (IQR 0.0-5.0), the median NRS during activity was 2.0 (IQR 0.5-7.0) and the median HOOS-PS was 76.6% (IQR 67.9-91.0). 4 patients had implant-specific complications (n = 4, 26.6%); 1 hip dislocation (Henderson type 1a), 3 structural complications (type 3a), 1 deep infection (type 4a) and 1 local tumour recurrence (type 5b). At follow-up, 4 out of 15 implants were classified as a failure, resulting in an implant survival rate of 73.3%. CONCLUSIONS Acceptable peri-operative outcomes, functional results, complication rates and short-term implant survival can be achieved in a cohort of complex patients undergoing 3DPPI reconstruction after hemipelvectomy including the acetabulum.
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Affiliation(s)
| | - Richard Boyle
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Alfred Chua
- Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Paul Stalley
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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7
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Spierenburg G, Verspoor FGM, Wunder JS, Griffin AM, Ferguson PC, Houdek MT, King DM, Boyle R, Lor Randall R, Thorpe SW, Priester JI, Geiger EJ, van der Heijden L, Bernthal NM, Schreuder BHWB, Gelderblom H, van de Sande MAJ. One-Stage Synovectomies Result in Improved Short-Term Outcomes Compared to Two-Stage Synovectomies of Diffuse-Type Tenosynovial Giant Cell Tumor (D-TGCT) of the Knee: A Multicenter, Retrospective, Cohort Study. Cancers (Basel) 2023; 15:cancers15030941. [PMID: 36765897 PMCID: PMC9913566 DOI: 10.3390/cancers15030941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023] Open
Abstract
Diffuse-type tenosynovial giant cell tumors' (D-TGCTs) intra- and extra-articular expansion about the knee often necessitates an anterior and posterior surgical approach to facilitate an extensive synovectomy. There is no consensus on whether two-sided synovectomies should be performed in one or two stages. This retrospective study included 191 D-TGCT patients from nine sarcoma centers worldwide to compare the postoperative short-term outcomes between both treatments. Secondary outcomes were rates of radiological progression and subsequent treatments. Between 2000 and 2020, 117 patients underwent one-stage and 74 patients underwent two-stage synovectomies. The maximum range of motion achieved within one year postoperatively was similar (flexion 123-120°, p = 0.109; extension 0°, p = 0.093). Patients undergoing two-stage synovectomies stayed longer in the hospital (6 vs. 4 days, p < 0.0001). Complications occurred more often after two-stage synovectomies, although this was not statistically different (36% vs. 24%, p = 0.095). Patients treated with two-stage synovectomies exhibited more radiological progression and required subsequent treatments more often than patients treated with one-stage synovectomies (52% vs. 37%, p = 0.036) (54% vs. 34%, p = 0.007). In conclusion, D-TGCT of the knee requiring two-side synovectomies should be treated by one-stage synovectomies if feasible, since patients achieve a similar range of motion, do not have more complications, but stay for a shorter time in the hospital.
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Affiliation(s)
- Geert Spierenburg
- Department of Orthopedic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Correspondence: ; Tel.: +31-(0)71-5263161
| | - Floortje G. M. Verspoor
- Department of Orthopedic Surgery, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands
| | - Jay S. Wunder
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Anthony M. Griffin
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Peter C. Ferguson
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Matthew T. Houdek
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - David M. King
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Richard Boyle
- Department of Orthopedic Surgery, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Robert Lor Randall
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Steven W. Thorpe
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Jacob I. Priester
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Erik J. Geiger
- Rothman Institute and Department of Orthopedic Surgery Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Lizz van der Heijden
- Department of Orthopedic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Nicholas M. Bernthal
- Department of Orthopaedic Surgery, University of California-Los Angeles, Los Angeles, CA 90404, USA
| | | | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Davis JRC, Boyle R, Knight SP, Romero-Ortuño R, Zúñiga RG. 66 GRIP STRENGTH, ONLY A PHYSICAL TASK? ASSOCIATIONS BETWEEN RESTING-STATE BRAIN CONNECTIVITY AND GRIP STRENGTH. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Grip strength (GS) is a simple measure used in the assessment of frailty and sarcopenia. Despite being physical, studies show that it is also related with depression and cognition. Our aim was to explore if brain connectivity is implicated in GS.
Methods
Participants from Wave 3 of TILDA with adequate resting-state functional-MRI data were included. Connectome-based predictive modelling was used on Shen parcellated brain connectivity matrices to find connections that are positively and negatively associated with grip strength: positive and negative networks (PN and NN). On each iteration of a randomized 10-fold cross-validation, the training folds were utilized to perform partial Spearman correlations (age-, sex-adjusted) between each connection and GS. Significant (p<0.001) connections were selected. PN and NN strengths were computed by summing across all significant correlations. Linear models regressing GS on network strengths were built on training data and used to predict GS in the test fold. After 10 folds were complete the performance was measured via Pearson R between predicted and true GS values. This 10-fold process was repeated 1000 times and a mean R obtained. Permutation significance testing was employed where the cross-validation procedure was repeated 1000 times, with GS randomly shuffled each time. The P-value was the proportion of permuted R values >= the mean R.
Results
317 participants were included (mean(SD) age 67.3(7.2) and 49.8% female). For PN: R[95% intervals]=0.29[0.26, 0.32], P<0.001 and for NN: R=0.24[0.20, 0.28], P<0.001. In both, the default mode, dorsal attention, and cerebellum networks were highly involved but with differing patterns: most notable was the presence of high connectivity between both cerebellar hemispheres in the PN but not in the NN.
Conclusion
Grip strength is related with different brain connectivity patterns suggesting the involvement of networks beyond motor areas. Further studies are required to disentangle the neuroscience behind this clinically relevant physio-cognitive task.
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Affiliation(s)
- JRC Davis
- Trinity College Dublin The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, , Dublin, Ireland
- Trinity College Dublin Discipline of Medical Gerontology, School of Medicine, , Dublin, Ireland
| | - R Boyle
- Harvard Medical School Department of Neurology, Massachusetts General Hospital, , Boston, MA, USA
| | - SP Knight
- Trinity College Dublin The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, , Dublin, Ireland
- Trinity College Dublin Discipline of Medical Gerontology, School of Medicine, , Dublin, Ireland
| | - R Romero-Ortuño
- Trinity College Dublin The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, , Dublin, Ireland
- Trinity College Dublin Discipline of Medical Gerontology, School of Medicine, , Dublin, Ireland
- Mercer’s Institute for Successful Ageing (MISA), St. James’s Hospital , Dublin, Ireland
- Trinity College Dublin Global Brain Health Institute, , Dublin, Ireland
| | - RG Zúñiga
- Trinity College Dublin The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, , Dublin, Ireland
- Trinity College Dublin Global Brain Health Institute, , Dublin, Ireland
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Shirsath MA, O'Connor J, Boyle R, Newman L, Whelan R, Knight S, Meaney J, Kenny RA. 148 ORTHOSTATIC HEMODYNAMICS AND ACCELERATED BRAIN AGING. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Impaired recovery of blood pressure (BP) in response to standing up is a prevalent condition in older individuals. We evaluated the relationship between the recovery of hemodynamic responses to standing and brain health in adults over 50.
Methods
Participants from The Irish Longitudinal Study on Aging (TILDA) (n=418) performed an active stand challenge while BP and heart rate (HR) were continuously monitored. The recovery of these parameters was determined as the difference in measurements taken at 10 s and 20 s after standing, in relation to the baseline value. The difference between biological and chronological brain age was determined using BrainPAD, a novel validated measure of accelerated brain ageing. The data was fitted using linear regression models, using age, sex, weight, height, cardiac disease prevalence, antihypertensive and antidepressant use, smoking status, standing speed and pulse wave velocity as covariates.
Results
Adjusting for age and sex only, each additional year of BrainPAD was associated with a –0.35 mmHg (95% CI: –0.54 – –0.16, P<.001) change in orthostatic systolic BP recovery. In a fully adjusted model, the regression coefficient was estimated at –0.29 mmHg (95% CI: –0.48 – –0.10, P<.01). Similarly, a year increase in BrainPAD was associated with –0.21 mmHg (95% CI: –0.32– –0.10, P<0.001) and –0.14 mmHg (95% CI: –0.25– –0.04, P<.01) change in orthostatic diastolic BP recovery, for minimally and fully adjusted models respectively. HR recovery was not significantly associated with BrainPAD.
Conclusion
These results demonstrate that impaired systolic and diastolic BP recovery after standing is associated with accelerated brain aging in older individuals. This suggests that the BP response to standing, measured using beat-to-beat monitoring, has potential to be used as a marker of accelerated brain aging, relying on a simple procedure and devices that are easily accessible for clinical use.
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Affiliation(s)
- MA Shirsath
- University of Dublin The Irish Longitudinal Study on Aging (TILDA), School of Medicine, Trinity College, , Dublin, Ireland
| | - J O'Connor
- Queen’s University School of Medicine, Dentistry and Biomedical Sciences, The Patrick G Johnston Centre for Cancer Research, , Belfast, United Kingdom
- University of Dublin The Irish Longitudinal Study on Aging (TILDA), School of Medicine, Trinity College, , Dublin, Ireland
| | - R Boyle
- University of Dublin Trinity College Institute of Neuroscience, Trinity College, , Dublin, Ireland
| | - L Newman
- University of Dublin The Irish Longitudinal Study on Aging (TILDA), School of Medicine, Trinity College, , Dublin, Ireland
| | - R Whelan
- University of Dublin Trinity College Institute of Neuroscience, Trinity College, , Dublin, Ireland
- Trinity College Dublin Global Brain Health Institute, Trinity College, , Dublin, Ireland
| | - S Knight
- University of Dublin The Irish Longitudinal Study on Aging (TILDA), School of Medicine, Trinity College, , Dublin, Ireland
| | - J Meaney
- St. James’s Hospital The National Centre for Advanced Medical Imaging (CAMI), , Dublin, Ireland
| | - RA Kenny
- University of Dublin The Irish Longitudinal Study on Aging (TILDA), School of Medicine, Trinity College, , Dublin, Ireland
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Abstract
Persistent sciatic arteries are rare congenital abnormalities, with an incidence between .01-.6%. Whilst most patients with the pathology are asymptomatic during their younger years, up to 48% of patients will suffer aneurysmal degeneration of the persistent sciatic artery and present with claudication or lower limb ischaemia (from distal embolisation of mural thrombus). Due to the rare nature of persistent sciatic artery aneurysms, optimal management of the pathology is yet to be determined. Both endovascular and open techniques have been described in the management of this pathology, however hybrid management approaches are reported infrequently. The authors present a case of a persistent sciatic artery aneurysm successfully treated in a 69-year-old male utilising a hybrid approach with a femoropopliteal bypass (below knee), Amplatzer plug occlusion of the aneurysm and subsequent resection of the aneurysm.
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Affiliation(s)
- Madeleine de Boer
- Department of Vascular Surgery, 2205Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Simon Joseph
- Department of Vascular Surgery, 2205Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Timothy Shiraev
- Department of Vascular Surgery, 2205Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Medicine, University of Notre Dame, Darlinghurst, NSW, Australia
| | - Richard Boyle
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Steven Dubenec
- Department of Vascular Surgery, 2205Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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Strach MC, Grimison PS, Hong A, Boyle R, Stalley P, Karim R, Connolly EA, Bae S, Desai J, Crowe P, Singhal N, Bhadri VA. Mesenchymal chondrosarcoma: An Australian multi-centre cohort study. Cancer Med 2022; 12:368-378. [PMID: 35603739 PMCID: PMC9844591 DOI: 10.1002/cam4.4849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/29/2022] [Accepted: 05/04/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Mesenchymal chondrosarcoma (MCS) is an ultra-rare sarcoma that follows a more aggressive course than conventional chondrosarcoma. This study evaluates prognostic factors, treatments (surgery, chemotherapy, and radiation), and outcomes in an Australian setting. METHODS We collected demographics, clinicopathological variables, treatment characteristics, and survival status from patients with MCS registered on the national ACCORD sarcoma database. Outcomes include overall survival (OS) and progression-free survival (PFS). RESULTS We identified 22 patients with MCS between 2001-2022. Median age was 28 (range 10-59) years, 19 (86%) had localised disease at diagnosis of whom 16 had surgery (84%), 11 received radiation (58%), and 10 chemotherapy (53%). Ten (52%) developed recurrence and/or metastases on follow-up and three patients with initial metastatic disease received surgery, radiation, and chemotherapy. At a median follow-up of 50.9 (range 0.4-210) months nine patients had died. The median OS was 104.1 months (95% CI 25.8-182.3). There was improved OS for patients with localised disease who had surgical resection of the primary (p = 0.003) and those with ECOG 0-1 compared to 2-3 (p = 0.023) on univariate analysis. CONCLUSIONS This study demonstrates contemporary Australian treatment patterns of MCS. The role of chemotherapy for localised disease remains uncertain. Understanding treatment patterns and outcomes help support treatment decisions and design of trials for novel therapeutic strategies.
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Affiliation(s)
- Madeleine C. Strach
- Chris O'Brien LifehouseSydneyNew South WalesAustralia,Royal Prince Alfred HospitalSydneyNew South WalesAustralia,The University of SydneyFaculty of Medicine and HealthSydneyNew South WalesAustralia,Present address:
The Christie NHS Foundation TrustManchesterUK
| | - Peter S. Grimison
- Chris O'Brien LifehouseSydneyNew South WalesAustralia,Royal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Angela Hong
- Chris O'Brien LifehouseSydneyNew South WalesAustralia
| | - Richard Boyle
- Chris O'Brien LifehouseSydneyNew South WalesAustralia,Royal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Paul Stalley
- Chris O'Brien LifehouseSydneyNew South WalesAustralia,Royal Prince Alfred HospitalSydneyNew South WalesAustralia
| | | | | | - Susie Bae
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia,Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneVictoriaAustralia
| | - Jayesh Desai
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia,Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneVictoriaAustralia
| | - Philip Crowe
- Prince of Wales HospitalSydneyNew South WalesAustralia
| | - Nimit Singhal
- Cancer Centre, Royal Adelaide Hospital and Department of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Vivek A. Bhadri
- Chris O'Brien LifehouseSydneyNew South WalesAustralia,Royal Prince Alfred HospitalSydneyNew South WalesAustralia,The University of SydneyFaculty of Medicine and HealthSydneyNew South WalesAustralia
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12
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Twiggs J, Miles B, Roe J, Fritsch B, Liu D, Parker D, Dickison D, Shimmin A, BarBo J, McMahon S, Solomon M, Boyle R, Walter L. Can TKA outcomes be predicted with computational simulation? Generation of a patient specific planning tool. Knee 2021; 33:38-48. [PMID: 34543991 DOI: 10.1016/j.knee.2021.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/21/2021] [Accepted: 08/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Computer simulations of knee movement allow Total Knee Arthroplasty (TKA) dynamic outcomes to be studied. This study aims to build a model predicting patient reported outcome from a simulation of post-operative TKA joint dynamics. METHODS Landmark localisation was performed on 239 segmented pre-operative computerized tomography (CT) scans to capture patient specific soft tissue attachments. The pre-operative bones and 3D implant files were registered to post-operative CT scans following TKA. Each post-operative knee was simulated undergoing a deep knee bend with assumed ligament balancing of the extension space. The kinematic results from this simulation were used in a Multivariate Adaptive Regression Spline algorithm, predicting attainment of a Patient Acceptable Symptom State (PASS) score in captured 12 month post-operative Knee Injury and Osteoarthritis Outcome Scores (KOOS). An independent series of 250 patients was evaluated by the predictive model to assess how the predictive model behaved in a pre-operative planning context. RESULTS The generated predictive algorithm, called the Dynamic Knee Score (DKS) contained features, in order of significance, related to tibio-femoral force, patello-femoral motion and tibio-femoral motion. Area Under the Curve for predicting attainment of the PASS KOOS Score was 0.64. The predictive model produced a bimodal spread of predictions, reflecting a tendency to either strongly prefer one alignment plan over another or be ambivalent. CONCLUSION A predictive algorithm relating patient reported outcome to the outputs of a computational simulation of a deep knee bend has been derived (the DKS). Simulation outcomes related to tibio-femoral balance had the highest correlation with patient reported outcome.
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Affiliation(s)
| | | | - Justin Roe
- North Sydney Orthopaedic and Sports Medicine Centre, The Mater Hospital, North Sydney 2060, Australia
| | - Brett Fritsch
- Sydney Orthopaedic Research Institute, Sydney 2067, Australia
| | - David Liu
- Gold Coast Centre for Bone and Joint Surgery, Gold Coast 4221, Australia
| | - David Parker
- Sydney Orthopaedic Research Institute, Sydney 2067, Australia
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Knight S, Boyle R, Newman L, Davis J, Rizzo R, Duggan E, De Looze C, Whelan R, Kenny RA, Romero-Ortuno R. 78 HIGHER NEUROVASCULAR SIGNAL ENTROPY IS ASSOCIATED WITH ACCELERATED BRAIN AGEING. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Often chronological age is not the most accurate marker of an individual’s health status since ageing is a heterogeneous process across individuals. Machine learning can be used to quantify the relationship between structural brain MRI data and chronological age, to estimate an individual’s ‘brain age’, which, when subtracted from chronological age, provides a brain predicted-age difference score (BrainPAD) [1]. BrainPAD reflects the biological ageing of the brain. Increased complexity in neurovascular signals has been shown to be associated with poorer cognitive performance and physical frailty [2]. The aim of this study was to investigate associations between the complexity of frontal-lobe oxygenation (tissue saturation index (TSI)) data and BrainPAD in a cohort of older community-dwelling adults.
Methods
To calculate BrainPAD, machine learning was applied to 1,359 T1-weighted MRI brain scans from various open-access repositories, and this model was subsequently applied to MRI data acquired from the study cohort. TSI was non-invasively measured in the left frontal lobe using near-infrared spectroscopy. TSI data were acquired continuously during five minutes of supine rest and the last minute was utilized in this analysis. The complexity of TSI signals was quantified using sample entropy (SampEn). Multivariable linear regression was employed, controlling for age, sex, education, antihypertensive medications, diabetes, cardiovascular conditions, smoking, alcohol, depression, BMI, physical activity, and blood pressure.
Results
Complete data were available for 397 individuals (age: 67.9 ± 7.7 years; 53.7% female). An increase in TSI SampEn of 0.1 was associated with an increase in BrainPAD of 0.9 years (P = 0.007, 95%CIs: 0.3 to 1.6). Similar results were found with and without the inclusion of chronological age in the models.
Conclusion
This study reports significant associations between higher complexity in peripherally measured frontal lobe oxygenation concentration and accelerated brain ageing.
References
1. Boyle R. et al. Brain Imaging and Behavior. 15,327–345 (2021) https://doi.org/10.1007/s11682-020-00260-3.
2. Knight S. et al. Entropy. 23(1):4 (2021) https://doi.org/10.3390/e23010004.
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Affiliation(s)
- S Knight
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, the University of Dublin , Dublin, Ireland
- School of Medicine, Trinity College Dublin, the University of Dublin , Dublin, Ireland
| | - R Boyle
- Trinity College Institute of Neuroscience, Trinity College Dublin, the University of Dublin , Dublin, Ireland
| | - L Newman
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, the University of Dublin , Dublin, Ireland
- School of Medicine, Trinity College Dublin, the University of Dublin , Dublin, Ireland
| | - J Davis
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, the University of Dublin , Dublin, Ireland
- School of Medicine, Trinity College Dublin, the University of Dublin , Dublin, Ireland
| | - R Rizzo
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, the University of Dublin , Dublin, Ireland
- School of Medicine, Trinity College Dublin, the University of Dublin , Dublin, Ireland
| | - E Duggan
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, the University of Dublin , Dublin, Ireland
- School of Medicine, Trinity College Dublin, the University of Dublin , Dublin, Ireland
| | - C De Looze
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, the University of Dublin , Dublin, Ireland
- School of Medicine, Trinity College Dublin, the University of Dublin , Dublin, Ireland
| | - R Whelan
- Trinity College Institute of Neuroscience, Trinity College Dublin, the University of Dublin , Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, the University of Dublin , Dublin, Ireland
| | - R A Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, the University of Dublin , Dublin, Ireland
- School of Medicine, Trinity College Dublin, the University of Dublin , Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, the University of Dublin , Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
| | - R Romero-Ortuno
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, the University of Dublin , Dublin, Ireland
- School of Medicine, Trinity College Dublin, the University of Dublin , Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, the University of Dublin , Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
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14
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Boyle R, Varelas J. Otoconia Structure After Short- and Long-Duration Exposure to Altered Gravity. J Assoc Res Otolaryngol 2021; 22:509-525. [PMID: 34008038 PMCID: PMC8476704 DOI: 10.1007/s10162-021-00791-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 02/09/2021] [Indexed: 10/21/2022] Open
Abstract
Vertebrates use weight-lending otoconia in the inner ear otolith organs to enable detection of their translation during self or imposed movements and a change in their orientation with respect to gravity. In spaceflight, otoconia are near weightless. It has been hypothesized that otoconia undergo structural remodeling after exposure to weightlessness to restore normal sensation. A structural remodeling is reasoned to occur for hypergravity but in the opposite sense. We explored these hypotheses in several strains of mice within a Biospecimen Sharing Program in separate space- and ground-based projects. Mice were housed 90 days on the International Space Station, 13 days on two Shuttle Orbiter missions, or exposed to 90 days of hindlimb unloading or net 2.38 g via centrifugation. Corresponding flight habitat and standard cage vivarium controls were used. Utricular otoliths were visually analyzed using scanning electron microscopy and in selected samples before and after focused ion beam (FIB) milling. Results suggest a possible mass addition to the otoconia outer shell might occur after exposure to longer-duration spaceflight, but not short ones or hindlimb unloading. A destructive process is clearly seen after centrifugation: an ablation or thinning of the outer shell and cavitation of the inner core. This study provides a purely descriptive account of otoconia remodeling after exposures to altered gravity. The mechanism(s) underlying these processes must be identified and quantitatively validated to develop countermeasures to altered gravity levels during exploration missions.
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Affiliation(s)
- Richard Boyle
- National Aeronautics and Space Administration, Ames Research Center, Moffett Field, CA, 94035, USA.
| | - Joseph Varelas
- National Aeronautics and Space Administration, Ames Research Center, Moffett Field, CA, 94035, USA
- Science & Technology Innovation Labs, Universities Space Research Association, Ames Research Center, Moffett Field, CA, 94035, USA
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15
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Boyle R, Knight SP, De Looze C, Carey D, Scarlett S, Stern Y, Robertson IH, Kenny RA, Whelan R. Verbal intelligence is a more robust cross-sectional measure of cognitive reserve than level of education in healthy older adults. Alzheimers Res Ther 2021; 13:128. [PMID: 34253231 PMCID: PMC8276413 DOI: 10.1186/s13195-021-00870-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/28/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cognitive reserve is most commonly measured using socio-behavioural proxy variables. These variables are easy to collect, have a straightforward interpretation, and are widely associated with reduced risk of dementia and cognitive decline in epidemiological studies. However, the specific proxies vary across studies and have rarely been assessed in complete models of cognitive reserve (i.e. alongside both a measure of cognitive outcome and a measure of brain structure). Complete models can test independent associations between proxies and cognitive function in addition to the moderation effect of proxies on the brain-cognition relationship. Consequently, there is insufficient empirical evidence guiding the choice of proxy measures of cognitive reserve and poor comparability across studies. METHOD In a cross-sectional study, we assessed the validity of 5 common proxies (education, occupational complexity, verbal intelligence, leisure activities, and exercise) and all possible combinations of these proxies in 2 separate community-dwelling older adult cohorts: The Irish Longitudinal Study on Ageing (TILDA; N = 313, mean age = 68.9 years, range = 54-88) and the Cognitive Reserve/Reference Ability Neural Network Study (CR/RANN; N = 234, mean age = 64.49 years, range = 50-80). Fifteen models were created with 3 brain structure variables (grey matter volume, hippocampal volume, and mean cortical thickness) and 5 cognitive variables (verbal fluency, processing speed, executive function, episodic memory, and global cognition). RESULTS No moderation effects were observed. There were robust positive associations with cognitive function, independent of brain structure, for 2 individual proxies (verbal intelligence and education) and 16 composites (i.e. combinations of proxies). Verbal intelligence was statistically significant in all models. Education was significant only in models with executive function as the cognitive outcome variable. Three robust composites were observed in more than two-thirds of brain-cognition models: the composites of (1) occupational complexity and verbal intelligence, (2) education and verbal intelligence, and (3) education, occupational complexity, and verbal intelligence. However, no composite had larger average effects nor was more robust than verbal intelligence alone. CONCLUSION These results support the use of verbal intelligence as a proxy measure of CR in cross-sectional studies of cognitively healthy older adults.
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Affiliation(s)
- R Boyle
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - S P Knight
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - C De Looze
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - D Carey
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - S Scarlett
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Y Stern
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York City, USA
| | - I H Robertson
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - R A Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - R Whelan
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.
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16
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Allan PJ, Ambrose T, Mountford C, Bond A, Donnellan C, Boyle R, Calvert C, Cernat E, Clarke E, Cooper SC, Donnelly S, Evans B, Glynn M, Hewett R, Holohan AS, Leitch EF, Louis-Auguste J, Mehta S, Naik S, Nightingale J, Rafferty G, Rodrigues A, Sharkey L, Small M, Teubner A, Urs A, Wyer N, Lal S. COVID-19 infection in patients with intestinal failure: UK experience. JPEN J Parenter Enteral Nutr 2021; 45:1369-1375. [PMID: 33586170 PMCID: PMC8013499 DOI: 10.1002/jpen.2087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The direct effect of the coronavirus disease 2019 (COVID-19) pandemic on patients with intestinal failure (IF) has not been described. METHODS We conducted a nationwide study of UK IF centers to evaluate the infection rates, presentations, and outcomes in patients with types 2 and 3 IF. RESULTS A total of 45 patients with IF contracted COVID-19 between March and August 2020; this included 26 of 2191 (1.2%) home parenteral nutrition (HPN)-dependent adults and 19 of 298 (6.4%) adults hospitalized with type 2 IF. The proportion of patients receiving nursing care for HPN administration was higher in those with community-acquired COVID-19 (66.7%) than the proportion in the entire HPN cohort (26.1%; P < .01). Two HPN-dependent and 1 hospitalized patient with type 2 IF died as a direct consequence of the virus (6.7% of 45 patients with types 2 or 3 infected). CONCLUSION This is the first study to describe the outcomes of COVID-19 in a large cohort of patients requiring long-term PN. Methods to reduce hospital and community nosocomial spread would likely be beneficial.
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Affiliation(s)
- P J Allan
- Translational Gastroenterology Unit, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - T Ambrose
- Translational Gastroenterology Unit, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C Mountford
- Department of Gastroenterology, Freeman Hospital, Newcastle, UK
| | - A Bond
- Department of Gastroenterology, Royal Liverpool and Broadgreen Hospitals, Liverpool, UK
| | - C Donnellan
- St James' and Leeds Gastroenterology Institute, St James' Hospital, Leeds, UK
| | - R Boyle
- Department of Biochemistry, Aberdeen Royal Infirmary, Aberdeen, UK
| | - C Calvert
- Department of Gastroenterology, Royal Devon and Exeter Hospital, Exeter, UK
| | - E Cernat
- Department of Paediatric Gastroenterology, Leeds General Infirmary, Leeds, UK
| | - E Clarke
- Department of Gastroenterology, Southampton University Hospital, Southampton, UK
| | - S C Cooper
- GI Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Donnelly
- Leonard Jones' Intestinal Rehabilitation Unit, St Mark's Hospital, Harrow, UK
| | - B Evans
- Department of Gastroenterology, Bristol Royal Infirmary, Bristol, UK
| | - M Glynn
- Centre for Digestive Diseases, Royal London Hospital, London, UK
| | - R Hewett
- Department of Gastroenterology, University of Wales Hospital, Cardiff, UK
| | - A S Holohan
- Nutrition, Leicester Royal Infirmary, Leicester, UK
| | - E F Leitch
- Intestinal Failure Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | | | - S Mehta
- Intestinal Failure Unit, University College London Hospitals, London, UK
| | - S Naik
- Department of Paediatric Gastroenterology, Royal London Children's Hospital, London, UK
| | | | - G Rafferty
- Department of Gastroenterology, Belfast City Hospital, Belfast, UK
| | - A Rodrigues
- Department of Paediatric Gastroenterology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - L Sharkey
- Intestinal Failure and Transplant, Cambridge University Hospitals, Cambridge, UK
| | - M Small
- Leonard Jones' Intestinal Rehabilitation Unit, St Mark's Hospital, Harrow, UK
| | - A Teubner
- Intestinal Failure Unit, Salford Royal Hospital, Salford, UK
| | - A Urs
- Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, UK
| | - N Wyer
- Intestinal Failure and Nutrition Support, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - S Lal
- Intestinal Failure Unit, Salford Royal Hospital, Salford, UK.,Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
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17
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Vargas AC, Ardakani NM, Wong DD, Maclean FM, Kattampallil J, Boyle R, Santos L, Gill AJ. Chromosomal imbalances detected in NTRK-rearranged sarcomas by the use of comparative genomic hybridisation. Histopathology 2021; 78:932-942. [PMID: 33128780 DOI: 10.1111/his.14295] [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: 09/27/2020] [Accepted: 10/29/2020] [Indexed: 12/25/2022]
Abstract
AIMS NTRK-rearranged sarcomas are emerging as a distinct class of sarcomas of particular importance in the era of targeted therapy. The aim of this study was to use array comparative genomic hybridisation (aCGH) to explore the cytogenetic profile of six adult soft tissue sarcomas harbouring NTRK gene fusions. METHODS AND RESULTS aCGH was performed on six adult soft tissue sarcomas with proven NTRK rearrangements [NTRK1, n = 1 (TPM3-NTRK1); NTRK2, n = 1 (MTMR2-NTRK2); NTRK3, n = 4 (two ETV6-NTRK3; two with unknown partners). The morphological patterns of these cases included inflammatory myofibroblastic tumour-like, fibrosarcoma/malignant peripheral nerve sheath tumour-like, and Ewing sarcoma-like. On the basis of the number of chromosomal copy number variations (CNVs), ranging from two to 15 per sample, NTRK-associated sarcomas could be subdivided into two groups: one with a relatively simple karyotype (n = 2; median of three genomic alterations), and those with a more complex karyotype (n = 4; median of 11 genomic imbalances). Recurrent chromosomal CNVs included gains at chromosomes 6p, 1q, 7 (whole chromosome), and 12p, and losses at chromosomes 10q, 13q, 19q, and 9p. CONCLUSIONS NTRK-rearranged sarcomas constitute a heterogeneous group of tumours that can show a relatively simple or a complex karyotype. Although there were some, but inconsistent, associations between karyotype complexity and morphology, our study showed that a more complex karyotype in this group of tumours appeared to correlate with more aggressive clinical behaviour. Gains at chromosome 6p and 1q were the most common recurrent genomic alterations, being present in 67% of the samples (4/6), followed by gains at chromosome 7, which were present in 50% of the samples (3/6).
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Affiliation(s)
- Ana Cristina Vargas
- Anatomical Pathology, Douglass Hanly Moir Pathology, Macquarie Park, NSW, Australia.,Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Nima M Ardakani
- Anatomical Pathology, PathWest, QEII Medical Centre, Nedlands, WA, Australia.,School of Medicine, The University of Western Australia, Crawley, WA, Australia
| | - Daniel D Wong
- Anatomical Pathology, PathWest, QEII Medical Centre, Nedlands, WA, Australia.,School of Medicine, The University of Western Australia, Crawley, WA, Australia
| | - Fiona M Maclean
- Anatomical Pathology, Douglass Hanly Moir Pathology, Macquarie Park, NSW, Australia.,Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia.,Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | | | - Richard Boyle
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Leonardo Santos
- Anatomical Pathology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
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18
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Rathod KS, Jain AK, Firoozi S, Lim P, Boyle R, Nevett J, Dalby MC, Kalra S, Malik IS, Sirker A, Mathur A, Redwood S, MacCarthy PA, Wragg A, Jones DA. Outcome of inter-hospital transfer versus direct admission for primary percutaneous coronary intervention: An observational study of 25,315 patients with ST-elevation myocardial infarction from the London Heart Attack Group. European Heart Journal. Acute Cardiovascular Care 2020; 9:948-957. [DOI: 10.1177/2048872619882340] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background and aims:
In patients with ST-segment elevation myocardial infarction (STEMI), mortality is directly related to time to reperfusion with guidelines recommending patients be delivered directly to centres for primary percutaneous coronary intervention (PCI). The aim of this study was to describe the impact of inter-hospital transfer on reperfusion time and to assess whether or not treatment delays influenced clinical outcomes in comparison with direct admission to a primary PCI centre in a large regional network.
Method and results:
We undertook an observational cohort study of patients with STEMI treated with primary PCI between 2005 and 2015 in London, UK. Patient details were recorded at the time of the procedure in databases using the British Cardiovascular Intervention Society PCI dataset. The primary end-point was all-cause mortality at a median of 4.1 years (interquartile range: 2.2–5.8 years). Secondary outcomes were in-hospital major adverse cardiac events. Of 25,315 patients, 17,560 (69.4%) were admitted directly to a primary PCI centre and 7755 (31.6%) were transferred from a non-primary PCI centre. Patients in the direct admission group were older and more likely to have left ventricular impairment compared with the inter-hospital transfer group. Median time from call for help to reperfusion in transferred patients was 52 minutes longer compared with patients admitted directly (p <0.001). However, call to first hospital admission was similar. Kaplan–Meier analysis demonstrated significantly lower mortality rates in patients who were transferred directed to a primary PCI centre compared with patients who were transferred from a non-PCI centre (17.4% direct vs. 18.7% transfer, p=0.017). Furthermore, after propensity matching, direct admission for primary PCI was still a predictor of all-cause mortality (hazard ratio: 0.89, 95% confidence interval: 0.64–0.95).
Conclusions:
In this large registry of over 25,000 STEMI patients treated by primary PCI survival was better in patients admitted directly to a cardiac centre versus patients transferred for primary PCI, most likely due to longer call to balloon times in patient transferred from other hospitals.
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Affiliation(s)
| | | | - Sam Firoozi
- St George’s Healthcare NHS Foundation Trust, St George’s Hospital, London, UK
| | - Pitt Lim
- St George’s Healthcare NHS Foundation Trust, St George’s Hospital, London, UK
| | - Richard Boyle
- St George’s Healthcare NHS Foundation Trust, St George’s Hospital, London, UK
| | - Jo Nevett
- London Ambulance Service NHS Trust, UK
| | - Miles C Dalby
- Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Sundeep Kalra
- Royal Free Hospital, Royal Free London Foundation Trust, UK
| | - Iqbal S Malik
- Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, UK
| | | | | | - Simon Redwood
- St Thomas’ NHS Foundation Trust, Guys & St. Thomas Hospital, London, UK
| | - Philip A MacCarthy
- King’s College Hospital, King’s College Hospital NHS Foundation Trust, London, UK
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Roberts G, Almqvist C, Boyle R, Crane J, Hogan SP, Marsland B, Saglani S, Woodfolk JA. Developments allergy in 2019 through the eyes of Clinical and Experimental Allergy, Part II clinical allergy. Clin Exp Allergy 2020; 50:1302-1312. [PMID: 33283366 DOI: 10.1111/cea.13778] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In the second of two linked articles, we describe the development in clinical as described by Clinical & Experimental Allergy and other journals in 2019. Epidemiology, clinical allergy, asthma and rhinitis are all covered. In this article, we described the development in the field of allergy as described by Clinical and Experimental Allergy in 2019. Epidemiology, clinical allergy, asthma and rhinitis are all covered.
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Affiliation(s)
- Graham Roberts
- Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - C Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - R Boyle
- Department of Paediatrics, Imperial College London, London, UK
| | - J Crane
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - S P Hogan
- Department of Pathology, Michigan Medicine, Mary H Weiser Food Allergy Center, University of Michigan, Ann Arbor, MI, USA
| | - B Marsland
- Department of Immunology and Pathology, Monash University, Melbourne, Vic, Australia
| | - S Saglani
- National Heart & Lung Institute, Imperial College London, London, UK
| | - J A Woodfolk
- Division of Asthma, Allergy and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
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Roberts G, Almqvist C, Boyle R, Crane J, Hogan SP, Marsland B, Saglani S, Woodfolk JA. Developments allergy in 2019 through the eyes of clinical and experimental allergy, part I mechanisms. Clin Exp Allergy 2020; 50:1294-1301. [PMID: 33283368 DOI: 10.1111/cea.13777] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In the first of two linked articles, we describe the development in the mechanisms underlying allergy as described by Clinical & Experimental Allergy and other journals in 2019. Experimental models of allergic disease, basic mechanisms, clinical mechanisms and allergens are all covered.
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Affiliation(s)
- Graham Roberts
- Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - C Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - R Boyle
- Department of Paediatrics, Imperial College London, London, UK
| | - J Crane
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - S P Hogan
- Department of Pathology, Mary H Weiser Food Allergy Center, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - B Marsland
- Department of Immunology and Pathology, Monash University, Melbourne, Vic., Australia
| | - S Saglani
- National Heart & Lung Institute, Imperial College London, London, UK
| | - J A Woodfolk
- Division of Asthma, Allergy and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
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Abstract
The force of gravity has remained constantly present over the course of animal evolution and forms our frame of reference with the environment, including spatial orientation, navigation, gaze and postural stability. Inertial head accelerations occur within this gravity frame of reference naturally during voluntary movements and perturbations. Execution of movements of aquatic, terrestrial and flight species widely differ, but the sensory systems detecting acceleration forces, including gravity, have remained remarkably conserved among vertebrates. The utricular organ senses the sum of inertial force due to head translation and head tilt relative to gravitational vertical. A sudden or persistent change in gravitational force would be expected to have profound and global effects on an organism. Physiological data collected immediately after orbital missions, after short and extended increases in gravity load via centrifugation, and after readaptation to normal gravity exist in the toadfish model. This review focuses on the otolith adaptive responses to changes in gravity in a number of model organisms and their potential impact on human space travel.
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Affiliation(s)
- Richard Boyle
- National Aeronautics and Space Administration, Ames Research Center, Mountain View, CA USA.
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Roberts G, Almqvist C, Boyle R, Crane J, Hogan SP, Marsland B, Saglani S, Woodfolk JA. Developments in the field of clinical allergy in 2018 through the eyes of Clinical and Experimental Allergy, Part II. Clin Exp Allergy 2020; 49:1550-1557. [PMID: 31833123 DOI: 10.1111/cea.13535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In this article, we describe developments in the field of clinical allergy as described by Clinical and Experimental Allergy in 2018; epidemiology, asthma and rhinitis, clinical allergy and allergens are all covered.
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Affiliation(s)
- Graham Roberts
- Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - C Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - R Boyle
- Department of Paediatrics, Imperial College London, London, UK
| | - J Crane
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - S P Hogan
- Department of Pathology, Mary H Weiser Food Allergy Center, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - B Marsland
- Department of Immunology and Pathology, Monash University, Melbourne, Vic., Australia
| | - S Saglani
- National Heart & Lung Institute, Imperial College London, London, UK
| | - J A Woodfolk
- Division of Asthma, Allergy and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
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23
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Brown W, Bonar SF, McGuigan L, Soper J, Boyle R. Blau syndrome: a rare cause of exuberant granulomatous synovitis of the knee. Skeletal Radiol 2020; 49:1161-1166. [PMID: 31960075 DOI: 10.1007/s00256-020-03376-1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 02/02/2023]
Abstract
Blau syndrome (BS) is a rare autosomal dominant familial granulomatous inflammatory disease presenting in early childhood with dermatitis, arthritis and uveitis. Early-onset sarcoidosis represents the sporadic form, and both are characterised by mutations in the CARD15/NOD2 gene on chromosome 16. We describe a 38-year-old man with known BS who presented for orthopaedic review following right-sided patellar dislocation. MRI of the injured knee demonstrated diffuse synovitis and prominent fatty tissue resembling lipoma arborescens with evidence of recent patellar dislocation. Synovectomy was performed and confirmed granulomatous synovitis. Knee imaging findings are described for the first time. Combining distinct morphological bone changes with synovitis which resembles lipoma arborescens and histology which includes sarcoidal-type granulomatous synovitis should lead the radiologist and pathologist to consider the diagnosis of BS.
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Affiliation(s)
- Wendy Brown
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia.
| | - S Fiona Bonar
- Douglass Hanly Moir Pathology, 14 Giffnock Avenue, Macquarie Park, NSW, 2113, Australia
| | | | - Judy Soper
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - Richard Boyle
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
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Strach MC, Grimison PS, Boyle R, Stalley P, Connolly EA, Bhadri V. Mesenchymal chondrosarcoma: An Australian multi-centre cohort study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e23509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e23509 Background: Mesenchymal chondrosarcoma (MCS) is a rare sarcoma that has a more aggressive course than conventional chondrosarcoma. Treatment is often multimodal with combinations of surgery, chemotherapy and radiotherapy. This study gives opportunity to evaluate prognostic factors and treatments in an Australian setting. Methods: We performed a retrospective study on patients with MCS registered on the ACCORD prospective sarcoma database from 6 Australian sarcoma centres since 2009. We collected data including baseline demographics, clinicopathological variables, treatment characteristics and survival status. We assessed outcomes of overall survival (OS), progression-free survival (PFS) and proportions of metastatic and localised patients receiving surgery, chemotherapy and/or radiotherapy. Results: We identified 20 patients diagnosed with MCS between Jan 2001 and Dec 2019. Median age was 35 years (range 20-69 years). Two (10%) had metastatic disease at diagnosis and 7 (35%) developed metastases on follow up. Median follow-up was 20 months (0.4 – 210 months). 17 (85%) patients underwent surgical resection (17 of primary, 8 of recurrence/metastasis), 10 (50%) received chemotherapy (95% anthracycline; 1 preoperative, 9 palliative), 12 (60%) received radiotherapy (7 to primary, 9 to recurrence/metastasis), and 13 (65%) received multimodality therapy. All six patients who received surgery alone remained alive at follow-up with no metastatic disease. Table shows survival estimates for the study population. There was no difference in median OS in patients who received all therapies compared to those who did not (8.4 v 7.5 years; p = 0.53). Median PFS was not prolonged in those who received all therapies compared to those who did not (37 vs 43 months, p = 0.4). Conclusions: This study demonstrates contemporary Australian treatment patterns of MCS. Understanding treatment patterns and outcomes helps promote standardisation of treatment and design of prospective trials for novel therapeutic strategies. Future analysis of prospective patients for patient and treatment factors influencing survival is planned. [Table: see text]
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25
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Farina FR, Emek-Savaş DD, Rueda-Delgado L, Boyle R, Kiiski H, Yener G, Whelan R. A comparison of resting state EEG and structural MRI for classifying Alzheimer's disease and mild cognitive impairment. Neuroimage 2020; 215:116795. [PMID: 32278090 DOI: 10.1016/j.neuroimage.2020.116795] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 05/16/2019] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 12/31/2022] Open
Abstract
Alzheimer's disease (AD) is the leading cause of dementia, accounting for 70% of cases worldwide. By 2050, dementia prevalence will have tripled, with most new cases occurring in low- and middle-income countries. Mild cognitive impairment (MCI) is a stage between healthy aging and dementia, marked by cognitive deficits that do not impair daily living. People with MCI are at increased risk of dementia, with an average progression rate of 39% within 5 years. There is urgent need for low-cost, accessible and objective methods to facilitate early dementia detection. Electroencephalography (EEG) has potential to address this need due to its low cost and portability. Here, we collected resting state EEG, structural MRI (sMRI) and rich neuropsychological data from older adults (55+ years) with AD, amnestic MCI (aMCI) and healthy controls (~60 per group). We evaluated a range of candidate EEG markers (i.e., frequency band power and functional connectivity) for AD and aMCI classification and compared their performance with sMRI. We also tested a combined EEG and cognitive classification model (using Mini-Mental State Examination; MMSE). sMRI outperformed resting state EEG at classifying AD (AUCs = 1.00 vs 0.76, respectively). However, both EEG and sMRI were only moderately good at distinguishing aMCI from healthy aging (AUCs = 0.67-0.73), and neither method achieved sensitivity above 70%. The addition of EEG to MMSE scores had no added benefit relative to MMSE scores alone. This is the first direct comparison of EEG and sMRI for classification of AD and aMCI.
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Affiliation(s)
- F R Farina
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland.
| | - D D Emek-Savaş
- Department of Psychology, Faculty of Letters, Dokuz Eylul University, Izmir, 35160, Turkey; Department of Neurosciences, Institute of Health Sciences, Dokuz Eylul University, Izmir, 35340, Turkey; Global Brain Health Institute, Trinity College Dublin, Dublin 2, Ireland
| | - L Rueda-Delgado
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
| | - R Boyle
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
| | - H Kiiski
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
| | - G Yener
- Department of Neurosciences, Institute of Health Sciences, Dokuz Eylul University, Izmir, 35340, Turkey; Department of Neurology, Dokuz Eylul University Medical School, Izmir, 35340, Turkey
| | - R Whelan
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland; Global Brain Health Institute, Trinity College Dublin, Dublin 2, Ireland.
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26
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Ansar S, Boyle R, Brown W, Karim R, Luk P, Maclean F, Cheah A, Bonar F, Mahar A. An unusual cause of a multifocal bone lesion: Epstein–Barr Virus-Associated Smooth Muscle Tumour (EBV-SMT) involving bone. Pathology 2020. [DOI: 10.1016/j.pathol.2020.01.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Smires S, Afach S, Mazaud C, Phan C, Garcia Doval I, Boyle R, Dellavalle R, Williams H, Grindlay D, Sbidian E, Le Cleach L. Méthodologie et description des revues systématiques et méta-analyses en dermatologie. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Roberts G, Almqvist C, Boyle R, Crane J, Hogan SP, Marsland B, Saglani S, Woodfolk JA. Developments in the field of allergy in 2017 through the eyes of Clinical and Experimental Allergy. Clin Exp Allergy 2019; 48:1606-1621. [PMID: 30489681 DOI: 10.1111/cea.13318] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In this article, we described the development in the field of allergy as described by Clinical and Experimental Allergy in 2017. Experimental models of allergic disease, basic mechanisms, clinical mechanisms, allergens, asthma and rhinitis and clinical allergy are all covered.
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Affiliation(s)
- G Roberts
- Faculty of Medicine, Clinical and Experimental Sciences and Human Development and Health, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - C Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - R Boyle
- Department of Paediatrics, Imperial College London, London, UK
| | - J Crane
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - S P Hogan
- Mary H Weiser Food Allergy Center, Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - B Marsland
- Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - S Saglani
- National Heart & Lung Institute, Imperial College London, London, UK
| | - J A Woodfolk
- Division of Asthma, Allergy and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
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29
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Othman J, Bonar F, Brown W, Boyle R, Khoo TL. Multiply relapsed mixed histiocytosis in an adult responding to clofarabine after failure of cladribine. Leuk Lymphoma 2019; 61:477-480. [PMID: 31483174 DOI: 10.1080/10428194.2019.1660976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jad Othman
- Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Fiona Bonar
- Department of Histopathology, Douglass Hanly Moir Pathology, Sydney, Australia
| | - Wendy Brown
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Richard Boyle
- Department of Orthopaedics, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Teh-Liane Khoo
- Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, Australia
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30
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Marsh-Wakefield F, Kruzins A, McGuire HM, Yang S, Bryant C, Fazekas de St Groth B, Nassif N, Byrne SN, Gibson J, Brown C, Larsen S, McCulloch D, Boyle R, Clark G, Joshua D, Ho PJ, Vuckovic S. Mass Cytometry Discovers Two Discrete Subsets of CD39 -Treg Which Discriminate MGUS From Multiple Myeloma. Front Immunol 2019; 10:1596. [PMID: 31428081 PMCID: PMC6688400 DOI: 10.3389/fimmu.2019.01596] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 03/15/2019] [Accepted: 06/26/2019] [Indexed: 12/13/2022] Open
Abstract
Multiple Myeloma (MM) is preceded by the clinically stable condition monoclonal gammopathy of undetermined significance (MGUS). Critical immune events that discriminate MGUS from newly diagnosed MM (ND)MM patients remain unknown, but may involve changes in the regulatory T cell (Treg) compartment that favor myeloma growth. To address this possibility, we used mass cytometry and the unsupervised clustering algorithm Flow self-organizing map (FlowSOM) to interrogate the distribution of multiple subsets within CD25+CD127low/negTreg in matched bone marrow (BM) and peripheral blood (PB) of MGUS and NDMM patients. Both mass cytometry and flow cytometry confirmed a trend toward prevalence of CD39-Treg within the Treg compartment in BM and PB of NDMM patients compared to CD39-Treg in MGUS patients. FlowSOM clustering displayed a phenotypic organization of Treg into 25 metaclusters that confirmed Treg heterogeneity. It identified two subsets which emerged within CD39-Treg of NDMM patients that were negligible or absent in CD39-Treg of MGUS patients. One subset was found in both BM and PB which phenotypically resembled activated Treg based on CD45RO, CD49d, and CD62L expression; another subset resembled BM-resident Treg based on its tissue-resident CD69+CD62L-CD49d- phenotype and restricted location within the BM. Both subsets co-expressed PD-1 and TIGIT, but PD-1 was expressed at higher levels on BM-resident Treg than on activated Treg. Within BM, both subsets had limited Perforin and Granzyme B production, whilst activated Treg in PB acquired high Perforin and Granzyme B production. In conclusion, the use of mass cytometry and FlowSOM clustering discovered two discrete subsets of CD39-Treg which are discordant in MGUS and NDMM patients and may be permissive of myeloma growth which warrants further study. Understanding the regulatory properties of these subsets may also advance MGUS and MM diagnosis, prognosis, and therapeutic implications for MM patients.
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Affiliation(s)
- Felix Marsh-Wakefield
- Discipline of Infectious Diseases and Immunology, Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia.,Discipline of Pathology, Faculty of Medicine and Health, School of Medical Science, The University of Sydney, Sydney, NSW, Australia
| | - Annabel Kruzins
- School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - Helen M McGuire
- Ramaciotti Facility for Human Systems Biology, The University of Sydney, Sydney, NSW, Australia.,Discipline of Pathology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Shihong Yang
- Royal Prince Alfred Hospital, Institute of Haematology, Sydney, NSW, Australia
| | - Christian Bryant
- Royal Prince Alfred Hospital, Institute of Haematology, Sydney, NSW, Australia
| | - Barbara Fazekas de St Groth
- Ramaciotti Facility for Human Systems Biology, The University of Sydney, Sydney, NSW, Australia.,Discipline of Pathology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Najah Nassif
- School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - Scott N Byrne
- Discipline of Infectious Diseases and Immunology, Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - John Gibson
- Royal Prince Alfred Hospital, Institute of Haematology, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Christina Brown
- Royal Prince Alfred Hospital, Institute of Haematology, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Stephen Larsen
- Royal Prince Alfred Hospital, Institute of Haematology, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Derek McCulloch
- Royal Prince Alfred Hospital, Institute of Haematology, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Richard Boyle
- Orthopaedics Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Georgina Clark
- Concord Repatriation General Hospital, ANZAC Research Institute, Concord, NSW, Australia
| | - Douglas Joshua
- Royal Prince Alfred Hospital, Institute of Haematology, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Phoebe Joy Ho
- Royal Prince Alfred Hospital, Institute of Haematology, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Slavica Vuckovic
- Royal Prince Alfred Hospital, Institute of Haematology, Sydney, NSW, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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Colebatch A, Boyle R, Stalley P, Soper J, Schatz J, Bonar F, Maclean F, Mahar A, Karim R. 6. Rosai–Dorfman presenting as a femoral lesion: A case report. Pathology 2019. [DOI: 10.1016/j.pathol.2018.09.007] [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]
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32
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Boyle R. Book Review: Atlas of Pain Management Injection Techniques. Second Edition. Anaesth Intensive Care 2019. [DOI: 10.1177/0310057x0703500632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gibson TN, Beeput S, Gaspard J, George C, Gibson D, Jackson N, Leandre-Broome V, Palmer-Mitchell N, Alexis C, Bird-Compton J, Bodkyn C, Boyle R, McLean-Salmon S, Reece-Mills M, Quee-Brown CS, Allen U, Weitzman S, Blanchette V, Gupta S. Baseline characteristics and outcomes of children with cancer in the English-speaking Caribbean: A multinational retrospective cohort. Pediatr Blood Cancer 2018; 65:e27298. [PMID: 30094928 DOI: 10.1002/pbc.27298] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 11/28/2017] [Revised: 05/24/2018] [Accepted: 05/30/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND English-speaking Caribbean (ESC) childhood cancer outcomes are unknown. PROCEDURE Through the SickKids-Caribbean Initiative (SCI), we established a multicenter childhood cancer database across seven centers in six ESC countries. Data managers entered patient demographics, disease, treatment, and outcome data. Data collection commenced in 2013, with retrospective collection to 2011 and subsequent prospective collection. RESULTS A total of 367 children were diagnosed between 2011 and 2015 with a median age of 5.7 years (interquartile range 2.9-10.6 years). One hundred thirty (35.4%) patients were diagnosed with leukemia, 30 (8.2%) with lymphoma, and 149 (40.6%) with solid tumors. A relative paucity of children with brain tumors was seen (N = 58, 15.8%). Two-year event-free survival (EFS) for the cohort was 48.5% ± 3.2%; 2-year overall survival (OS) was 55.1% ± 3.1%. Children with acute lymphoblastic leukemia (ALL) and Wilms tumor (WT) experienced better 2-year EFS (62.1% ± 6.4% and 66.7% ± 10.1%), while dismal outcomes were seen in children with acute myeloid leukemia (AML; 22.7 ± 9.6%), rhabdomyosarcoma (21.0% ± 17.0%), and medulloblastoma (21.4% ± 17.8%). Of 108 deaths with known cause, 58 (53.7%) were attributed to disease and 50 (46.3%) to treatment complications. Death within 60 days of diagnosis was relatively common in acute leukemia [13/98 (13.3%) ALL, 8/26 (30.8%) AML]. Despite this, traditional prognosticators adversely impacted outcome in ALL, including higher age, higher white blood cell count, and T-cell lineage. CONCLUSIONS ESC childhood cancer outcomes are significantly inferior to high-income country outcomes. Based on these data, interventions for improving supportive care and modifying treatment protocols are under way. Continued data collection will allow evaluation of interventions and ensure maximal outcome improvements.
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Affiliation(s)
- T N Gibson
- The University Hospital of the West Indies, Kingston, Jamaica
| | - S Beeput
- Bustamante Hospital for Children, Kingston, Jamaica
| | - J Gaspard
- Victoria Hospital, Castries, St. Lucia
| | - C George
- Eric Williams Medical Sciences Complex, Mount Hope, Trinidad and Tobago
| | - D Gibson
- Princess Margaret Hospital, Nassau, Bahamas
| | - N Jackson
- Milton Cato Memorial Hospital, Kingstown, St. Vincent and the Grenadines
| | | | | | - C Alexis
- Queen Elizabeth Hospital, Bridgetown, Barbados
| | | | - C Bodkyn
- Eric Williams Medical Sciences Complex, Mount Hope, Trinidad and Tobago
| | - R Boyle
- Milton Cato Memorial Hospital, Kingstown, St. Vincent and the Grenadines
| | | | - M Reece-Mills
- The University Hospital of the West Indies, Kingston, Jamaica
| | | | - U Allen
- The Hospital for Sick Children, Toronto, Canada
| | - S Weitzman
- The Hospital for Sick Children, Toronto, Canada
| | | | - S Gupta
- The Hospital for Sick Children, Toronto, Canada
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Boyle R, Popova Y, Varelas J. Influence of Magnitude and Duration of Altered Gravity and Readaptation to 1 g on the Structure and Function of the Utricle in Toadfish, Opsanus tau. Front Physiol 2018; 9:1469. [PMID: 30405430 PMCID: PMC6204554 DOI: 10.3389/fphys.2018.01469] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/28/2018] [Indexed: 11/13/2022] Open
Abstract
Gravity has remained constant during animal evolution and the neural sensory systems detecting acceleration forces have remained remarkably conserved among vertebrates. The utricular organ senses the sum of inertial force due to head translation and head tilt relative to gravitational vertical. Change in gravitational force would be expected to have profound effects on how an organism maintains equilibrium. We characterize the physiology of utricular afferents to applied accelerations in the oyster toadfish, Opsanus tau, in normal 1 g to establish benchmarks, after 1–32-day exposures to 2.24 g (resultant) via centrifugation (hypergravity, HG), after 4- and 16-day exposures to 1.12 g (resultant), and following 1–8 days recovery to HG exposures to study re-adaptation to 1 g. Afferents were also examined during activation of efferent vestibular pathway. Centrifugation at 2.24 g included 228°/s constant angular velocity component, and thus horizontal canal afferent responses to yaw rotation were recorded as an internal control in each fish. Afferents studied after 228°/s rotation for 4 and 16 days without centripetal acceleration, called On-Center-Control, were indistinguishable from their control counterparts. Principal response to HG was an adjustment of afferent sensitivity as a function of magnitude and duration of exposure: an initial robust increase at 3–4 days followed by a significant decrease from 16 to 32 days. Initial increase observed after 4 days of HG took >4 days in 1 g to recover, and the decrease observed after 16 days of HG took >2 days to readapt to 1 g. Hair cells in striola and medial extrastriola macula regions were serially reconstructed in 3D from thin sections using transmission electron microscopy in control fish and fish exposed to 4 and 16 days of HG. Despite the highly significant differences in afferent physiology, synaptic body counts quantified in the same fish were equivalent in their inter-animal variability and averages. No clear role of the efferent pathway as a feedback mechanism regulating afferent behavior to HG was found. Transfer from 1 g to HG imparts profound effects on gravitational sensitivity of utricular afferents and the accompanying transfer from the HG back to the 1 g resembles in part (as an analog) the transfer from 1 g to the micrograms.
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Affiliation(s)
- Richard Boyle
- National Aeronautics and Space Administration Ames Research Center, Moffett Field, CA, United States
| | - Yekaterina Popova
- National Aeronautics and Space Administration Ames Research Center, Moffett Field, CA, United States
| | - Joseph Varelas
- National Aeronautics and Space Administration Ames Research Center, Moffett Field, CA, United States.,Universities Space Research Association (USRA) Science & Technology Innovation Labs at NASA Ames Research Center, Moffett Field, CA, United States
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Karunaratne S, Duan M, Pappas E, Fritsch B, Boyle R, Gupta S, Stalley P, Horsley M, Steffens D. The effectiveness of robotic hip and knee arthroplasty on patient-reported outcomes: A systematic review and meta-analysis. Int Orthop 2018; 43:1283-1295. [PMID: 30219968 DOI: 10.1007/s00264-018-4140-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of the study is to determine the effectiveness of semi-active and active robotic hip and knee arthroplasty on post-operative patient-reported outcomes of function, pain, quality of life and satisfaction with surgery. METHODS PubMed, Medline, Embase and CENTRAL were searched. Included were comparative studies investigating the effectiveness of semi-active or active robotic hip or knee arthroplasty compared to any other surgical intervention on function, pain, quality of life and satisfaction with surgery. Risk of bias and the strength of the evidence were assessed using the Downs and Black tool and the GRADE system, respectively. Relative risks, mean differences and 95% CI were calculated using random-effects models. RESULTS Fourteen studies involving 1342 patients were included. All studies compared robotic to conventional surgery, with active robotic surgery evaluated in total hip or knee arthroplasty and semi-active robotic surgery in total hip or unicompartmental knee arthroplasty. Most studies presented some risk of bias, and the strength of evidence was rated as low to very low quality. Random-effects meta-analyses showed that post-operative functional outcomes were comparable between active robotic and conventional total hip and knee arthroplasty at the short-, medium- and long-term follow-up. No significant difference in pain, quality of life and satisfaction with surgery were reported in individual studies. CONCLUSIONS This systematic and meta-analyses indicates that functional outcomes for patients undergoing active robotic total hip and knee arthroplasty were comparable to conventional surgery. Whether semi-active or active robotic hip or knee arthroplasty is effective in improving post-operative pain, quality of life and satisfaction with surgery is unclear. PROSPERO Registration Number: CRD42017059932.
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Affiliation(s)
- Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), PO Box M157, Sydney, NSW, 2050, Australia.
| | - Michael Duan
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Evangelos Pappas
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Brett Fritsch
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia
| | - Richard Boyle
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia
| | - Sanjeev Gupta
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia
| | - Paul Stalley
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia
| | - Mark Horsley
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), PO Box M157, Sydney, NSW, 2050, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Muir C, Szajer J, Mansberg R, Russo R, Banh J, Boyle R, Crawford BA. Low bone mineral density in a man with recurrent minimal trauma fractures: a cauTIOnary tale of unrecognised hypophosphataemia. Intern Med J 2018; 48:1003-1004. [DOI: 10.1111/imj.13980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/22/2018] [Accepted: 02/07/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Christopher Muir
- Department of Endocrinology; Concord Repatriation General Hospital; Sydney New South Wales Australia
| | - Jeremy Szajer
- Department of Nuclear Medicine; Concord Repatriation General Hospital; Sydney New South Wales Australia
| | - Robert Mansberg
- Department of Nuclear Medicine; Concord Repatriation General Hospital; Sydney New South Wales Australia
- Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | - Robert Russo
- Department of Nuclear Medicine; Concord Repatriation General Hospital; Sydney New South Wales Australia
- Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | - John Banh
- Department of Radiology; Concord Repatriation General Hospital; Sydney New South Wales Australia
| | - Richard Boyle
- Department of Orthopaedics; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | - Bronwyn A. Crawford
- Department of Endocrinology; Concord Repatriation General Hospital; Sydney New South Wales Australia
- Sydney Medical School; University of Sydney; Sydney New South Wales Australia
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Vargas AC, Selinger C, Satgunaseelan L, Cooper WA, Gupta R, Stalley P, Brown W, Soper J, Schatz J, Boyle R, Thomas DM, Tattersall MH, Bhadri V, Maclean F, Bonar SF, Scolyer RA, Karim RZ, McCarthy SW, Mahar A, O'Toole SA. FISH analysis of selected soft tissue tumors: Diagnostic experience in a tertiary center. Asia Pac J Clin Oncol 2018; 15:38-47. [DOI: 10.1111/ajco.12980] [Citation(s) in RCA: 9] [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: 07/29/2017] [Accepted: 03/29/2018] [Indexed: 12/20/2022]
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Hong AM, Jones D, Boyle R, Stalley P. Radiation Therapy as an Alternative Treatment for Desmoid Fibromatosis. Clin Oncol (R Coll Radiol) 2018; 30:589-592. [PMID: 29803344 DOI: 10.1016/j.clon.2018.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 04/11/2018] [Accepted: 05/09/2018] [Indexed: 11/19/2022]
Abstract
AIM To determine the outcome after radiation therapy for desmoid fibromatosis. MATERIALS AND METHODS A retrospective review of 50 patients treated between 1988 and 2016 in a specialised bone and soft tissue tumour clinic. RESULTS The median age at the time of radiation therapy was 36.8 years (range 15.1-69.0) and the median follow-up time was 51 months. Forty-three patients underwent radiation therapy as the definitive treatment with a median dose of 56 Gy (range 30-58.8 Gy). The median dose for the seven patients treated with postoperative radiation therapy was 50.4 Gy (range 48-56 Gy). Eleven patients (22%) developed progressive disease after radiation therapy at a median time of 41 months (range 12-113 months). The recurrences were within the radiation therapy field in four patients and outside the field in seven patients. One patient developed a radiation-induced malignancy 20 years after treatment. CONCLUSIONS Radiation therapy is an alternative treatment in the management of desmoid fibromatosis. It should be considered in patients for whom surgical resection is not feasible, or as adjuvant therapy after surgery with involved margins where any further recurrences would cause significant morbidity.
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Affiliation(s)
- A M Hong
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, Australia.
| | - D Jones
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - R Boyle
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
| | - P Stalley
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
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Gelderblom H, Cropet C, Chevreau C, Boyle R, Tattersall M, Stacchiotti S, Italiano A, Piperno-Neumann S, Le Cesne A, Ferraresi V, Penel N, Duffaud F, Cassier P, Toulmonde M, Casali P, Taieb S, Guillemaut S, Metzger S, Pérol D, Blay JY. Nilotinib in locally advanced pigmented villonodular synovitis: a multicentre, open-label, single-arm, phase 2 trial. Lancet Oncol 2018; 19:639-648. [DOI: 10.1016/s1470-2045(18)30143-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/26/2018] [Accepted: 01/26/2018] [Indexed: 12/19/2022]
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Abstract
The utricle provides the vestibular reflex pathways with the sensory codes of inertial acceleration of self-motion and head orientation with respect to gravity to control balance and equilibrium. Here we present an anatomical description of this structure in the adult oyster toadfish and establish a morphological basis for interpretation of subsequent functional studies. Light, scanning, and transmission electron microscopy techniques were applied to visualize the sensory epithelium at varying levels of detail, its neural innervation and its synaptic organization. Scanning electron microscopy was used to visualize otolith mass and morphological polarization patterns of hair cells. Afferent nerve fibers were visualized following labeling with biocytin, and light microscope images were used to make three-dimensional (3-D) reconstructions of individual labeled afferents to identify dendritic morphology with respect to epithelial location. Transmission electron micrographs were compiled to create a serial 3-D reconstruction of a labeled afferent over a segment of its dendritic field and to examine the cell-afferent synaptic contacts. Major observations are: a well-defined striola, medial and lateral extra-striolar regions with a zonal organization of hair bundles; prominent lacinia projecting laterally; dependence of hair cell density on macular location; narrow afferent dendritic fields that follow the hair bundle polarization; synaptic specializations issued by afferents are typically directed towards a limited number of 7-13 hair cells, but larger dendritic fields in the medial extra-striola can be associated with > 20 hair cells also; and hair cell synaptic bodies can be confined to only an individual afferent or can synapse upon several afferents.
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Affiliation(s)
- Richard Boyle
- Vestibular Biophysics Laboratory, Ames Research Center, NASA, Moffett Field, California, 94035-1000
| | - Reza Ehsanian
- Vestibular Biophysics Laboratory, Ames Research Center, NASA, Moffett Field, California, 94035-1000
| | - Alireza Mofrad
- Vestibular Biophysics Laboratory, Ames Research Center, NASA, Moffett Field, California, 94035-1000
| | - Yekaterina Popova
- Vestibular Biophysics Laboratory, Ames Research Center, NASA, Moffett Field, California, 94035-1000
| | - Joseph Varelas
- Vestibular Biophysics Laboratory, Ames Research Center, NASA, Moffett Field, California, 94035-1000.,University of California, Santa Cruz, California, 95064
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41
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Selinger C, Elston B, Gupta R, Stalley P, Boyle R, Brown W, Soper J, Schatz J, Karim R, McCarthy S, Bonar F, Cheah A, Maclean F, Vargas C, Cooper W, O'Toole S, Mahar A. Examples of the diagnostic utility of USP6 FISH in soft tissue and bone pathology. Pathology 2018. [DOI: 10.1016/j.pathol.2017.11.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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42
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Prempunpong C, Chalak LF, Garfinkle J, Shah B, Kalra V, Rollins N, Boyle R, Nguyen KA, Mir I, Pappas A, Montaldo P, Thayyil S, Sánchez PJ, Shankaran S, Laptook AR, Sant’Anna G. Prospective research on infants with mild encephalopathy: the PRIME study. J Perinatol 2018; 38:80-85. [PMID: 29095433 PMCID: PMC8592379 DOI: 10.1038/jp.2017.164] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/18/2017] [Accepted: 08/28/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine short-term outcomes of infants with evidence of hypoxia-ischemia at birth and classified as mild neonatal encephalopathy (NE) at <6 h of age. STUDY DESIGN Prospective multicenter study. Mild NE was defined as ⩾1 abnormal category in modified Sarnat score. Primary outcome was any abnormality on early amplitude integrated electroencephalogram (aEEG) or seizures, abnormal brain magnetic resonance imaging (MRI) or neurological exam at discharge. RESULTS A total of 54/63 (86%) of enrolled infants had data on components of the primary outcome, which was abnormal in 28/54 (52%): discontinuous aEEG (n=4), MRI (n=9) and discharge exam (n=22). Abnormal tone and/or incomplete Moro were the most common findings. MRI abnormalities were confined to cerebral cortex but two infants had basal ganglia and/or thalamus involvement. The 18 to 24 months follow-up is ongoing. CONCLUSIONS A larger than expected proportion of mild NE infants with abnormal outcomes was observed. Future research should evaluate safety and efficacy of neuroprotection for mild NE.
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Affiliation(s)
| | - LF Chalak
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - J Garfinkle
- McGill University Health Center, Montreal, QC, Canada
| | - B Shah
- Brown University, Rhode Island, Providence, RI, USA
| | - V Kalra
- Wayne State University, Detroit, MI, USA
| | - N Rollins
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - R Boyle
- McGill University Health Center, Montreal, QC, Canada
| | - K-A Nguyen
- McGill University Health Center, Montreal, QC, Canada
| | - I Mir
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - A Pappas
- Wayne State University, Detroit, MI, USA
| | - P Montaldo
- Imperial College, London, UK and Nationwide Children’s Hospital–The Ohio State University, Columbus, OH, USA
| | - S Thayyil
- Imperial College, London, UK and Nationwide Children’s Hospital–The Ohio State University, Columbus, OH, USA
| | - PJ Sánchez
- Center for Perinatal Research, Nationwide Children’s Hospital–The Ohio State University, Columbus, OH, USA
| | | | - AR Laptook
- Brown University, Rhode Island, Providence, RI, USA
| | - G Sant’Anna
- McGill University Health Center, Montreal, QC, Canada
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Pham-Mondala A, Boyle R, Bond L, Vanek A, Joseph P. Utilization of Rosemary and Green Tea Extracts As Clean Label Antioxidant Solutions in Bacon Formulations. Meat and Muscle Biology 2018. [DOI: 10.22175/rmc2018.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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44
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Roberts G, Boyle R, Bryce PJ, Crane J, Hogan SP, Saglani S, Wickman M, Woodfolk JA. Developments in the field of clinical allergy in 2015 through the eyes of Clinical and Experimental Allergy. Clin Exp Allergy 2017; 46:1389-1397. [PMID: 27748974 DOI: 10.1111/cea.12831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In the second of two papers, we describe developments in the field of clinical allergy as documented by Clinical and Experimental Allergy in 2015. Epidemiology, clinical allergy, asthma and rhinitis are all covered.
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Affiliation(s)
- G Roberts
- Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK. .,NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK. .,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK.
| | - R Boyle
- Paediatric Research Unit, Imperial College London, London, UK
| | - P J Bryce
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J Crane
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - S P Hogan
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - S Saglani
- National Heart & Lung Institute, Imperial College London, London, UK
| | - M Wickman
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - J A Woodfolk
- Allergy Division, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
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45
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Roberts G, Boyle R, Bryce PJ, Crane J, Hogan SP, Saglani S, Wickman M, Woodfolk JA. Developments in the field of allergy mechanisms in 2015 through the eyes of Clinical & Experimental Allergy. Clin Exp Allergy 2017; 46:1248-57. [PMID: 27682977 DOI: 10.1111/cea.12823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In the first of two papers we described the development in the field of allergy mechanisms as described by Clinical and Experimental Allergy in 2015. Experimental models of allergic disease, basic mechanisms, clinical mechanisms and allergens are all covered. A second paper will cover clinical aspects.
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Affiliation(s)
- G Roberts
- Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK. .,NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK. .,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK.
| | - R Boyle
- Paediatric Research Unit, Imperial College London, London, UK
| | - P J Bryce
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J Crane
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - S P Hogan
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - S Saglani
- National Heart & Lung Institute, Imperial College London, London, UK
| | - M Wickman
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - J A Woodfolk
- Allergy Division, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
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46
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Jones CW, Shatrov J, Jagiello JM, Millington S, Hong A, Boyle R, Stalley PD. Clinical, functional and radiological outcomes of extracorporeal irradiation in limb salvage surgery for bone tumours. Bone Joint J 2017; 99-B:1681-1688. [PMID: 29212693 DOI: 10.1302/0301-620x.99b12.bjj-2016-0462.r2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 05/20/2016] [Accepted: 07/11/2017] [Indexed: 11/12/2022]
Abstract
AIMS We present a retrospective review of patients treated with extracorporeally irradiated allografts for primary and secondary bone tumours with the mid- and long-term survivorship and the functional and radiographic outcomes. PATIENTS AND METHODS A total of 113 of 116 (97.4%) patients who were treated with extracorporeally irradiated allografts between 1996 and 2014 were followed up. Forms of treatment included reconstructions, prostheses and composite reconstructions, both with and without vascularised grafts. Survivorship was determined by the Kaplan-Meier method. Clinical outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) scoring system, the Toronto Extremity Salvage Score (TESS) and Quality of Life-C30 (QLQ-30) measures. Radiographic outcomes were assessed using the International Society of Limb Salvage (ISOLS) radiographic scoring system. RESULTS There were 61 (54%) men with a mean age of 22 years (6 to 70) and 52 (46%) women with a mean age of 26 years (3 to 85). There were 23 deaths. The five-year patient survivorship was 82.3% and the ten-year patient survivorship was 79.6%. The mean follow-up of the 90 surviving patients was 80.3 months (2 to 207). At the last follow-up, 105 allografts (92.9%) were still in place or had been at the time of death; eight (7%) had failed due to infection, local recurrence or fracture. Outcome scores were comparable with or superior to those in previous studies. The mean outcome scores were: MSTS 79% (sd 8); TESS 83% (sd 19); QLQ 82% (sd 16); ISOLS 80.5% (sd 19). Pearson correlation analysis showed a strong relationship between the MSTS and ISOLS scores (r = 0.71, p < 0.001). CONCLUSION This study shows that extracorporeal irradiation is a versatile reconstructive technique for dealing with large defects after the resection of bone tumours with good functional and radiographic outcomes. Functional outcomes as measured by MSTS, TESS and QLQ-30 were strongly correlated to radiographic outcomes. Cite this article: Bone Joint J 2017;99-B:1681-8.
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Affiliation(s)
- C W Jones
- Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown NSW 2050, Sydney, Australia
| | - J Shatrov
- Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown NSW 2050, Sydney, Australia
| | - J M Jagiello
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, UK
| | - S Millington
- London Bridge Hospital, 27 Tooley Street, London SE1 2PR, UK
| | - A Hong
- The University of Sydney, Sydney, Australia
| | - R Boyle
- Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown NSW 2050, Sydney, Australia
| | - P D Stalley
- Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown NSW 2050, Sydney, Australia
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47
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Roberts G, Boyle R, Crane J, Hogan SP, Saglani S, Wickman M, Woodfolk JA. Developments in the field of allergy in 2016 through the eyes of Clinical and Experimental Allergy. Clin Exp Allergy 2017; 47:1512-1525. [PMID: 29068551 DOI: 10.1111/cea.13049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In this article, we described the development in the field of allergy as described by Clinical and Experimental Allergy in 2016. Experimental models of allergic disease, basic mechanisms, clinical mechanisms, allergens, asthma and rhinitis, and clinical allergy are all covered.
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Affiliation(s)
- G Roberts
- Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - R Boyle
- Department of Paediatrics, Imperial College London, London, UK
| | - J Crane
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - S P Hogan
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - S Saglani
- National Heart & Lung Institute, Imperial College London, London, UK
| | - M Wickman
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - J A Woodfolk
- Division of Asthma, Allergy and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
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48
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Boyle R, van Zundert AAJ. Professor Tess Cramond (1926–2015): Contributions to Anaesthesia and Pain Medicine. Anaesth Intensive Care 2017. [DOI: 10.1177/0310057x170450s102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Professor Tess Cramond joined the Queensland anaesthesia workforce in 1958, and contributed to high standards of clinical practice, pain management, training, scholarship and research. Evidence of her excellence, within the clinical, political and community spheres was recognised by multiple awards. Though deceased in 2015, she remains a role model for all physicians, using her expert knowledge, technical skills, clinical reasoning, emotions and values for the benefit of the individuals and community which she served.
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Affiliation(s)
- R. Boyle
- Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland
| | - A. A. J. van Zundert
- University of Queensland and Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland
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49
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Narayanappa H, Boyle R, Karim R, Brown W, Cooper W, Selinger C, Bonar F, Mahar A. CIC-rearranged sarcoma: a case report. Pathology 2017. [DOI: 10.1016/j.pathol.2016.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Vargas AC, Selinger CI, Satgunaseelan L, Cooper WA, Gupta R, Stalley P, Brown W, Soper J, Schatz J, Boyle R, Thomas DM, Tattersall MHN, Bhadri VA, Maclean F, Bonar SF, Scolyer RA, Karim RZ, McCarthy SW, Mahar A, O'Toole SA. Atypical Ewing sarcoma breakpoint region 1 fluorescencein-situhybridization signal patterns in bone and soft tissue tumours: diagnostic experience with 135 cases. Histopathology 2016; 69:1000-1011. [DOI: 10.1111/his.13031] [Citation(s) in RCA: 12] [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: 02/29/2016] [Accepted: 07/05/2016] [Indexed: 12/15/2022]
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