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Tobias DK, Merino J, Ahmad A, Aiken C, Benham JL, Bodhini D, Clark AL, Colclough K, Corcoy R, Cromer SJ, Duan D, Felton JL, Francis EC, Gillard P, Gingras V, Gaillard R, Haider E, Hughes A, Ikle JM, Jacobsen LM, Kahkoska AR, Kettunen JLT, Kreienkamp RJ, Lim LL, Männistö JME, Massey R, Mclennan NM, Miller RG, Morieri ML, Most J, Naylor RN, Ozkan B, Patel KA, Pilla SJ, Prystupa K, Raghavan S, Rooney MR, Schön M, Semnani-Azad Z, Sevilla-Gonzalez M, Svalastoga P, Takele WW, Tam CHT, Thuesen ACB, Tosur M, Wallace AS, Wang CC, Wong JJ, Yamamoto JM, Young K, Amouyal C, Andersen MK, Bonham MP, Chen M, Cheng F, Chikowore T, Chivers SC, Clemmensen C, Dabelea D, Dawed AY, Deutsch AJ, Dickens LT, DiMeglio LA, Dudenhöffer-Pfeifer M, Evans-Molina C, Fernández-Balsells MM, Fitipaldi H, Fitzpatrick SL, Gitelman SE, Goodarzi MO, Grieger JA, Guasch-Ferré M, Habibi N, Hansen T, Huang C, Harris-Kawano A, Ismail HM, Hoag B, Johnson RK, Jones AG, Koivula RW, Leong A, Leung GKW, Libman IM, Liu K, Long SA, Lowe WL, Morton RW, Motala AA, Onengut-Gumuscu S, Pankow JS, Pathirana M, Pazmino S, Perez D, Petrie JR, Powe CE, Quinteros A, Jain R, Ray D, Ried-Larsen M, Saeed Z, Santhakumar V, Kanbour S, Sarkar S, Monaco GSF, Scholtens DM, Selvin E, Sheu WHH, Speake C, Stanislawski MA, Steenackers N, Steck AK, Stefan N, Støy J, Taylor R, Tye SC, Ukke GG, Urazbayeva M, Van der Schueren B, Vatier C, Wentworth JM, Hannah W, White SL, Yu G, Zhang Y, Zhou SJ, Beltrand J, Polak M, Aukrust I, de Franco E, Flanagan SE, Maloney KA, McGovern A, Molnes J, Nakabuye M, Njølstad PR, Pomares-Millan H, Provenzano M, Saint-Martin C, Zhang C, Zhu Y, Auh S, de Souza R, Fawcett AJ, Gruber C, Mekonnen EG, Mixter E, Sherifali D, Eckel RH, Nolan JJ, Philipson LH, Brown RJ, Billings LK, Boyle K, Costacou T, Dennis JM, Florez JC, Gloyn AL, Gomez MF, Gottlieb PA, Greeley SAW, Griffin K, Hattersley AT, Hirsch IB, Hivert MF, Hood KK, Josefson JL, Kwak SH, Laffel LM, Lim SS, Loos RJF, Ma RCW, Mathieu C, Mathioudakis N, Meigs JB, Misra S, Mohan V, Murphy R, Oram R, Owen KR, Ozanne SE, Pearson ER, Perng W, Pollin TI, Pop-Busui R, Pratley RE, Redman LM, Redondo MJ, Reynolds RM, Semple RK, Sherr JL, Sims EK, Sweeting A, Tuomi T, Udler MS, Vesco KK, Vilsbøll T, Wagner R, Rich SS, Franks PW. Second international consensus report on gaps and opportunities for the clinical translation of precision diabetes medicine. Nat Med 2023; 29:2438-2457. [PMID: 37794253 PMCID: PMC10735053 DOI: 10.1038/s41591-023-02502-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/14/2023] [Indexed: 10/06/2023]
Abstract
Precision medicine is part of the logical evolution of contemporary evidence-based medicine that seeks to reduce errors and optimize outcomes when making medical decisions and health recommendations. Diabetes affects hundreds of millions of people worldwide, many of whom will develop life-threatening complications and die prematurely. Precision medicine can potentially address this enormous problem by accounting for heterogeneity in the etiology, clinical presentation and pathogenesis of common forms of diabetes and risks of complications. This second international consensus report on precision diabetes medicine summarizes the findings from a systematic evidence review across the key pillars of precision medicine (prevention, diagnosis, treatment, prognosis) in four recognized forms of diabetes (monogenic, gestational, type 1, type 2). These reviews address key questions about the translation of precision medicine research into practice. Although not complete, owing to the vast literature on this topic, they revealed opportunities for the immediate or near-term clinical implementation of precision diabetes medicine; furthermore, we expose important gaps in knowledge, focusing on the need to obtain new clinically relevant evidence. Gaps include the need for common standards for clinical readiness, including consideration of cost-effectiveness, health equity, predictive accuracy, liability and accessibility. Key milestones are outlined for the broad clinical implementation of precision diabetes medicine.
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Affiliation(s)
- Deirdre K Tobias
- Division of Preventative Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jordi Merino
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Abrar Ahmad
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden
| | - Catherine Aiken
- Department of Obstetrics and Gynaecology, The Rosie Hospital, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Jamie L Benham
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dhanasekaran Bodhini
- Department of Molecular Genetics, Madras Diabetes Research Foundation, Chennai, India
| | - Amy L Clark
- Division of Pediatric Endocrinology, Department of Pediatrics, Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Kevin Colclough
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
| | - Rosa Corcoy
- CIBER-BBN, ISCIII, Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Sara J Cromer
- Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Daisy Duan
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jamie L Felton
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Herman B Wells Center for Pediatric Research, University School of Medicine, Indianapolis, IN, USA
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ellen C Francis
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | | | - Véronique Gingras
- Department of Nutrition, Université de Montréal, Montreal, Quebec, Quebec, Canada
- Research Center, Sainte-Justine University Hospital Center, Montreal, Quebec, Quebec, Canada
| | - Romy Gaillard
- Department of Pediatrics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Eram Haider
- Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Alice Hughes
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
| | - Jennifer M Ikle
- Department of Pediatrics, Stanford School of Medicine, Stanford University, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | | | - Anna R Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jarno L T Kettunen
- Helsinki University Hospital, Abdominal Centre/Endocrinology, Helsinki, Finland
- Folkhalsan Research Center, Helsinki, Finland
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | - Raymond J Kreienkamp
- Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute, Cambridge, MA, USA
- Department of Pediatrics, Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
| | - Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Asia Diabetes Foundation, Hong Kong SAR, China
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jonna M E Männistö
- Departments of Pediatrics and Clinical Genetics, Kuopio University Hospital, Kuopio, Finland
- Department of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Robert Massey
- Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Niamh-Maire Mclennan
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Rachel G Miller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mario Luca Morieri
- Metabolic Disease Unit, University Hospital of Padova, Padova, Italy
- Department of Medicine, University of Padova, Padova, Italy
| | - Jasper Most
- Department of Orthopedics, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Rochelle N Naylor
- Departments of Pediatrics and Medicine, University of Chicago, Chicago, IL, USA
| | - Bige Ozkan
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kashyap Amratlal Patel
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
| | - Scott J Pilla
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Katsiaryna Prystupa
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Sridharan Raghavan
- Section of Academic Primary Care, US Department of Veterans Affairs Eastern Colorado Health Care System, Aurora, CO, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mary R Rooney
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Martin Schön
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, Neuherberg, Germany
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Zhila Semnani-Azad
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Magdalena Sevilla-Gonzalez
- Programs in Metabolism and Medical & Population Genetics, Broad Institute, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Pernille Svalastoga
- Mohn Center for Diabetes Precision Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
- Children and Youth Clinic, Haukeland University Hospital, Bergen, Norway
| | - Wubet Worku Takele
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Claudia Ha-Ting Tam
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anne Cathrine B Thuesen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mustafa Tosur
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Division of Pediatric Diabetes and Endocrinology, Texas Children's Hospital, Houston, TX, USA
- Children's Nutrition Research Center, USDA/ARS, Houston, TX, USA
| | - Amelia S Wallace
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caroline C Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jessie J Wong
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Katherine Young
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
| | - Chloé Amouyal
- Department of Diabetology, APHP, Paris, France
- Sorbonne Université, INSERM, NutriOmic team, Paris, France
| | - Mette K Andersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maxine P Bonham
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
| | - Mingling Chen
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Feifei Cheng
- Health Management Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Tinashe Chikowore
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sian C Chivers
- Department of Women and Children's Health, King's College London, London, UK
| | - Christoffer Clemmensen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Adem Y Dawed
- Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Aaron J Deutsch
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Laura T Dickens
- Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, Kovler Diabetes Center, University of Chicago, Chicago, IL, USA
| | - Linda A DiMeglio
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Herman B Wells Center for Pediatric Research, University School of Medicine, Indianapolis, IN, USA
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Carmella Evans-Molina
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Herman B Wells Center for Pediatric Research, University School of Medicine, Indianapolis, IN, USA
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
- Richard L. Roudebush VAMC, Indianapolis, IN, USA
| | - María Mercè Fernández-Balsells
- Biomedical Research Institute Girona, IdIBGi, Girona, Spain
- Diabetes, Endocrinology and Nutrition Unit Girona, University Hospital Dr Josep Trueta, Girona, Spain
| | - Hugo Fitipaldi
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden
| | - Stephanie L Fitzpatrick
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Stephen E Gitelman
- University of California at San Francisco, Department of Pediatrics, Diabetes Center, San Francisco, CA, USA
| | - Mark O Goodarzi
- Division of Endocrinology, Diabetes and Metabolism, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jessica A Grieger
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Marta Guasch-Ferré
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Public Health and Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nahal Habibi
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Chuiguo Huang
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Arianna Harris-Kawano
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Herman B Wells Center for Pediatric Research, University School of Medicine, Indianapolis, IN, USA
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Heba M Ismail
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Herman B Wells Center for Pediatric Research, University School of Medicine, Indianapolis, IN, USA
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Benjamin Hoag
- Division of Endocrinology and Diabetes, Department of Pediatrics, Sanford Children's Hospital, Sioux Falls, SD, USA
- University of South Dakota School of Medicine, E Clark St, Vermillion, SD, USA
| | - Randi K Johnson
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Angus G Jones
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Robert W Koivula
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Aaron Leong
- Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Gloria K W Leung
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
| | | | - Kai Liu
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - S Alice Long
- Center for Translational Immunology, Benaroya Research Institute, Seattle, WA, USA
| | - William L Lowe
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert W Morton
- Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Translational Medicine, Medical Science, Novo Nordisk Foundation, Hellerup, Denmark
| | - Ayesha A Motala
- Department of Diabetes and Endocrinology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Suna Onengut-Gumuscu
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - James S Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Maleesa Pathirana
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sofia Pazmino
- Department of Chronic Diseases and Metabolism, Clinical and Experimental Endocrinologyó, KU Leuven, Leuven, Belgium
| | - Dianna Perez
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Herman B Wells Center for Pediatric Research, University School of Medicine, Indianapolis, IN, USA
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John R Petrie
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Camille E Powe
- Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Alejandra Quinteros
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Rashmi Jain
- Sanford Children's Specialty Clinic, Sioux Falls, SD, USA
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA
| | - Debashree Ray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mathias Ried-Larsen
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- Institute for Sports and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Zeb Saeed
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Vanessa Santhakumar
- Division of Preventative Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sarah Kanbour
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
- AMAN Hospital, Doha, Qatar
| | - Sudipa Sarkar
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Gabriela S F Monaco
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Herman B Wells Center for Pediatric Research, University School of Medicine, Indianapolis, IN, USA
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Denise M Scholtens
- Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elizabeth Selvin
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wayne Huey-Herng Sheu
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Zhunan, Taiwan
- Divsion of Endocrinology and Metabolism, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Endocrinology and Metabolism, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cate Speake
- Center for Interventional Immunology, Benaroya Research Institute, Seattle, WA, USA
| | - Maggie A Stanislawski
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nele Steenackers
- Department of Chronic Diseases and Metabolism, Clinical and Experimental Endocrinologyó, KU Leuven, Leuven, Belgium
| | - Andrea K Steck
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Norbert Stefan
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, Neuherberg, Germany
- University Hospital of Tübingen, Tübingen, Germany
| | - Julie Støy
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | | | - Sok Cin Tye
- Sections on Genetics and Epidemiology, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Marzhan Urazbayeva
- Division of Pediatric Diabetes and Endocrinology, Texas Children's Hospital, Houston, TX, USA
- Gastroenterology, Baylor College of Medicine, Houston, TX, USA
| | - Bart Van der Schueren
- Department of Chronic Diseases and Metabolism, Clinical and Experimental Endocrinologyó, KU Leuven, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Camille Vatier
- Sorbonne University, Inserm U938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France
- Department of Endocrinology, Diabetology and Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France
| | - John M Wentworth
- Royal Melbourne Hospital Department of Diabetes and Endocrinology, Parkville, Victoria, Australia
- Walter and Eliza Hall Institute, Parkville, Victoria, Australia
- University of Melbourne Department of Medicine, Parkville, Victoria, Australia
| | - Wesley Hannah
- Deakin University, Melbourne, Victoria, Australia
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, India
| | - Sara L White
- Department of Women and Children's Health, King's College London, London, UK
- Department of Diabetes and Endocrinology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Gechang Yu
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yingchai Zhang
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shao J Zhou
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- School of Agriculture, Food and Wine, University of Adelaide, Adelaide, South Australia, Australia
| | - Jacques Beltrand
- Institut Cochin, Inserm U 10116, Paris, France
- Pediatric Endocrinology and Diabetes, Hopital Necker Enfants Malades, APHP Centre, Université de Paris, Paris, France
| | - Michel Polak
- Institut Cochin, Inserm U 10116, Paris, France
- Pediatric Endocrinology and Diabetes, Hopital Necker Enfants Malades, APHP Centre, Université de Paris, Paris, France
| | - Ingvild Aukrust
- Mohn Center for Diabetes Precision Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Elisa de Franco
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
| | - Sarah E Flanagan
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
| | - Kristin A Maloney
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew McGovern
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
| | - Janne Molnes
- Mohn Center for Diabetes Precision Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Mariam Nakabuye
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pål Rasmus Njølstad
- Mohn Center for Diabetes Precision Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
- Children and Youth Clinic, Haukeland University Hospital, Bergen, Norway
| | - Hugo Pomares-Millan
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Michele Provenzano
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cécile Saint-Martin
- Department of Medical Genetics, AP-HP Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Cuilin Zhang
- Global Center for Asian Women's Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yeyi Zhu
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Sungyoung Auh
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Russell de Souza
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Andrea J Fawcett
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Clinical and Organizational Development, Chicago, IL, USA
| | | | - Eskedar Getie Mekonnen
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Emily Mixter
- Department of Medicine and Kovler Diabetes Center, University of Chicago, Chicago, IL, USA
| | - Diana Sherifali
- Population Health Research Institute, Hamilton, Ontario, Canada
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Robert H Eckel
- Division of Endocrinology, Metabolism, Diabetes, University of Colorado, Aurora, CO, USA
| | - John J Nolan
- Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Endocrinology, Wexford General Hospital, Wexford, Ireland
| | - Louis H Philipson
- Department of Medicine and Kovler Diabetes Center, University of Chicago, Chicago, IL, USA
| | - Rebecca J Brown
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Liana K Billings
- Division of Endocrinology, NorthShore University HealthSystem, Skokie, IL, USA
- Department of Medicine, Prtizker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Kristen Boyle
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tina Costacou
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - John M Dennis
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
| | - Jose C Florez
- Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Anna L Gloyn
- Department of Pediatrics, Stanford School of Medicine, Stanford University, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford School of Medicine, Stanford University, Stanford, CA, USA
- Department of Genetics, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - Maria F Gomez
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden
- Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Peter A Gottlieb
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Siri Atma W Greeley
- Departments of Pediatrics and Medicine and Kovler Diabetes Center, University of Chicago, Chicago, IL, USA
| | - Kurt Griffin
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA
- Sanford Research, Sioux Falls, SD, USA
| | - Andrew T Hattersley
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Irl B Hirsch
- University of Washington School of Medicine, Seattle, WA, USA
| | - Marie-France Hivert
- Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Medicine, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Korey K Hood
- Stanford University School of Medicine, Stanford, CA, USA
| | - Jami L Josefson
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Soo Heon Kwak
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Lori M Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Siew S Lim
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ruth J F Loos
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ronald C W Ma
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | | | - James B Meigs
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute, Cambridge, MA, USA
| | - Shivani Misra
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Diabetes & Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Rinki Murphy
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Auckland Diabetes Centre, Te Whatu Ora Health New Zealand, Auckland, New Zealand
- Medical Bariatric Service, Te Whatu Ora Counties, Health New Zealand, Auckland, New Zealand
| | - Richard Oram
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Katharine R Owen
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Susan E Ozanne
- University of Cambridge, Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, Cambridge, UK
| | - Ewan R Pearson
- Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Wei Perng
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Toni I Pollin
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rodica Pop-Busui
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Maria J Redondo
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Division of Pediatric Diabetes and Endocrinology, Texas Children's Hospital, Houston, TX, USA
| | - Rebecca M Reynolds
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Robert K Semple
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | | | - Emily K Sims
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Herman B Wells Center for Pediatric Research, University School of Medicine, Indianapolis, IN, USA
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Arianne Sweeting
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Tiinamaija Tuomi
- Helsinki University Hospital, Abdominal Centre/Endocrinology, Helsinki, Finland
- Folkhalsan Research Center, Helsinki, Finland
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | - Miriam S Udler
- Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Programs in Metabolism and Medical & Population Genetics, Broad Institute, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Kimberly K Vesco
- Kaiser Permanente Northwest, Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Tina Vilsbøll
- Clinial Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Robert Wagner
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Department of Endocrinology and Diabetology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Stephen S Rich
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Paul W Franks
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden.
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK.
- Department of Translational Medicine, Medical Science, Novo Nordisk Foundation, Hellerup, Denmark.
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Ribic D, Remme E, Broch K, Massey R, Gullestad L, Eek C, Russell K. Validation of non-invasive assessment of myocardial work in aortic stenosis: improvements by modifying the method for estimating the left ventricular pressure waveform. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1547] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Non-invasive myocardial work (MW) index incorporates strain by speckle-tracking echocardiography (STE) and individually estimated left ventricular pressure (LVP) curves to calculate the area of the pressure strain loop without the need for invasive LVP measurements. The method was validated in patients without aortic stenosis (AS) where a reference pressure curve is adjusted for individually measured aortic and mitral valve events and the peak LVP is defined by the brachial artery cuff pressure. Before applying this method in patients with AS, potential limitations which can influence the area of the pressure strain loop, such as the LVP curve profile, correct scaling of peak LVP and correct assessment of aortic events must be addressed.
Purpose
The present study aimed to assess the impact of the potential limitations specific to patients with AS and thereby the validity of non-invasive MW index in patients with AS.
Methods
In 20 patients with severe AS we obtained simultaneous LVP, by a micromanometer-tipped catheter, and strain by STE. For each patient, LVP curve estimations were done using three different models: 1. The established LVP reference model based on patients without AS. 2. Enhancement of the established LVP reference model by defining aortic valve opening with diastolic cuff pressure. 3. A new AS specific LVP reference model based on our current invasive measurements. Valvular events were determined by 2D and Doppler echocardiography, and peak LVP estimated as a sum of mean trans-aortic gradient and systolic cuff pressure. Estimated LVP curve tracings were thereafter directly compared with simultaneous invasive measurements (Figure 1). Furthermore, area of the pressure-strain loops using the different estimations of LVP curve were calculated to assess MW and compared to simultaneous invasive measurements for direct comparison.
Results
All three methods had excellent average correlation coefficient between estimated and invasively measured LVP traces. However, estimations with the AS specific reference curve and those enhanced with incorporation of diastolic pressure for aortic valve opening had a higher correlation coefficient (r=0.99, p<0.001) and a more physiological profile during early systole compared to that of the previously validated reference curve (r=0.96, p<0.001) (Figure 1). Furthermore, there was an excellent correlation (r=0.98, p<0.001) and good agreement between MW calculated with all three non-invasive estimation methods and invasive LVP (Figure 2).
Conclusions
The present study is the first to confirm the validity of non-invasive MW in patients with AS. Furthermore, a AS specific reference curve and the enhanced reference curve incorporating diastolic cuff pressure to define aortic valve opening both increased the accuracy of the estimated LVP curve and hence estimation of MW. This could be pivotal when assessing AS patients with marked regional differences such as LBBB or regional ischaemia.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Oslo University Hospital Rikshospitalet
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Affiliation(s)
- D Ribic
- Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - E Remme
- Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - K Broch
- Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - R Massey
- Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - L Gullestad
- Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - C Eek
- Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - K Russell
- Oslo University Hospital Rikshospitalet , Oslo , Norway
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3
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Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, Hancock AB, Johnson TW, Karasic DH, Knudson GA, Leibowitz SF, Meyer-Bahlburg HFL, Monstrey SJ, Motmans J, Nahata L, Nieder TO, Reisner SL, Richards C, Schechter LS, Tangpricha V, Tishelman AC, Van Trotsenburg MAA, Winter S, Ducheny K, Adams NJ, Adrián TM, Allen LR, Azul D, Bagga H, Başar K, Bathory DS, Belinky JJ, Berg DR, Berli JU, Bluebond-Langner RO, Bouman MB, Bowers ML, Brassard PJ, Byrne J, Capitán L, Cargill CJ, Carswell JM, Chang SC, Chelvakumar G, Corneil T, Dalke KB, De Cuypere G, de Vries E, Den Heijer M, Devor AH, Dhejne C, D'Marco A, Edmiston EK, Edwards-Leeper L, Ehrbar R, Ehrensaft D, Eisfeld J, Elaut E, Erickson-Schroth L, Feldman JL, Fisher AD, Garcia MM, Gijs L, Green SE, Hall BP, Hardy TLD, Irwig MS, Jacobs LA, Janssen AC, Johnson K, Klink DT, Kreukels BPC, Kuper LE, Kvach EJ, Malouf MA, Massey R, Mazur T, McLachlan C, Morrison SD, Mosser SW, Neira PM, Nygren U, Oates JM, Obedin-Maliver J, Pagkalos G, Patton J, Phanuphak N, Rachlin K, Reed T, Rider GN, Ristori J, Robbins-Cherry S, Roberts SA, Rodriguez-Wallberg KA, Rosenthal SM, Sabir K, Safer JD, Scheim AI, Seal LJ, Sehoole TJ, Spencer K, St Amand C, Steensma TD, Strang JF, Taylor GB, Tilleman K, T'Sjoen GG, Vala LN, Van Mello NM, Veale JF, Vencill JA, Vincent B, Wesp LM, West MA, Arcelus J. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgend Health 2022; 23:S1-S259. [PMID: 36238954 PMCID: PMC9553112 DOI: 10.1080/26895269.2022.2100644] [Citation(s) in RCA: 455] [Impact Index Per Article: 227.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.
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Affiliation(s)
- E Coleman
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A E Radix
- Callen-Lorde Community Health Center, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - W P Bouman
- Nottingham Centre for Transgender Health, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - G R Brown
- James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
- James H. Quillen VAMC, Johnson City, TN, USA
| | - A L C de Vries
- Department of Child and Adolescent Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M B Deutsch
- Department of Family & Community Medicine, University of California-San Francisco, San Francisco, CA, USA
- UCSF Gender Affirming Health Program, San Francisco, CA, USA
| | - R Ettner
- New Health Foundation Worldwide, Evanston, IL, USA
- Weiss Memorial Hospital, Chicago, IL, USA
| | - L Fraser
- Independent Practice, San Francisco, CA, USA
| | - M Goodman
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - J Green
- Independent Scholar, Vancouver, WA, USA
| | - A B Hancock
- The George Washington University, Washington, DC, USA
| | - T W Johnson
- Department of Anthropology, California State University, Chico, CA, USA
| | - D H Karasic
- University of California San Francisco, San Francisco, CA, USA
- Independent Practice at dankarasic.com
| | - G A Knudson
- University of British Columbia, Vancouver, Canada
- Vancouver Coastal Health, Vancouver, Canada
| | - S F Leibowitz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - H F L Meyer-Bahlburg
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - J Motmans
- Transgender Infopunt, Ghent University Hospital, Gent, Belgium
- Centre for Research on Culture and Gender, Ghent University, Gent, Belgium
| | - L Nahata
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Endocrinology and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - T O Nieder
- University Medical Center Hamburg-Eppendorf, Interdisciplinary Transgender Health Care Center Hamburg, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Hamburg, Germany
| | - S L Reisner
- Harvard Medical School, Boston, MA, USA
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - C Richards
- Regents University London, UK
- Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - V Tangpricha
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - A C Tishelman
- Boston College, Department of Psychology and Neuroscience, Chestnut Hill, MA, USA
| | - M A A Van Trotsenburg
- Bureau GenderPRO, Vienna, Austria
- University Hospital Lilienfeld-St. Pölten, St. Pölten, Austria
| | - S Winter
- School of Population Health, Curtin University, Perth, WA, Australia
| | - K Ducheny
- Howard Brown Health, Chicago, IL, USA
| | - N J Adams
- University of Toronto, Ontario Institute for Studies in Education, Toronto, Canada
- Transgender Professional Association for Transgender Health (TPATH)
| | - T M Adrián
- Asamblea Nacional de Venezuela, Caracas, Venezuela
- Diverlex Diversidad e Igualdad a Través de la Ley, Caracas, Venezuela
| | - L R Allen
- University of Nevada, Las Vegas, NV, USA
| | - D Azul
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - H Bagga
- Monash Health Gender Clinic, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - K Başar
- Department of Psychiatry, Hacettepe University, Ankara, Turkey
| | - D S Bathory
- Independent Practice at Bathory International PLLC, Winston-Salem, NC, USA
| | - J J Belinky
- Durand Hospital, Guemes Clinic and Urological Center, Buenos Aires, Argentina
| | - D R Berg
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J U Berli
- Oregon Health & Science University, Portland, OR, USA
| | - R O Bluebond-Langner
- NYU Langone Health, New York, NY, USA
- Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - M-B Bouman
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Plastic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - M L Bowers
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - P J Brassard
- GrS Montreal, Complexe CMC, Montreal, Quebec, Canada
- Université de Montreal, Quebec, Canada
| | - J Byrne
- University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - L Capitán
- The Facialteam Group, Marbella International Hospital, Marbella, Spain
| | | | - J M Carswell
- Harvard Medical School, Boston, MA, USA
- Boston's Children's Hospital, Boston, MA, USA
| | - S C Chang
- Independent Practice, Oakland, CA, USA
| | - G Chelvakumar
- Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University, College of Medicine, Columbus, OH, USA
| | - T Corneil
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - K B Dalke
- Penn State Health, PA, USA
- Penn State College of Medicine, Hershey, PA, USA
| | - G De Cuypere
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - E de Vries
- Nelson Mandela University, Gqeberha, South Africa
- University of Cape Town, Cape Town, South Africa
| | - M Den Heijer
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - A H Devor
- University of Victoria, Victoria, BC, Canada
| | - C Dhejne
- ANOVA, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - A D'Marco
- UCTRANS-United Caribbean Trans Network, Nassau, The Bahamas
- D M A R C O Organization, Nassau, The Bahamas
| | - E K Edmiston
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - L Edwards-Leeper
- Pacific University, Hillsboro, OR, USA
- Independent Practice, Beaverton, OR, USA
| | - R Ehrbar
- Whitman Walker Health, Washington, DC, USA
- Independent Practice, Maryland, USA
| | - D Ehrensaft
- University of California San Francisco, San Francisco, CA, USA
| | - J Eisfeld
- Transvisie, Utrecht, The Netherlands
| | - E Elaut
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Clinical Experimental and Health Psychology, Ghent University, Gent, Belgium
| | - L Erickson-Schroth
- The Jed Foundation, New York, NY, USA
- Hetrick-Martin Institute, New York, NY, USA
| | - J L Feldman
- Institute for Sexual and Gender Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A D Fisher
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | - M M Garcia
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Departments of Urology and Anatomy, University of California San Francisco, San Francisco, CA, USA
| | - L Gijs
- Institute of Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | | | - B P Hall
- Duke University Medical Center, Durham, NC, USA
- Duke Adult Gender Medicine Clinic, Durham, NC, USA
| | - T L D Hardy
- Alberta Health Services, Edmonton, Alberta, Canada
- MacEwan University, Edmonton, Alberta, Canada
| | - M S Irwig
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - A C Janssen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - K Johnson
- RMIT University, Melbourne, Australia
- University of Brighton, Brighton, UK
| | - D T Klink
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital, Gent, Belgium
- Division of Pediatric Endocrinology and Diabetes, ZNA Queen Paola Children's Hospital, Antwerp, Belgium
| | - B P C Kreukels
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - L E Kuper
- Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, USA
- Department of Endocrinology, Children's Health, Dallas, TX, USA
| | - E J Kvach
- Denver Health, Denver, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - M A Malouf
- Malouf Counseling and Consulting, Baltimore, MD, USA
| | - R Massey
- WPATH Global Education Institute
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - T Mazur
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - C McLachlan
- Professional Association for Transgender Health, South Africa
- Gender DynamiX, Cape Town, South Africa
| | - S D Morrison
- Division of Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA
- Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - S W Mosser
- Gender Confirmation Center, San Francisco, CA, USA
- Saint Francis Memorial Hospital, San Francisco, CA, USA
| | - P M Neira
- Johns Hopkins Center for Transgender Health, Baltimore, MD, USA
- Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity, Baltimore, MD, USA
| | - U Nygren
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - J M Oates
- La Trobe University, Melbourne, Australia
- Melbourne Voice Analysis Centre, East Melbourne, Australia
| | - J Obedin-Maliver
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford, CA, USA
| | - G Pagkalos
- Independent PracticeThessaloniki, Greece
- Military Community Mental Health Center, 424 General Military Training Hospital, Thessaloniki, Greece
| | - J Patton
- Talkspace, New York, NY, USA
- CytiPsychological LLC, San Diego, CA, USA
| | - N Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - K Rachlin
- Independent Practice, New York, NY, USA
| | - T Reed
- Gender Identity Research and Education Society, Leatherhead, UK
| | - G N Rider
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J Ristori
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | | | - S A Roberts
- Harvard Medical School, Boston, MA, USA
- Division of Endocrinology, Boston's Children's Hospital, Boston, MA, USA
| | - K A Rodriguez-Wallberg
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - S M Rosenthal
- Division of Pediatric Endocrinology, UCSF, San Francisco, CA, USA
- UCSF Child and Adolescent Gender Center
| | - K Sabir
- FtM Phoenix Group, Krasnodar Krai, Russia
| | - J D Safer
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Center for Transgender Medicine and Surgery, New York, NY, USA
| | - A I Scheim
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - L J Seal
- Tavistock and Portman NHS Foundation Trust, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - K Spencer
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - C St Amand
- University of Houston, Houston, TX, USA
- Mayo Clinic, Rochester, MN, USA
| | - T D Steensma
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - J F Strang
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - G B Taylor
- Atrium Health Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Charlotte, NC, USA
| | - K Tilleman
- Department for Reproductive Medicine, Ghent University Hospital, Gent, Belgium
| | - G G T'Sjoen
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Endocrinology, Ghent University Hospital, Gent, Belgium
| | - L N Vala
- Independent Practice, Campbell, CA, USA
| | - N M Van Mello
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - J F Veale
- School of Psychology, University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - J A Vencill
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - B Vincent
- Trans Learning Partnership at https://spectra-london.org.uk/trans-learning-partnership, UK
| | - L M Wesp
- College of Nursing, University of Wisconsin MilwaukeeMilwaukee, WI, USA
- Health Connections Inc., Glendale, WI, USA
| | - M A West
- North Memorial Health Hospital, Robbinsdale, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - J Arcelus
- School of Medicine, University of Nottingham, Nottingham, UK
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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4
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Augustin M, Misery L, Kobyletzski LV, Mealing S, Redding M, Chuang CC, Massey R, Cawkwell M, Bego Le-Bagousse G, Haddy L, Rout R. Systematic literature review assessing the overall costs and societal impacts of moderate-to-severe atopic dermatitis in Europe. J Eur Acad Dermatol Venereol 2022; 36:2316-2324. [PMID: 35920758 DOI: 10.1111/jdv.18481] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/11/2022] [Indexed: 11/29/2022]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory disease, driven by type 2 inflammation. The condition manifests as moderate-to-severe disease in approximately 20% of adults with AD across Europe, and is associated with a substantial burden on patients, society, and healthcare systems. However, systematic assessments capturing the totality of disease burden associated with moderate-to-severe AD are limited; therefore, the overall impacts of the disease may be underestimated. A systematic literature review was carried out to assess the overall costs of moderate-to-severe AD across Europe, including the financial, societal, and humanistic impacts. PubMed, Embase and Cochrane databases were searched to identify relevant studies published between 1 January 2010 and 2 June 2020. Scientific conference proceedings, health technology assessment websites and patient association group websites were also searched for relevant information. Twenty-seven publications, corresponding to 22 unique studies, were included in the analysis. Total costs (direct and productivity losses) reached €20 695 per-person-per-year (PPPY) for adults with uncontrolled symptoms of moderate-to-severe AD. Direct medical costs ranged between €307 and €6993 PPPY; prescription medications and specialist dermatologist visits were the main contributors. Costs increased with disease severity or with uncontrolled disease. Patients with AD also incurred personal costs of €927 per year for healthcare items not reimbursed, which increased by 9% for those with moderate-to-severe forms. Annual work productivity losses comprised most of the total costs reported for adults with moderate-to-severe AD (up to 60.8% of the total burden) and were highest in those with uncontrolled disease (€13 702 PPPY). Patients with moderate-to-severe disease also experienced physical, emotional, and social impacts. The overall costs of moderate-to-severe AD greatly impact on healthcare systems, patients, and society. Sustained control of moderate-to-severe AD, through effective treatment and care management, is essential to limit the burden caused by the disease.
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Affiliation(s)
- M Augustin
- University Medical Center Hamburg, Hamburg, Germany
| | - L Misery
- University Hospital of Brest, Brest, France
| | | | - S Mealing
- York Health Economics Consortium (YHEC), York, UK
| | - M Redding
- Eczema Outreach Support, Linlithgow, Scotland
| | | | | | | | | | - L Haddy
- Aixial on behalf of Sanofi, Chilly-Mazarin, France
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5
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Yu C, Negishi T, Thavendiranathan P, Pathan F, Penicka M, Côté M, Massey R, Miyazaki S, Shirazi M, Santoro C, Cho G, Popescu B, Vinereanu D, Kosmala W, Thomas L, Marwick T, Negishi K. Baseline Left Atrial Strain is Predictive of Chemotherapy Induced Cardiotoxicity in High-Risk Cancer Patients. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.227] [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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6
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Monteiro De Barros J, Hodson J, Glasbey J, Massey R, Rintoul-Hoad O, Chetan M, Desai A, Almond LM, Gourevitch D, Ford SJ, Strauss D, Smith H, Hayes A, Cardona K, Lopez-Aguiar A, Johnson A, Swallow C, Burtenshaw S, Nessim C, Weng R, Purgin B, Gronchi A, Fiore M, Callegaro D, Raut CP, Fairweather M, Bagaria S, Novak M, Gyorki D, Reid F, Mullinax J, Gonzalez RJ, Van Coevorden F, Van Houdt W, Haas RLM, Van Boven H, Heeres B. Intercontinental collaborative experience with abdominal, retroperitoneal and pelvic schwannomas. Br J Surg 2019; 107:452-463. [DOI: 10.1002/bjs.11376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/09/2019] [Accepted: 08/30/2019] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Schwannomas are rare tumours that pose a significant management challenge in the abdomen, retroperitoneum and pelvis. No data are available to inform management strategy.
Methods
A collaborative international cohort study, across specialist sarcoma units, was conducted to include adults presenting between 2000 and 2017 with histopathologically confirmed schwannomas within the abdomen, retroperitoneum or pelvis.
Results
Of 485 patients across 12 centres, 38 (7·8 per cent) were discharged without follow-up, 199 (41·0 per cent) underwent early resection and 248 (51·1 per cent) had radiological monitoring. Of these 248 patients, 96 (38·7 per cent) eventually had surgery, giving an overall resection rate of 60·8 per cent (295 of 485). At baseline, median tumour volume was 90·1 (i.q.r. 26·5–262·0) cm3. The estimated growth rate was 10·5 (95 per cent c.i. 9·4 to 11·6) per cent per year, and was consistent in the short term (within 2 years of diagnosis) and long term (beyond 2 years) (ρ = 0·405, P = 0·021). A decision to operate was more common in symptomatic patients (P < 0·001) and for rapidly growing tumours (growth rate more than 20 per cent per year) (P = 0·025). R0/R1 resection was achieved in 91·6 per cent of patients (263 of 287). Kaplan–Meier long-term recurrence rates after R0/R1 resection were 2·3 and 6·7 per cent at 3 and 5 years respectively.
Conclusion
Specific recommendations include: indications for early surgery, prediction of growth from radiological monitoring, promotion of selective submacroscopic resection and cessation of postoperative imaging surveillance.
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Affiliation(s)
| | | | - J Hodson
- Queen Elizabeth Hospital, Birmingham, UK
| | - J Glasbey
- Queen Elizabeth Hospital, Birmingham, UK
| | - R Massey
- Queen Elizabeth Hospital, Birmingham, UK
| | | | - M Chetan
- Queen Elizabeth Hospital, Birmingham, UK
| | - A Desai
- Queen Elizabeth Hospital, Birmingham, UK
| | - L M Almond
- Queen Elizabeth Hospital, Birmingham, UK
| | | | - S J Ford
- Queen Elizabeth Hospital, Birmingham, UK
| | | | - H Smith
- Royal Marsden Hospital, London, UK
| | - A Hayes
- Royal Marsden Hospital, London, UK
| | - K Cardona
- Emory University Hospital, Atlanta, Georgia, USA
| | | | - A Johnson
- Emory University Hospital, Atlanta, Georgia, USA
| | - C Swallow
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | - C Nessim
- Ottawa Hospital Research Institute, Ottawa, Quebec, Canada
| | - R Weng
- Ottawa Hospital Research Institute, Ottawa, Quebec, Canada
| | - B Purgin
- Ottawa Hospital Research Institute, Ottawa, Quebec, Canada
| | - A Gronchi
- Istituto Nazionale dei Tumori, Milan, Italy
| | - M Fiore
- Istituto Nazionale dei Tumori, Milan, Italy
| | | | - C P Raut
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - M Fairweather
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - S Bagaria
- Mayo Clinic, Jacksonville, Florida, USA
| | - M Novak
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - D Gyorki
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - F Reid
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - J Mullinax
- Moffitt Cancer Centre, Tampa, Florida, USA
| | | | | | - W Van Houdt
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - R L M Haas
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - H Van Boven
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - B Heeres
- Netherlands Cancer Institute, Amsterdam, the Netherlands
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7
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Massey R, Diep PP, Ruud E, Aakhus S, Beitnes JO. P691Left ventricular systolic function in long term survivors of allogeneic hematopoietic stem cell transplantation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0296] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is increasingly utilized in young patients. Allo-HSCT usually requires myeloablative therapy that is potentially cardiotoxic. In addition, allo-HSCT survivors have a high prevalence of cardiovascular risk factors.
Purpose
We aim to describe left ventricular systolic function in long term survivors after allo-HSCT.
Methods
This study included 104 patients, aged (mean±SD) 18±10 years at allo-HSCT, and follow-up time was 17±6 years. 74% were sufferers of malignant disease. Pre-transplantation therapies consisted of anthracyclines (AnT) in 44% and mediastinal radiotherapy in 2%. Conditioning regimes consisted of cyclophosphamide with bulsulfsan in 77%. 22% received anti-lymphocyte globulin and 6% received total body irradiation. Left ventricular (LV) function was evaluated by 2D and 3D echocardiography. Healthy controls matched for age, sex and BMI were used in group comparisons. Group comparisons were performed by t-tests and chi-square. A linear regression was used to identify contributing factors to reduced systolic LV function in allo-HSCT survivors.
Results
Most parameters of LV systolic function including 2D and 3D LV ejection fraction (LVEF), global longitudinal strain (GLS), mitral annulus excursion (MAPSE) and s' were all significantly impaired after allo-HSCT as compared to the control group. Significant (p<0.05) contributors to LVEF in the multivariate regression analysis were age, AnT dosage, graft versus host disease (GVHD, occurring in 67%) and hypertension (HT, occurring in 31%).
Allo-HSCT Control p value n 104 55 – Gender (female) 56 (54) 29 (53) 0.89 Age (yr) 35±12 36±11 0.44 BMI (kg/m2) 25±5 24±3 0.57 Fractional Shortening (%) 31±6 32±4 0.26 2D LVEF (%) 55±6 59±3 <0.005 3D LVEF (%) 54±5 58±3 <0.005 MAPSE (mm) 13±2 15±2 <0.005 Mean s' (mm) 81±17 89±17 <0.005 2D GLS (%) −17±2 −20±2 <0.005 Values: mean ± SD or n (%), t-test or chi-square.
Conclusion
LV systolic function is reduced in long term survivors of allo-HSCT. Pre-transplantation AnT, HT and GVHD are significantly associated with increased risk of cardiotoxicity.
Acknowledgement/Funding
Norwegian Cancer Foundation and Norwegian ExtraFoundation for Health and Rehabilitation
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Affiliation(s)
- R Massey
- Oslo University Hospital, Department of Cardiology, Oslo, Norway
| | - P P Diep
- Oslo University Hospital, Department of Hematology and Oncology, Division of Pediatric and Adolescent Medicine, Oslo, Norway
| | - E Ruud
- Oslo University Hospital, Department of Hematology and Oncology, Division of Pediatric and Adolescent Medicine, Oslo, Norway
| | - S Aakhus
- Norwegian University of Science and Technology, Department of Medicine and Health Science, Trondheim, Norway
| | - J O Beitnes
- Oslo University Hospital, Department of Cardiology, Oslo, Norway
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8
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Massey R, Jurgens JS. Abnormal Biodistribution on 99mTc-Red Blood Cell-Labeled Multigated Acquisition in the Presence of Suspected Cold Agglutinin Disease. J Nucl Med Technol 2019; 47:175-176. [PMID: 30700537 DOI: 10.2967/jnmt.118.222182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/14/2018] [Indexed: 11/16/2022] Open
Abstract
A 99mTc-red blood cell (RBC)-labeled multigated acquisition is a procedure in which the patient's RBCs are radiolabeled and imaged with electrocardiography-gated cardiac scintigraphy to assess the heart's pumping efficiency. Cold agglutinin disease, or cold antibody autoimmune hemolytic anemia, is a rare form of autoimmune hemolytic anemia in which the body's immune system attacks and destroys its own RBCs. This case addresses an altered biodistribution pattern of radiolabeled RBCs in the presence of suspected cold agglutinin disease observed during a multigated acquisition.
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Affiliation(s)
- Robert Massey
- Nuclear Medicine Service, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Jennifer S Jurgens
- Nuclear Medicine Service, Walter Reed National Military Medical Center, Bethesda, Maryland
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9
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Murbraech K, Massey R, Karason K, Gustafsson F, Eiskjær H, Rådegran G, Solbu D, Broch K, Gude E, Andreassen A, Gullestad L. The Effect of Everolimus vs Calcineurin Inhibitors on Left Ventricular Mass in De Novo Heart Transplant Recipients After 3 Years Follow-Up - Results From the Randomized Controlled SCHEDULE Trial. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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10
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Ciobanu DC, Kachman SD, Olson S, Spangler ML, Trenhaile MD, Wijesena H, Miller PS, Riethoven JJ, Lents CA, Thorson JF, Massey R, Safranski TJ. 0691 Translational genomics for improving sow reproductive longevity. J Anim Sci 2016. [DOI: 10.2527/jam2016-0691] [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: 11/13/2022] Open
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11
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Hefner JN, Howard RS, Massey R, Valencia M, Stocker DJ, Philla KQ, Goldman MD, Nylund CM, Min SB. A Randomized Controlled Comparison of Esophageal Clearance Times of Oral Budesonide Preparations. Dig Dis Sci 2016; 61:1582-90. [PMID: 26921083 DOI: 10.1007/s10620-015-3990-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 08/03/2015] [Accepted: 12/06/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Topical steroids prepared as oral viscous slurries have become common in the treatment of eosinophilic esophagitis. Esophageal mucosal contact time correlates with clinical and histologic improvement. AIM To compare the mucosal contact time of alternative oral viscous budesonide (OVB) slurries with the conventional sucralose OVB. METHODS A blinded randomized crossover trial investigating esophageal clearance of three OVB slurry preparations was done on healthy adults. Honey and xanthan gum OVB slurries were compared with standard sucralose OVB in 24 randomly assigned subjects. Each subject ingested the sucralose OVB and either the honey or xanthan gum OVB slurries. The esophageal clearance of each slurry was evaluated as an area under the curve (AUC) using 1 millicurie of technetium-99m-sulfur colloid (Tc99) co-administered in each OVB preparation using nuclear scintigraphy. A standardized taste survey was also administered. RESULTS Xanthan gum had greater mucosal contact time compared to sucralose as measured by a higher AUC at 3 min (P = 0.002), while honey showed no significant difference in esophageal clearance relative to sucralose. Taste scores were significantly higher in the honey group, while scores for xanthan gum were no different from standard sucralose. CONCLUSION OVB slurries utilizing xanthan gum may be a superior alternative to a sucralose-based slurry due to its increased mucosal contact time and similar taste tolerance. Honey may be a suitable alternative as well, due to its similar contact time and favorable taste.
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Affiliation(s)
- Jody N Hefner
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA. .,Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Robin S Howard
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Robert Massey
- Department of Nuclear Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Miland Valencia
- Department of Nuclear Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Derek J Stocker
- Department of Nuclear Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Katherine Q Philla
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA.,Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Matthew D Goldman
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA.,Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Cade M Nylund
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA.,Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Steve B Min
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA.,Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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12
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Merten J, Meneghetti M, Postman M, Umetsu K, Zitrin A, Medezinski E, Nonino M, Koekemoer A, Melchior P, Gruen D, Moustakas LA, Bartelmann M, Host O, Donahue M, Coe D, Molino A, Jouvel S, Monna A, Seitz S, Czakon N, Lemze D, Sayers J, Balestra I, Rosati P, Benítez N, Biviano A, Bouwens R, Bradley L, Broadhurst T, Carrasco M, Ford H, Grillo C, Infante L, Kelson D, Lahav O, Massey R, Moustakas J, Rasia E, Rhodes J, Vega J, Zheng W. CLASH: THE CONCENTRATION-MASS RELATION OF GALAXY CLUSTERS. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/0004-637x/806/1/4] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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13
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Deinhardt F, Wolfe L, Massey R, Hoekstra J, McDonald R. Simian sarcoma virus: oncogenicity, focus assay, presence of associated virus, and comparison with avian and feline sarcoma virus-induced neoplasia in marmoset monkeys. Bibl Haematol 2015; 39:258-62. [PMID: 4360159 DOI: 10.1159/000427850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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14
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Deinhardt F, Wolfe L, Falk L, Johnson T, Johnson D, Massey R. Immunological control of virus-induced tumors in primates. Bibl Haematol 2015:639-48. [PMID: 169832 DOI: 10.1159/000397585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cells infected by oncogenic viruses may transform, may develop a latent carrier state, or may be destroyed but understanding of the control of the results of infection is incomplete. Even if cells transform, ultimate development of a tumor may be immunologically controlled. For example, cells of some marmoset species transform after infection with RNA tumor viruses, and animals react to the transformed cells with cell-mediated and humoral immune responses. Both virus specific and cross-reacting cell membrane antigens have been demonstrated. Immune deficiency accelerates tumor growth or causes recurrence of a regressing tumor. In contrast certain simian herpesvirus (Herpesvirus saimiri, HVS and Herpesvirus ateles, HVA), which cause no or minor disease in their natural hosts, induce lymphomas or lymphoblastic leukemias in other primate species. The immune response of the natural host species to HVS is greater than that of animals developing malignancies after experimental infection. HVS and HVA share many properties with Epstein-Barr virus (EBV) of man, including antigens appearing early and late during infection and their related antibody responses but no evidence exists that they induce malignancies in their natural hosts. However, if induction is as infrequent as that with EBV and Burkitt's lymphoma (BL), we have not observed sufficient numbers of squirrel or spider monkeys to have seen a BL-like tumor. Interference with the immune systems of animals carrying HVS or HVA may induce tumor development, and clarify our understanding of the relationships between EBV and BL.
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15
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Bertrand P, Grieten L, Smeets C, Verbrugge F, Mullens W, Vrolix M, Rivero-Ayerza M, Verhaert D, Vandervoort P, Tong L, Ramalli A, Tortoli P, D'hoge J, Bajraktari G, Lindqvist P, Henein M, Obremska M, Boratynska M, Kurcz J, Zysko D, Baran T, Klinger M, Darahim K, Mueller H, Carballo D, Popova N, Vallee JP, Floria M, Chistol R, Tinica G, Grecu M, Rodriguez Serrano M, Osa-Saez A, Rueda-Soriano J, Buendia-Fuentes F, Domingo-Valero D, Igual-Munoz B, Alonso-Fernandez P, Quesada-Carmona A, Miro-Palau V, Palencia-Perez M, Bech-Hanssen O, Polte C, Lagerstrand K, Janulewicz M, Gao S, Erdogan E, Akkaya M, Bacaksiz A, Tasal A, Sonmez O, Turfan M, Kul S, Vatankulu M, Uyarel H, Goktekin O, Mincu R, Magda L, Mihaila S, Florescu M, Mihalcea D, Enescu O, Chiru A, Popescu B, Tiu C, Vinereanu D, Broch K, Kunszt G, Massey R, De Marchi S, Aakhus S, Gullestad L, Urheim S, Yuan L, Feng J, Jin X, Bombardini T, Casartelli M, Simon D, Gaspari M, Procaccio F, Hasselberg N, Haugaa K, Brunet A, Kongsgaard E, Donal E, Edvardsen T, Sahin T, Yurdakul S, Cengiz B, Bozkurt A, Aytekin S, Cesana F, Spano' F, Santambrogio G, Alloni M, Vallerio P, Salvetti M, Carerj S, Gaibazzi N, Rigo F, Moreo A, Wdowiak-Okrojek K, Michalski B, Kasprzak J, Shim A, Lipiec P, Generati G, Pellegrino M, Bandera F, Donghi V, Alfonzetti E, Guazzi M, Marcun R, Stankovic I, Farkas J, Vlahovic-Stipac A, Putnikovic B, Kadivec S, Kosnik M, Neskovic A, Lainscak M, Iliuta L, Szymanski P, Lipczynska M, Klisiewicz A, Sobieszczanska-Malek M, Zielinski T, Hoffman P, Gjerdalen GF, Hisdal J, Solberg E, Andersen T, Radunovic Z, Steine K, Svanadze A, Poteshkina N, Krylova N, Mogutova P, Shim A, Kasprzak J, Szymczyk E, Wdowiak-Okrojek K, Michalski B, Stefanczyk L, Lipiec P, Benedek T, Matei C, Jako B, Suciu Z, Benedek I, Yaroshchuk NA, Kochmasheva VV, Dityatev VP, Kerbikov OB, Przewlocka-Kosmala M, Orda A, Karolko B, Mysiak A, Kosmala W, Rechcinski T, Wierzbowska-Drabik K, Lipiec P, Chmiela M, Kasprzak J, Aziz A, Hooper J, Rayasamudra S, Uppal H, Asghar O, Potluri R, Zaroui A, Mourali M, Rezine Z, Mbarki S, Jemaa M, Aloui H, Mechmeche R, Farhati A, Gripari P, Maffessanti F, Tamborini G, Muratori M, Fusini L, Vignati C, Bartorelli A, Alamanni F, Agostoni P, Pepi M, Ruiz Ortiz M, Mesa D, Delgado M, Seoane T, Carrasco F, Martin M, Mazuelos F, Suarez De Lezo Herreros De Tejada J, Romero M, Suarez De Lezo J, Brili S, Stamatopoulos I, Misailidou M, Chrisochoou C, Christoforatou E, Stefanadis C, Ruiz Ortiz M, Mesa D, Delgado M, Martin M, Seoane T, Carrasco F, Ojeda S, Segura J, Pan M, Suarez De Lezo J, Cammalleri V, Ussia G, Muscoli S, Marchei M, Sergi D, Mazzotta E, Romeo F, Igual Munoz B, Bel Minguez A, Perez Guillen M, Maceira Gonzalez A, Monmeneu Menadas J, Hernandez Acuna C, Estornell Erill J, Lopez Lereu P, Francisco Jose Valera Martinez F, Montero Argudo A, Sunbul M, Akhundova A, Sari I, Erdogan O, Mutlu B, Cacicedo A, Velasco Del Castillo S, Anton Ladislao A, Aguirre Larracoechea U, Rodriguez Sanchez I, Subinas Elorriaga A, Oria Gonzalez G, Onaindia Gandarias J, Laraudogoitia Zaldumbide E, Lekuona Goya I, Ding W, Zhao Y, Lindqvist P, Nilson J, Winter R, Holmgren A, Ruck A, Henein M, Attenhofer Jost CH, Soyka R, Oxenius A, Kretschmar O, Valsangiacomo Buechel E, Greutmann M, Weber R, Keramida K, Kouris N, Kostopoulos V, Karidas V, Damaskos D, Makavos G, Paraskevopoulos K, Olympios C, Eskesen K, Olsen N, Fritz-Hansen T, Sogaard P, Cameli M, Lisi M, Righini F, Curci V, Massoni A, Natali B, Maccherini M, Chiavarelli M, Massetti M, Mondillo S, Mabrouk Salem Omar A, Ahmed Abdel-Rahman M, Khorshid H, Rifaie O, Santoro C, Santoro A, Ippolito R, De Palma D, De Stefano F, Muscariiello R, Galderisi M, Squeri A, Censi S, Baldelli M, Grattoni C, Cremonesi A, Bosi S, Saura Espin D, Gonzalez Canovas C, Gonzalez Carrillo J, Oliva Sandoval M, Caballero Jimenez L, Espinosa Garcia M, Garcia Navarro M, Valdes Chavarri M, De La Morena Valenzuela G, Ryu S, Shin D, Son J, Choi J, Goh C, Choi J, Park J, Hong G, Sklyanna O, Yuan L, Yuan L, Planinc I, Bagadur G, Ljubas J, Baricevic Z, Skoric B, Velagic V, Bijnens B, Milicic D, Cikes M, Gospodinova M, Chamova T, Guergueltcheva V, Ivanova R, Tournev I, Denchev S, Ancona R, Comenale Pinto S, Caso P, Arenga F, Coppola M, Calabro R, Neametalla H, Boitard S, Hamdi H, Planat-Benard V, Casteilla L, Li Z, Hagege A, Mericskay M, Menasche P, Agbulut O, Merlo M, Stolfo D, Anzini M, Negri F, Pinamonti B, Barbati G, Di Lenarda A, Sinagra G, Stolfo D, Merlo M, Pinamonti B, Gigli M, Poli S, Porto A, Di Nora C, Barbati G, Di Lenarda A, Sinagra G, Coppola C, Piscopo G, Cipresso C, Rea D, Maurea C, Esposito E, Arra C, Maurea N, Nemes A, Kalapos A, Domsik P, Forster T, Voilliot D, Huttin O, Vaugrenard T, Schwartz J, Sellal JM, Aliot E, Juilliere Y, Selton-Suty C, Sanchez Millan PJ, Cabeza Lainez P, Castillo Ortiz J, Chueca Gonzalez E, Gheorghe L, Fernandez Garcia P, Herruzo Rojas M, Del Pozo Contreras R, Fernandez Garcia M, Vazquez Garcia R, Rosca M, Popescu B, Botezatu D, Calin A, Beladan C, Gurzun M, Enache R, Ginghina C, Farouk H, Al-Maimoony T, Alhadad A, El Serafi M, Abdel Ghany M, Poorzand H, Mirfeizi S, Javanbakht A, Tellatin S, Famoso G, Dassie F, Martini C, Osto E, Maffei P, Iliceto S, Tona F, Radunovic Z, Steine K, Jedrzejewska I, Braksator W, Krol W, Swiatowiec A, Sawicki J, Kostarska-Srokosz E, Dluzniewski M, Maceira Gonzalez AM, Cosin-Sales J, Diago J, Aguilar J, Ruvira J, Monmeneu J, Igual B, Lopez-Lereu M, Estornell J, Olszanecka A, Dragan A, Kawecka-Jaszcz K, Czarnecka D, Scholz F, Gaudron P, Hu K, Liu D, Florescu C, Herrmann S, Bijnens B, Ertl G, Stoerk S, Weidemann F, Krestjyaninov M, Razin V, Gimaev R, Bogdanovic Z, Burazor I, Deljanin Ilic M, Peluso D, Muraru D, Cucchini U, Mihaila S, Casablanca S, Pigatto E, Cozzi F, Punzi L, Badano L, Iliceto S, Zhdanova E, Rameev V, Safarova A, Moisseyev S, Kobalava Z, Magnino C, Omede' P, Avenatti E, Presutti D, Losano I, Moretti C, Bucca C, Gaita F, Veglio F, Milan A, Bellsham-Revell H, Bell A, Miller O, Simpson J, Hwang Y, Kim G, Jung M, Woo G, Driessen M, Leiner T, Schoof P, Breur J, Sieswerda G, Meijboom F, Bellsham-Revell H, Hayes N, Anderson D, Austin B, Razavi R, Greil G, Simpson J, Bell A, Zhao X, Xu X, Qin Y, Szmigielski CA, Styczynski G, Sobczynska M, Placha G, Kuch-Wocial A, Ikonomidis I, Voumbourakis A, Triantafyllidi H, Pavlidis G, Varoudi M, Papadakis I, Trivilou P, Paraskevaidis I, Anastasiou-Nana M, Lekakis I, Kong W, Yip J, Ling L, Milan A, Tosello F, Leone D, Bruno G, Losano I, Avenatti E, Sabia L, Veglio F, Zaborska B, Baran J, Pilichowska-Paszkiet E, Sikora-Frac M, Michalowska I, Kulakowski P, Budaj A, Mega S, Bono M, De Francesco V, Castiglione I, Ranocchi F, Casacalenda A, Goffredo C, Patti G, Di Sciascio G, Musumeci F, Kennedy M, Waterhouse D, Sheahan R, Foley D, Mcadam B, Ancona R, Comenale Pinto S, Caso P, Arenga F, Coppola M, Calabro R, Remme EW, Smedsrud MK, Hasselberg NE, Smiseth OA, Edvardsen T, Halmai L, Nemes A, Kardos A, Neubauer S, Degiovanni A, Baduena L, Dell'era G, Occhetta E, Marino P, Hotchi J, Yamada H, Nishio S, Bando M, Hayashi S, Hirata Y, Amano R, Soeki T, Wakatsuki T, Sata M, Lamia B, Molano L, Viacroze C, Cuvelier A, Muir J, Lipczynska M, Piotr Szymanski P, Anna Klisiewicz A, Lukasz Mazurkiewicz L, Piotr Hoffman P, Van 'T Sant J, Wijers S, Ter Horst I, Leenders G, Cramer M, Doevendans P, Meine M, Hatam N, Goetzenich A, Aljalloud A, Mischke K, Hoffmann R, Autschbach R, Sikora-Frac M, Zaborska B, Maciejewski P, Bednarz B, Budaj A, Evangelista A, Torromeo C, Pandian N, Nardinocchi P, Varano V, Schiariti M, Teresi L, Puddu P, Storve S, Dalen H, Snare S, Haugen B, Torp H, Fehri W, Mahfoudhi H, Mezni F, Annabi M, Taamallah K, Dahmani R, Haggui A, Hajlaoui N, Lahidheb D, Haouala H, Colombo A, Carminati M, Maffessanti F, Gripari P, Pepi M, Lang R, Caiani E, Walker J, Abadi S, Agmon Y, Carasso S, Aronson D, Mutlak D, Lessick J, Saxena A, Ramakrishnan S, Juneja R, Ljubas J, Reskovic Luksic V, Matasic R, Pezo Nikolic B, Lovric D, Separovic Hanzevacki J, Quattrone A, Zito C, Alongi G, Vizzari G, Bitto A, De Caridi G, Greco M, Tripodi R, Pizzino G, Carerj S, Ibrahimi P, Jashari F, Johansson E, Gronlund C, Bajraktari G, Wester P, Henein M, Kosmala W, Marwick T, Souza JRM, Zacharias LGT, Geloneze B, Pareja JC, Chaim A, Nadruz WJ, Coelho OR, Apostolovic S, Stanojevic D, Jankovic-Tomasevic R, Salinger-Martinovic S, Djordjevic-Radojkovic D, Pavlovic M, Tahirovic E, Musial-Bright L, Lainscak M, Duengen H, Filipiak D, Kasprzak J, Lipiec P. Poster session Wednesday 11 December all day display: 11/12/2013, 09:30-16:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Urheim S, Broch K, Massey R, De Marchi S, Aakhus S, Gullestad L. Left ventricular contraction pattern in asymptomatic patients with moderate to severe aortic regurgitation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p621] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Badagliacca R, Reali M, Vizza C, Poscia R, Pezzuto B, Gambardella C, Papa S, Mezzapesa M, Nocioni M, Fedele F, Freed B, Bhave N, Tsang W, Gomberg-Maitland M, Mor-Avi V, Patel A, Lang RM, Liel-Cohen N, Yaacobi M, Guterman H, Jurzak P, Ternacle J, Gallet R, Bensaid A, Kloeckner M, Monin JL, Gueret P, Dubois-Rande JL, Lim P, Otsuka T, Suzuki M, Yoshikawa H, Hashimoto G, Ishikawa Y, Osaki T, Masai H, Ono T, Yamamoto M, Sugi K, Satendra M, Sargento L, Sousa C, Arsenio A, Lousada N, Palma Reis R, Wang S, Lam Y, Liu M, Fang F, Shang Q, Luo X, Wang J, Sun J, Sanderson J, Yu C, De Marchi S, Hopp E, Urheim S, Hervold A, Murbrach K, Massey R, Remme E, Hol P, Aakhus S, Bouzas Mosquera A, Peteiro J, Broullon F, Garcia NA, Rodriguez Garrido J, Martinez Ruiz D, Yanez Wonenburger J, Bouzas Zubeldia B, Fabregas Casal R, Castro Beiras A, Le Tourneau T, Sportouch C, Foucher C, Delasalle B, Rosso J, Neuder Y, Trochu J, Roncalli J, Lemarchand P, Manrique A, Sharif D, Sharif-Rasslan A, Shahla C, Khalil A, Rosenschein U, Monti L, Tramarin M, Calcagnino M, Lisignoli V, Nardi B, Balzarini L, Khalatbari A, Mills J, Chenzbraun A, Theron A, Morera P, Resseguier N, Thuny F, Riberi A, Giorgi R, Collart F, Habib G, Avierinos J, Liu D, Hu K, Niemann M, Herrmann S, Gaudron P, Voelker W, Ertl G, Bijnens B, Weidemann F, Lenders GD, Bosmans JM, Van Herck PL, Rodrigus IE, Claeys MJ, Vrints CJ, Paelinck BP, Veronesi F, Fusini L, Tamborini G, Gripari P, Maffessanti F, Mirea O, Alamanni F, Pepi M, Caiani E, Frikha Z, Zairi I, Saib W, Fennira S, Ben Moussa F, Kammoun S, Mrabet K, Ben Yaala A, Said L, Ghannouchi M, Carlomagno G, Ascione L, Sordelli C, Iengo R, Severino S, D'andrea A, Calabro' R, Caso P, Mizia M, Mizia-Stec K, Sikora-Puz A, Gieszczyk-Strozik K, Chmiel A, Haberka M, Hudziak D, Jasinski M, Gasior Z, Wos S, Biaggi P, Felix C, Gruner C, Hohlfeld S, Herzog B, Gaemperli O, Gruenenfelder J, Corti R, Tanner F, Bettex D, Kovalova S, Necas J, Dominguez Rodriguez F, Monivas V, Mingo S, Garcia-Lunar I, Garcia-Pavia P, Gonzalez-Mirelis J, Zegri I, Cavero M, Jeon HK, Lee D, Youn H, Shin H, Yoon J, Chung H, Choi E, Kim J, Min P, Lee B, Yoon Y, Hong B, Kwon H, Rim S, Petronilli V, Cimino S, De Luca L, Cicogna F, Arcari L, Francone M, Iacoboni C, Agati L, Halmai L, Atkinson P, Kardos A, Bogle R, Meimoun P, Flahaut G, Charles V, Villain Y, Clerc J, Germain A, Elmkies F, Zemir H, Luycx-Bore A, Kim K, Song J, Jeong H, Yoon H, Ahn Y, Jeong M, Cho J, Park J, Kang J, Tolba OA, El-Shanshory MR, El-Shitany NAEA, El-Hawary ES, Elkilany GN, Tolba OA, El-Shanshory MR, El-Shitany AEA, El-Hawary EES, Nagib Elkilany GE, Costanzo L, Buccheri S, Monte IP, Curatolo G, Crapanzano P, Di Pino L, Rodolico M, Blundo A, Leggio S, Tamburino C, Rees E, Hocking R, Dunstan F, Lewis M, Tunstall K, Rees DA, Halcox JP, Fraser AG, Rodrigues A, Guimaraes L, Guimaraes J, Monaco C, Cordovil A, Lira E, Vieira M, Fischer C, Nomura C, Morhy S, Bruno R, Cogo A, Sharma R, Bartesaghi M, Pomidori L, Basnyat B, Taddei S, Picano E, Sicari R, Pratali L, Satendra M, Sargento L, Sousa C, Lousada N, Palma Reis R, Zakhama L, Sioua S, Naffati S, Marouen A, Boussabah E, Kadour R, Thameur M, Benyoussef S, Vanoli D, Wiklund U, Henein M, Naslund U, Lindqvist P, Palinsky M, Petrovicova J, Pirscova M, Korpi K, Blafield H, Suomi H, Linden P, Valtonen M, Jarvinen V, Laine M, Loimaala A, Kaldararova M, Kantorova A, Vrsanska V, Tittel P, Hraska V, Masura J, Simkova I, Attenhofer Jost C, Zimmermann C, Greutmann M, Dave H, Valsangiacomo Buechel E, Pretre R, Mueller C, Seifert B, Kretschmar O, Weber R, Carro A, Teixido G, Rodriguez-Palomares J, Gutierrez L, Maldonado G, Paucca E, Gonzalez-Alujas T, Evangelista A, Al Akhfash A, Al Mesned D, Maan Hasson D, Al Harbi B M, Cruz C, Pinho T, Lebreiro A, Silva Cardoso J, Julia Maciel M, Kalimanovska-Ostric D, Nastasovic T, Deljanin-Ilic M, Milakovic B, Dostanic M, Stosic M, Lam YY, Fang F, Yu C, Bobbo M, Leonelli V, Piazza R, Leiballi E, Pecoraro R, Cinello M, Mimo R, Cervesato E, Nicolosi GL, Cruz C, Pinho T, Lebreiro A, Silva Cardoso J, Julia Maciel M, Moral Torres S, Evangelista A, Gonzalez-Alujas M, Rodriguez-Palomares J, Teixido G, Gutierrez L, Cuellar H, Carro A, Maldonado G, Garcia-Dorado D, Kocabay G, Dal Bianco L, Muraru D, Peluso D, Segafredo B, Iliceto S, Badano L, Schiano Lomoriello V, Santoro A, Esposito R, Ippolito R, De Palma D, Schiattarella P, Muscariello R, Galderisi M, Teixido Tura G, Redheuil A, Rodriguez-Palomares J, Gutierrez L, Sanchez V, Forteza A, Lima J, Garcia-Dorado D, Evangelista A, Moral Torres S, Evangelista A, Gonzalez-Alujas M, Rodriguez-Palomares J, Teixido G, Gutierrez L, Cuellar H, Carro A, Maldonado G, Garcia-Dorado D, Mihalcea D, Florescu M, Suran B, Enescu O, Mincu R, Patrascu N, Serbanoiu I, Margulescu A, Vinereanu D, Teixido Tura G, Rodriguez-Palomares J, Gutierrez L, Gonzalez-Alujas T, Carro A, Thomas M, Garcia-Dorado D, Evangelista A, Tosello F, Milan A, Magnino C, Leone D, Chiarlo M, Bruno G, Losano I, Burrello J, Fulcheri C, Veglio F, Styczynski G, Szmigielski CA, Kaczynska A, Kuch-Wocial A, Jansen R, Kracht P, Kluin J, Tietge W, Cramer M, Chamuleau S, Zito C, Tripepi S, Cusma-Piccione M, Di Bella G, Mohammed M, Oreto L, Manganaro R, D'angelo M, Pizzino F, Carerj S, Arapi S, Tsounis D, Matzraki V, Kaplanis I, Perpinia A, Varoudi M, Mpitsios G, Lazaros G, Karavidas A, Pyrgakis V, Mornos C, Ionac A, Cozma D, Mornos A, Dragulescu D, Petrescu L, Pescariu S, Lupinek P, Sramko M, Kubanek M, Kautznerova D, Tintera J, Lanska V, Kadrabulatova S, Pavlukova E, Tarasov D, Karpov R, Sveric K, Forkmann M, Richter U, Wunderlich C, Strasser R, Grapsa J, Dawson D, Zimbarra Cabrita I, Punjabi P, Nihoyannopoulos P, Kovacs A, Apor A, Nagy A, Vago H, Toth A, Becker D, Merkely B, Ranjbar S, Karvandi M, Hassantash S, Yoshikawa H, Suzuki M, Kusunose Y, Hashimoto G, Otsuka T, Nakamura M, Sugi K, De Knegt M, Biering-Sorensen T, Sogaard P, Sivertsen J, Jensen J, Mogelvang R, Montserrat S, Gabrielli L, Borras R, Bijnens B, Castella M, Berruezo A, Mont L, Brugada J, Sitges M, Tarr A, Stoebe S, Pfeiffer D, Hagendorff A, Ternacle J, Jurzak P, Gallet R, Champagne S, Teiger E, Monin JL, Gueret P, Dubois-Rande JL, Lim P, Monney P, Jeanrenaud X, Monivas Palomero V, Mingo Santos S, Garcia Lunar I, Beltran Correas P, Gonzalez Lopez E, Sanchez Garcia M, Gonzalez Mirelis J, Cavero Gibanel M, Gomez Bueno M, Segovia Cubero J, Haarman M, Van Den Bosch A, Domburg R, Mcghie J, Roos-Hesselink J, Geleijnse M, Yanikoglu A, Altekin E, Kucuk M, Karakas S, Ozel D, Yilmaz H, Demir I, Tsuruta H, Iwanaga S, Sato T, Miyoshi S, Nishiyama N, Aizawa Y, Tanimoto K, Murata M, Takatsuki S, Fukuda K, Carrilho-Ferreira P, Cortez-Dias N, Silva D, Jorge C, Goncalves S, Santos I, Sargento L, Marques P, Carpinteiro L, Sousa J, Schubert U, Kockova R, Tintera J, Kautznerova D, Cerna D, Sedlacek K, Kryze L, Sikula V, Segetova M, Kautzner J, Iwaki T, Dores H, Goncalves P, Sousa P, Carvalho M, Marques H, Machado F, Gaspar A, Aleixo A, Carmo M, Roquette J, Lagopati N, Sotiropoulos M, Baka I, Ploussi A, Lyra Georgosopoulou M, Miglioranza M, Gargani L, Sant'anna R, Rover M, Mantovani A, Kalil R, Sicari R, Picano E, Leiria T, Minarik T, Taborsky M, Fedorco M, Novak P, Ledakowicz-Polak A, Polak L, Zielinska M, Zhong L, Chin C, Lau Y, Sim L, Chua T, Tan B, Tan R. Poster session: Dobutamine stress echo. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Drossner DM, Hirsh DA, Sturm JJ, Mahle WT, Goo DJ, Massey R, Simon HK. Cardiac disease in pediatric patients presenting to a pediatric ED with chest pain. Am J Emerg Med 2010; 29:632-8. [PMID: 20627219 DOI: 10.1016/j.ajem.2010.01.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Revised: 01/07/2010] [Accepted: 01/07/2010] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Chest pain is a frequent chief complaint among the pediatric population. To date, limited data exist on the full spectrum of emergent cardiac disease among such patients; and existing data have been limited to relatively small cohorts. OBJECTIVES The aims of the study were to investigate the emergent cardiac etiologies of chest pain in a large cohort of patients presenting to a tertiary care pediatric emergency department (PED) and to examine the use of resources (electrocardiogram, chest radiograph, echocardiogram, and laboratories) in those with and without cardiac-related chest pain. METHODS Patient visits to 2 tertiary care PEDs were evaluated over a 3 and half-year period. Records of patients less than 19 years of age with a chief complaint of chest pain and no history of cardiovascular disease were reviewed. Patients were categorized as having cardiac or noncardiac etiologies or history of cardiovascular disease at the time of discharge, based on PED attending's final diagnoses. Final diagnoses classified as emergent cardiac etiologies were determined a priori. RESULTS Four thousand four hundred thirty-six patients reported a chief complaint of chest pain during the study period. Three percent were excluded secondary to a history of heart disease. Only 24 (0.6%) of the remaining 4288 were determined to have chest pain of cardiac origin. Those with cardiac-related chest pain had a rate of admission of 50% compared to those without cardiac disease at 4% (P < .001). Nine patients had an arrhythmia, 6 had pericarditis, 4 had myocarditis, 3 had acute myocardial infarction, and 1 had pulmonary embolism and pneumopericardium. Ninety-two percent of the cardiac-related chest pain cohort received electrocardiograms compared to those without cardiac-related chest pain at 27% (P < .01). Only 1 (4%) of 24 subjects with cardiac-related chest pain had a prior emergency department visit within 72 hours suggesting a high detection rate upon initial presentation. The most common noncardiac etiologies for the chest pain were 56% musculoskeletal disorders; 12% related to wheezing, asthma, and cough; 8% infectious causes; 6% gastrointestinal; and 4% related to sickle cell anemia. CONCLUSION Cardiac-related chest pain in pediatric patients is rare but potentially serious. Arrhythmia was the most common cardiac-related etiology among this cohort. Those with myocarditis and myocardial infarction were the most acutely ill. An electrocardiogram in addition to history and physical examination was most useful in detecting relatively uncommon but significant cardiac-related chest pain. Using a thorough physical examination and potentially an electrocardiogram evaluation by a pediatric emergency care physician has an excellent rate of detection of cardiac-related causes.
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Affiliation(s)
- David M Drossner
- Department of Pediatrics, Emory University, Sibley Heart Center at Children's Healthcare of Atlanta, GA 30322, USA.
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Costello BE, Simon HK, Massey R, Hirsh DA. Pandemic H1N1 influenza in the pediatric emergency department: a comparison with previous seasonal influenza outbreaks. Ann Emerg Med 2010; 56:643-8. [PMID: 20363533 DOI: 10.1016/j.annemergmed.2010.03.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 02/17/2010] [Accepted: 03/01/2010] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE We compare the acuity of pediatric emergency department (ED) patients between the ongoing H1N1 influenza pandemic and previous seasonal influenza outbreaks. METHODS An observational, cross-sectional analysis of patient visits at 2 pediatric tertiary care EDs was made for the following periods: (1) regional fall 2009 H1N1 influenza surge (August 17 to September 20, 2009), and (2) combined regional 2007 to 2009 early peak influenza seasons (January 28 to March 2, 2008, and February 2 to March 8, 2009). Proportions of admissions, return visits, and return visits resulting in admission were compared between the 2 periods. Subset analysis of patients with influenza-like illness was performed. RESULTS Of total visits, no difference was found in the proportions of hospital admissions between the 2009 H1N1 surge (18,503 visits) and the previous influenza seasons (29,002 visits): non-ICU 9.9% versus 10.4%, 95% confidence interval of the difference -0.07% to 1.0%; ICU 0.9% versus 0.9%, 95% CI of the difference -0.1% to 0.2%. Of patients with influenza-like illness, no difference was found in the proportions of non-ICU admissions between the 2009 H1N1 surge (7,064 visits) and the previous influenza seasons (8,489 visits): 4.8% versus 5.2%, 95% CI of the difference -0.3% to 1.1%, whereas the proportion of ICU admissions increased during the 2009 H1N1 surge: 0.3% versus 0.1%, 95% CI of the difference 0.05% to 0.4%. The proportions of return visits within 7 days, including those resulting in admission, were similar between the 2 periods for both the total ED population and the influenza-like illness subset. CONCLUSION The severity of illness during the 2009 H1N1 surge appeared similar to that of previous influenza seasons for the total population of the 2 pediatric tertiary care EDs, whereas an increase in the proportion of ICU admissions was observed for patients with influenza-like illness.
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Affiliation(s)
- Brian E Costello
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA.
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Nelson BA, Massey R. Implementing an Electronic Change-of-Shift Report Using Transforming Care at the Bedside Processes and Methods. J Nurs Adm 2010; 40:162-8. [DOI: 10.1097/nna.0b013e3181d40dfc] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [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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21
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Sturm JJ, Hirsh DA, Schweickert A, Massey R, Simon HK. Ondansetron use in the pediatric emergency department and effects on hospitalization and return rates: are we masking alternative diagnoses? Ann Emerg Med 2010; 55:415-22. [PMID: 20031265 DOI: 10.1016/j.annemergmed.2009.11.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 10/08/2009] [Accepted: 11/11/2009] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE We evaluate the effect of ondansetron use in cases of suspected gastroenteritis on the proportion of hospital admissions and return visits and assess whether children who receive ondansetron on their initial visit to the pediatric emergency department (ED) for suspected gastroenteritis return with an alternative diagnosis more frequently than those who did not receive ondansetron. METHODS This is a retrospective review of visits to 2 tertiary care pediatric EDs with an International Classification of Diseases, Ninth Revision diagnosis of vomiting or gastroenteritis. A logistic regression model was developed to determine the effect of ondansetron use during the initial pediatric ED visit on hospital admission, return to the pediatric ED within 72 hours, and admission on this return visit. For patients who returned within 72 hours and were admitted, hospital discharge records were reviewed. The proportions of alternative diagnoses, defined as a hospital discharge diagnosis that was not a continuation of gastroenteritis or vomiting, were compared between the groups. RESULTS During the 3-year study period (2005 to 2007), 34,117 patients met study criteria. Ondansetron was used for 19,857 (58.2%) of these patients on their initial pediatric ED visit. After controlling for differences between the groups, patients who received ondansetron were admitted on their initial visit less often: odds ratio (OR) 0.47 (95% confidence interval [CI] 0.42 to 0.53). However, those who received ondansetron were more likely to return to the pediatric ED within 72 hours (OR 1.45; 95% CI 1.27 to 1.65) and be admitted on the return visit (OR 1.74; 95% CI 1.39 to 2.19). The proportions of alternative diagnoses at hospital discharge were not significantly different in the group that received ondansetron on the initial pediatric ED visit (14.9%) compared with the group that did not (22.4%) (absolute difference 7.5% [95% CI -0.5% to 16.4%). CONCLUSION Ondansetron use in the pediatric ED reduces hospital admissions for suspected gastroenteritis and vomiting. However, children who receive ondansetron in the pediatric ED appear more likely to return to the pediatric ED and be admitted on this return visit than their counterparts. Furthermore, the use of ondansetron does not appear to be associated with increased risks of masking serious diagnoses in children.
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Affiliation(s)
- Jesse J Sturm
- Department of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
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Sturm JJ, Hirsh DA, Lee EK, Massey R, Weselman B, Simon HK. Practice characteristics that influence nonurgent pediatric emergency department utilization. Acad Pediatr 2010; 10:70-4. [PMID: 20129483 DOI: 10.1016/j.acap.2009.10.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [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: 09/18/2008] [Revised: 10/02/2009] [Accepted: 10/06/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The goal of this study was to determine what characteristics of a primary care pediatric practice are associated with nonurgent use of the pediatric emergency department (PED). METHODS Primary care practice characteristics were prospectively collected from 33 practices. Nonurgent and urgent visits to the PED for patients from these practices were analyzed retrospectively. A discriminant analysis classification model was used to identify practice characteristics that were associated with nonurgent versus urgent utilization of the PED. RESULTS Patients in the network of 33 practices accounted for 31 076 visits to the PED during the 12-month study period, 47% of which were classified as nonurgent. Based on the discriminant analysis classification model, discriminant patterns that predict the frequency of nonurgent utilization included the percentage of patients with Medicaid, total available sick slots to see patients per physician, closer distance to the PED, whether or not the nurse triage line notified all on-call physicians of disposition to the PED, whether it is practice policy to accept all walk-in sick visits, and ability of practice to have same-day turnaround of laboratory tests. CONCLUSIONS Nonurgent utilization of the PED by patients in a specific primary care practice can be predicted based on discriminant practice characteristics, several of which may be modifiable. Use of these predictive rules can be used to optimize pediatric services and policy to help mitigate the high volume of PED nonurgent visitation. Focused interventions on practice characteristics of significance may help reduce PED overcrowding and improve continuity of care.
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Affiliation(s)
- Jesse J Sturm
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA.
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Littleton LT, Fileta BB, Massey R, Wood TI. Kinevac Stability After Reconstitution with Sodium Chloride Injection USP, 0.9%. J Nucl Med Technol 2009; 37:57-9. [DOI: 10.2967/jnmt.108.050732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Paul S, Johnson DR, Massey R. Binding and multiple hydrolytic sites in epitopes recognized by catalytic anti-peptide antibodies. Ciba Found Symp 2007; 159:156-67; discussion 167-73. [PMID: 1720373 DOI: 10.1002/9780470514108.ch11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Autoantibodies purified from humans catalyse the hydrolysis of the neurotransmitter, vasoactive intestinal peptide (VIP). Evidence that the hydrolysis of VIP is due to antibodies includes: the antibody preparations are free of detectable non-immunoglobulin (non-Ig) contamination; the hydrolytic activity is removed by precipitation with anti-human IgG antibody; human B lymphoblastoid cells transformed with Epstein-Barr virus secrete hydrolytic antibodies in culture; the Fab fragments of the antibodies exhibit VIP hydrolysis; and affinity chromatography on immobilized VIP permits purification of specific antibodies with greatly enriched hydrolytic and binding activities. One of the catalytic antibody preparations hydrolyses the Gln-16-Met-17 bond. Studies with synthetic VIP fragments showed that the epitope recognized by this antibody is formed by VIP(15-28). Important binding interactions are contributed by VIP(22-28), a sequence four residues distant from the scissile bond. Antibodies from a second subject hydrolyse six peptide bonds in VIP, clustered between residues 14 and 22. These bonds link amino acids of different charge, size and hydrophobicity, suggesting that the hydrolytic repertoire of the antibodies is considerable. The antibodies do not hydrolyse peptides unrelated in sequence to VIP. Cleavage of several peptide bonds in VIP by polyclonal antibody preparations may be due to several antibodies, each with a unique cleavage specificity. Alternatively, a single antibody may make catalytically productive contact at multiple peptide bonds in the substrate, because of conformational flexibility of VIP or of the antibody active site. Purified light chains from the catalytic antibodies hydrolysed VIP more rapidly than did intact antibodies. The residues constituting the catalytic site of an antibody may be encoded in germline V-region genes or may arise during maturation of the antibody response.
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Affiliation(s)
- S Paul
- Department of Pharmacology, University of Nebraska Medical Center, Omaha, 68198
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25
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Abstract
OBJECTIVES The goals were to (1) define and illustrate an automated method of monitoring the safety of telephone triage, (2) demonstrate that this method approximates reasonably a more-global safety measure, and (3) describe the month-to-month variability of this automated measure for the call center studied. METHODS From October 2005 through March 2006, hospitalizations at a tertiary care pediatric hospital after calls to its call center were matched with their respective call-center dispositions. The host hospital 24-hour underreferral rate was defined as the percentage of total admissions to the study institution within 24 hours after a call to the call center for treatment of the same illness or injury that had been assigned a nonurgent disposition by the call center. A convenience sample of call-center calls was surveyed for admissions to other facilities. This sample was then combined with admissions to the pediatric hospital to estimate a true 24-hour underreferral rate. Underreferrals were subjected to clinical and statistical analyses. RESULTS The host hospital 24-hour underreferral rate was 5.2%. The estimated true 24-hour underreferral rate was 5.95% +/- 2.75%. Diagnoses frequently associated with underreferral were gastroenteritis, croup, asthma, and bronchiolitis. Underreferred patients admitted to the study institution were hospitalized for an average of 1.6 +/- 1.1 days, compared with 2.8 +/- 3.1 days for patients referred by the call center to a higher level of care. The monthly SD of the host hospital 24-hour underreferral rate was 1.56%. CONCLUSIONS For the call center studied, the host hospital 24-hour underreferral rate could be determined easily and objectively and approximated reasonably the true 24-hour underreferral rate. The month-to-month variability of the host hospital 24-hour underreferral rate was sufficiently small to allow for meaningful internal trending analyses.
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Affiliation(s)
- Daniel A Hirsh
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
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26
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Eriksson F, Culp WD, Massey R, Egevad L, Garland D, Persson MAA, Pisa P. Tumor specific phage particles promote tumor regression in a mouse melanoma model. Cancer Immunol Immunother 2007; 56:677-87. [PMID: 16967280 PMCID: PMC11031031 DOI: 10.1007/s00262-006-0227-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [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: 06/04/2006] [Accepted: 08/09/2006] [Indexed: 11/25/2022]
Abstract
Within cancer research, phage display libraries have been widely used for the identification of tumor targeting peptides and antibodies. Additionally, phages are known to be highly immunogenic; therefore we evaluated the immunotherapeutic potential of tumor specific phages to treat established solid tumors in a mouse model of melanoma. We developed two tumor specific phages, one derived from a peptide phage display library and one Fab expressing phage with known specificity, for the treatment of mice bearing palpable B16-F10 or B16/A2K(b) tumors. Therapy in B16-F10 tumor bearing mice with tumor specific phages was superior to treatment with non-tumor specific phages and lead to delayed tumor growth and increased survival. In B16/A2K(b )tumor bearing mice, therapy with tumor specific phages resulted in complete tumor regression and long-term survival in 50% of the mice. Histological analysis of tumors undergoing treatment with tumor specific phages revealed that phage administration induced a massive infiltration of polymorphonuclear neutrophils. Furthermore, phages induced secretion of IL-12 (p70) and IFN-gamma as measured in mouse splenocyte culture supernatants. These results demonstrate a novel, immunotherapeutic cancer treatment showing that tumor specific phages can promote regression of established tumors by recruitment of inflammatory cells and induction of Th1 cytokines.
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Affiliation(s)
- Fredrik Eriksson
- Department of Oncology and Pathology, Immune and Gene Therapy Laboratory, Cancer Centre Karolinska, Karolinska Institute, Stockholm, Sweden.
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Culp WD, Neal R, Massey R, Egevad L, Pisa P, Garland D. Proteomic analysis of tumor establishment and growth in the B16-F10 mouse melanoma model. J Proteome Res 2006; 5:1332-43. [PMID: 16739985 DOI: 10.1021/pr060059q] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The B16-F10 mouse model of melanoma is a widely used model to study many aspects of cancer biology and therapeutics in a solid tumor. Melanomas aggressively progress within a dynamic microenvironment containing in addition to tumor cells, stroma cells and components such as fibroblasts, immune cells, vascular cells, extracellular matrix (ECM) and extracellular molecules. The goal of this study was to elucidate the processes of tumor progression by identifying differentially expressed proteins in the tumor mass during specific stages of tumor growth. A comparative proteome analysis was performed on B16-F10 derived tumors in C57BL/6 mice at days 3, 5, 7, and 10. Statistical approaches were used to determine quantitative differential protein expression at each tumor time stage. Hierarchical clustering of 44 protein spots (p < 0.01) revealed a progressive change in the tumor mass when all 4 time stages were classified together, but there was a clear switch in expression of these proteins between the day 5 and the day 7 tumors. A trend analysis showed 53 protein spots (p < 0.001) following 6 predominant kinetic paths of expression as the tumor progressed. The protein spots were then identified using MALDI-TOF mass spectrometry. Proteins involved in glycolysis, inflammation, wounding, superoxide metabolism, and chemotaxis increased during tumorigenesis. From day 3 to day 7 VEGF and active cathepsin D were induced 7-fold and 4-fold, respectively. Proteins involved in electron transport, protein folding, blood coagulation, and transport decreased during tumorigenesis. This work illustrates changes in the biology of the B16-F10 tumor mass during tumor progression.
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Affiliation(s)
- W David Culp
- Protein Biochemistry Section, National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
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Abstract
Legionella pneumophila endocarditis is extremely rare. The case of a fit 26 year old man who had previously undergone homograft aortic root replacement is reported. He was admitted with legionella pneumonia during the recent localised outbreak but went on to develop endocarditis. His aortic valve was replaced with a mechanical valve and he made an uneventful recovery. Public health issues and diagnosis in susceptible patients during localised outbreaks are discussed.
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Affiliation(s)
- R Massey
- Department of Cardiothoracic Surgery, Royal Brompton Hospital, Sydney Street, London, UK.
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Abstract
AIMS To determine the incidence, severity, and clinical course of whiplash associated disorder (WAD) in children aged 4-16 years involved as passengers in car crashes. METHODS Prospective surveillance of all paediatric attendances to three English urban emergency departments after car crashes over an eight month period. An initial structured telephone interview at day 2 after the car crash was performed. This was followed by clinical review of symptomatic patients on day 5 after the crash using the Quebec Task Force criteria for outcome assessment, with subsequent clinical review at 14, 28, and 56 days or until earlier symptom resolution. RESULTS 105 children were identified as having been involved in car crashes as passengers. Forty nine children (47%) experienced symptoms of a WAD. Twenty nine children developed symptoms within 24 hours with the remainder developing symptoms by 48 hours. Forty children experienced a WAD grade 1 and nine children suffered a WAD grade 2 injury. The mean duration of symptoms was 8.8 days (range 3-70, SD 10.7). WAD grade 2 symptoms lasted significantly longer than WAD grade 1 symptoms. CONCLUSIONS The incidence of WAD in children in this series was higher than in other studies. The clinical course was more favourable than that reported for adults.
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Affiliation(s)
- R Boyd
- Department of Emergency Medicine, Hope Hospital, Salford, UK.
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Kroes R, Müller D, Lambe J, Löwik MRH, van Klaveren J, Kleiner J, Massey R, Mayer S, Urieta I, Verger P, Visconti A. Assessment of intake from the diet. Food Chem Toxicol 2002; 40:327-85. [PMID: 11893401 DOI: 10.1016/s0278-6915(01)00113-2] [Citation(s) in RCA: 249] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Exposure assessment is one of the key parts of the risk assessment process. Only intake of toxicologically significant amounts can lead to adverse health effects even for a relatively toxic substance. In the case of chemicals in foods this is based on three major aspects: (i) how to determine quantitatively the presence of a chemical in individual foods and diets, including its fate during the processes within the food production chain; (ii) how to determine the consumption patterns of the individual foods containing the relevant chemicals; (iii) how to integrate both the likelihood of consumers eating large amounts of the given foods and of the relevant chemical being present in these foods at high levels. The techniques used for the evaluation of these three aspects have been critically reviewed in this paper to determine those areas where the current approaches provide a solid basis for assessments and those areas where improvements are needed or desirable. For those latter areas, options for improvements are being suggested, including, for example, the development of a pan-European food composition database, activities to understand better effects of processing on individual food chemicals, harmonisation of food consumption survey methods with the option of a regular pan-European survey, evaluation of probabilistic models and the development of models to assess exposure to food allergens. In all three areas, the limitations of the approaches currently used lead to uncertainties which can either cause an over- or underestimation of real intakes and thus risks. Given these imprecisions, risk assessors tend to build in additional uncertainty factors to avoid health-relevant underestimates. This is partly done by using screening methods designed to look for "worst case" situations. Such worse case assumptions lead to intake estimates that are higher than reality. These screening methods are used to screen all those chemicals with a safe intake distribution. For chemicals with a potential risk, more information is needed to allow more refined screening or even the most accurate estimation. More information and more refined methods however, require more resources. The ultimate aims are: (1) to obtain appropriate estimations for the presence and quantity of a given chemical in a food and in the diet in general; (2) to assess the consumption patterns for the foods containing these substances, including especially those parts of the population with high consumption and thus potentially high intakes; and (3) to develop and apply tools to predict reliably the likelihood of high end consumption with the presence of high levels of the relevant substances. It has thus been demonstrated that a tiered approach at all three steps can be helpful to optimise the use of the available resources: if relatively crude tools - designed to provide a "worst case" estimate - do not suggest a toxicologically significant exposure (or a relevant deficit of a particular nutrient) it may not be necessary to use more sophisticated tools. These will be needed if initially high intakes are indicated for at least parts of the population. Existing pragmatic approaches are a first crude step to model food chemical intake. It is recommended to extend, refine and validate this approach in the near future. This has to result in a cost-effective exposure assessment system to be used for existing and potential categories of chemicals. This system of knowledge (with information on sensitivities, accuracy, etc.) will guide future data collection.
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Affiliation(s)
- R Kroes
- Utrecht University, Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Yalelaan 2, PO Box 80176, NL-3508 TD, Utrecht, The Netherlands
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31
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Massey R. The "drug war" in Colombia: echoes of Vietnam. J Public Health Policy 2001; 22:280-5. [PMID: 11603310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- R Massey
- Environmental Research Foundation, P.O. Box 5036, Annapolis, Maryland 21403-7036, USA
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32
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Crow YJ, Jackson AP, Roberts E, van Beusekom E, Barth P, Corry P, Ferrie CD, Hamel BCJ, Jayatunga R, Karbani G, Kálmánchey R, Kelemen A, King M, Kumar R, Livingstone J, Massey R, McWilliam R, Meager A, Rittey C, Stephenson JBP, Tolmie JL, Verrips A, Voit T, van Bokhoven H, Brunner HG, Woods CG. Aicardi-Goutières syndrome displays genetic heterogeneity with one locus (AGS1) on chromosome 3p21. Am J Hum Genet 2000; 67:213-21. [PMID: 10827106 PMCID: PMC1287108 DOI: 10.1086/302955] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [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: 01/27/2000] [Accepted: 04/17/2000] [Indexed: 11/03/2022] Open
Abstract
We have studied 23 children from 13 families with a clinical diagnosis of Aicardi-Goutières syndrome. Affected individuals had developed an early-onset progressive encephalopathy that was characterized by a normal head circumference at birth, basal ganglia calcification, negative viral studies, and abnormalities of cerebrospinal fluid comprising either raised white cell counts and/or raised levels of interferon-alpha. By means of genomewide linkage analysis, a maximum-heterogeneity LOD score of 5.28 was reached at marker D3S3563, with alpha=.48, where alpha is the proportion of families showing linkage. Our data suggest the existence of locus heterogeneity in Aicardi-Goutières syndrome and highlight potential difficulties in the differentiation of this condition from pseudo-TORCH (toxoplasmosis, rubella, cytomegalovirus, and herpes simplex virus types 1 and 2) syndrome.
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MESH Headings
- Abnormalities, Multiple/diagnosis
- Abnormalities, Multiple/epidemiology
- Abnormalities, Multiple/genetics
- Abnormalities, Multiple/physiopathology
- Age of Onset
- Brain Damage, Chronic/diagnosis
- Brain Damage, Chronic/epidemiology
- Brain Damage, Chronic/genetics
- Brain Damage, Chronic/physiopathology
- Child
- Child, Preschool
- Chromosome Mapping
- Chromosomes, Human, Pair 3/genetics
- Diagnosis, Differential
- Female
- Genetic Heterogeneity
- Genetic Markers/genetics
- Humans
- Infant
- Infant, Newborn
- Lod Score
- Male
- Models, Genetic
- Pedigree
- Syndrome
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Affiliation(s)
- Y. J. Crow
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - A. P. Jackson
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - E. Roberts
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - E. van Beusekom
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - P. Barth
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - P. Corry
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - C. D. Ferrie
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - B. C. J. Hamel
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - R. Jayatunga
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - G. Karbani
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - R. Kálmánchey
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - A. Kelemen
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - M. King
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - R. Kumar
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - J. Livingstone
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - R. Massey
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - R. McWilliam
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - A. Meager
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - C. Rittey
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - J. B. P. Stephenson
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - J. L. Tolmie
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - A. Verrips
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - T. Voit
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - H. van Bokhoven
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - H. G. Brunner
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
| | - C. G. Woods
- Molecular Medicine Unit and Department of Clinical Genetics, St. James’s University Hospital, University of Leeds, and Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom; Departments of Human Genetics and Child Neurology, University Hospital Nijmegen, Nijmegen, The Netherlands; Department of Paediatrics, University of Amsterdam; Department of Paediatrics, St. Luke’s Hospital, Bradford, United Kingdom; Department of Paediatrics, Sandwell Hospital, West Bromwich, United Kingdom; Department of Paediatrics, Semmelweis Medical University, Budapest; Department of Paediatric Neurology, Children's Hospital, Dublin; Clinical Genetics Unit and Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, United Kingdom; Department of Paediatrics, Hull Royal Infirmary, Hull, United Kingdom; Departments of Paediatric Neurology and Clinical Genetics, Yorkhill Hospital, Glasgow; National Institute for Biological Standards and Control, South Mimms, United Kingdom; and Department of Paediatrics, University of Essen, Essen, Germany
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MacDonald S, Wilson P, Barnes K, Damant A, Massey R, Mortby E, Shepherd MJ. Ochratoxin A in dried vine fruit: method development and survey. Food Addit Contam 1999; 16:253-60. [PMID: 10560578 DOI: 10.1080/026520399284019] [Citation(s) in RCA: 148] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A method is described for the determination of concentrations of the mycotoxin ochratoxin A in dried vine fruits (currants, raisins and sultanas) using acidic methanolic extraction, immunoaffinity chromatography clean-up and HPLC determination. The limit of detection was estimated as 0.2 microgram/kg, and recoveries of 63-77% were achieved at 5 micrograms/kg. HPLC-mass spectrometric confirmation of the identity of ochratoxin was obtained. Ochratoxin A and aflatoxins were determined in 60 samples of retail dried vine fruits purchased in the United Kingdom. Ochratoxin A was found in excess of 0.2 microgram/kg in 19 of 20 currant, 17 of 20 sultana and 17 of 20 raisin samples examined, an overall incidence of 88%. The maximum level found was 53.6 micrograms/kg. No aflatoxin was found in any sample analysed, using a method with a detection limit of 0.2 microgram/kg for each of aflatoxin B1, B2, G1 and G2.
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Affiliation(s)
- S MacDonald
- CSL Food Science Laboratory, Norwich Research Park, UK
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Abstract
Sertoli-Leydig cell tumors (SLCT) are sex cord-stromal tumors which exhibit testicular differentiation.1 They account for less than 0.2% of ovarian neoplasms in total but comprise 4% of ovarian tumors in females under 20 yrs of age.2 The morphological appearance of these tumors varies more widely than that of any other ovarian tumor except for the teratomas. Histologically they are now classified into 5 categories: well-differentiated, intermediately differentiated, poorly differentiated, heterologous and retiform.1 We describe the case of an ovarian Sertoli-Leydig cell tumor with retiform pattern in a 7 yr old girl.
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Affiliation(s)
- K Moyles
- Histopathology Laboratory and Paediatric Surgery, Auckland, New Zealand
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Frizelle FA, Massey R, Pettigrew RA. Metastatic basal cell carcinoma. Case report. Eur J Surg 1995; 161:369-72. [PMID: 7662784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- F A Frizelle
- Department of Surgery, Dunedin Hospital, New Zealand
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Abstract
To investigate the possible presence of protein-bound mutagens in food an analytical procedure has been devised in which the sample is enzymically hydrolysed, fractionated by HPLC and examined by a modified liquid incubation Ames assay. To validate the method MeIQx was added, as a model compound, to beefburger and a recovery of 82% obtained. The limit of detection for protein-bound mutagens was 1 microgram/kg, expressed as equivalents of MeIQx. No detectable mutagenicity was observed when the procedure was applied to samples of well cooked beefburger, irradiated chicken or mycoprotein.
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Affiliation(s)
- F I Ibe
- BIBRA Toxicology International, Carshalton, Surrey, UK
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Affiliation(s)
- S Paul
- University of Nebraska Medical Center, Omaha 68198
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Abstract
Describes the results of a project carried out at Derby City General Hospital to introduce new pay and grading arrangements for nurses and midwives, consistent with their locally developed reward strategy. Identifies the factors critical to the success of the project, and also considers the project in the context of research carried out by the Hay Group in to the characteristics of high performing health-care organizations.
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Abstract
Examines the growing use of "work transformation" or process re-engineering techniques in health-care organizations. Identifies how pressures on funding and increased expectations are forcing health-care organizations to adopt radical solutions in their search for lower costs and improved quality of care. Also examines the experience of a number of organizations, and highlights some of the risks involved in taking these approaches.
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Affiliation(s)
- K Vestal
- Hay Management Consultants, Dallas, TX
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40
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Archbald LF, Tran T, Massey R, Klapstein E. Conception rates in dairy cows after timed-insemination and simultaneous treatment with gonadotrophin releasing hormone and/or prostaglandin F2 alpha. Theriogenology 1992; 37:723-31. [PMID: 16727073 DOI: 10.1016/0093-691x(92)90151-g] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/1991] [Accepted: 11/15/1991] [Indexed: 11/25/2022]
Abstract
This study was designed to determine conception rates in dairy cows after timed-insemination and simultaneous treatment with gonadotrophin releasing hormone (GnRH) and/or prostaglandin F2 alpha (PGF2alpha). A total of 2352 cows was randomly assigned to six groups. Cows in Groups 1 to 5 were palpated per rectum to determine the presence of a corpus luteum (CL) on the ovary, and blood samples were obtained for the determination of plasma progesterone (P4) concentrations. Cows with a CL and P4 concentrations >1 ng/ml were treated (Day 0) with PGF2alpha (25 mg, i.m.) and were observed for estrus. Cows in estrus prior to 72 hours after treatment (Group 5, n = 106) were bred, but were not treated. Cows not observed in estrus by 72 hours were divided into four remaining groups, were bred between 72 and 80 hours and were assigned as follows: Cows in Group 1 (n = 203) were not treated; Cows in Group 2 (n = 200) were treated with GnRH (100 ug, i.m.); Cows in Group 3 (n = 201) were treated with PGF2alpha (25 mg, i.m.); and cows in Group 4 (n = 202) were treated with both GnRH and PGF2alpha. Cows in Group 6 (n = 1440) were not treated with PGF2alpha on Day 0 and were estrual cows that were bred on days when cows in Groups 1 to 5 were time-inseminated. The percentage of cows in all groups pregnant at 45 to 50 days after one insemination was compared using analysis of variance (P<0.05). The conception rate of cows in Group 2 was significantly higher than that of cows in Groups 1 to 4. There was a significant group-by-season interaction. Cows treated with GnRH during the spring had a higher conception rate than at other times of the year. Conception rates of cows in Groups 1 to 4 that were inseminated during the summer were low and not significantly different from each other. Conception rates of cows in Groups 5 and 6 inseminated during the summer were not significantly different from each other, but were significantly higher than that of cows in Groups 1 to 4 that were inseminated during the summer.
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Affiliation(s)
- L F Archbald
- Large Animal Clinical Sciences College of Veterinary Medicine University of Florida, Gainesville FL 32610 USA
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Ibe FI, Grinter R, Massey R, Homer R. Detection of o-tyrosine in irradiated chicken by reverse-phase HPLC and fluorescence detection. Food Addit Contam 1991; 8:787-92. [PMID: 1812025 DOI: 10.1080/02652039109374037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A method for the measurement of o-tyrosine in irradiated chicken has been developed. The procedure involves the solvent extraction and removal of free o-tyrosine, which is present in unirradiated tissue, followed by acid hydrolysis of bound o-tyrosine in the proteinaceous residue and measurement of the cleaved residues by HPLC with fluorescence detection. Bound o-tyrosine was not detected above 0.01 mg/kg in unirradiated tissue but was observed, in increasing amounts of up to 5.18 mg/kg, when the tissue was irradiated at doses of between 2.5 and 20 kGy. The precision of the analysis was assessed by duplicate determinations, the agreement between duplicates and their respective means averaged 1.7% as defined by the term [(a-b)/(a+b)] x 100% where a and b are the repeat determination values.
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Affiliation(s)
- F I Ibe
- School of Chemical Sciences, University of East Anglia, Norwich, UK
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43
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Kenten JH, Casadei J, Link J, Lupold S, Willey J, Powell M, Rees A, Massey R. Rapid electrochemiluminescence assays of polymerase chain reaction products. Clin Chem 1991; 37:1626-32. [PMID: 1654234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We demonstrate the first use of an electrochemiluminescent (ECL) label, [4-(N-succimidyloxycarbonylpropyl)-4'-methyl-2,2'- bipyridine]ruthenium(II) dihexafluorophosphate (Origen label; IGEN Inc.), in DNA probe assays. This label allows rapid (less than 25 min) quantification and detection of polymerase chain reaction (PCR)-amplified products from oncogenes, viruses, and cloned genes. For the PCR, we used labeled oligonucleotide primers complementary to human papiloma virus and the Ha-ras oncogene. These samples were followed by ECL analysis or hybridization with specific, Origen-labeled oligonucleotide probes. These studies demonstrate the speed, specificity, and effectiveness of the new ECL labels, compared with 32P, for nucleic acid probe applications. We describe formats involving conventional methodologies and a new format that requires no wash step, allowing simple and rapid sample analysis. These rapid assays also reduce PCR contamination, by requiring less sample handling. Improvements in ECL detectability are currently under investigation for use in DNA probe assays without amplification.
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Affiliation(s)
- J H Kenten
- Department of Molecular Biology, IGEN Inc., Rockville, MD 20852
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Kenten JH, Casadei J, Link J, Lupold S, Willey J, Powell M, Rees A, Massey R. Rapid electrochemiluminescence assays of polymerase chain reaction products. Clin Chem 1991. [DOI: 10.1093/clinchem/37.9.1626] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
We demonstrate the first use of an electrochemiluminescent (ECL) label, [4-(N-succimidyloxycarbonylpropyl)-4'-methyl-2,2'- bipyridine]ruthenium(II) dihexafluorophosphate (Origen label; IGEN Inc.), in DNA probe assays. This label allows rapid (less than 25 min) quantification and detection of polymerase chain reaction (PCR)-amplified products from oncogenes, viruses, and cloned genes. For the PCR, we used labeled oligonucleotide primers complementary to human papiloma virus and the Ha-ras oncogene. These samples were followed by ECL analysis or hybridization with specific, Origen-labeled oligonucleotide probes. These studies demonstrate the speed, specificity, and effectiveness of the new ECL labels, compared with 32P, for nucleic acid probe applications. We describe formats involving conventional methodologies and a new format that requires no wash step, allowing simple and rapid sample analysis. These rapid assays also reduce PCR contamination, by requiring less sample handling. Improvements in ECL detectability are currently under investigation for use in DNA probe assays without amplification.
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Affiliation(s)
- J H Kenten
- Department of Molecular Biology, IGEN Inc., Rockville, MD 20852
| | - J Casadei
- Department of Molecular Biology, IGEN Inc., Rockville, MD 20852
| | - J Link
- Department of Molecular Biology, IGEN Inc., Rockville, MD 20852
| | - S Lupold
- Department of Molecular Biology, IGEN Inc., Rockville, MD 20852
| | - J Willey
- Department of Molecular Biology, IGEN Inc., Rockville, MD 20852
| | - M Powell
- Department of Molecular Biology, IGEN Inc., Rockville, MD 20852
| | - A Rees
- Department of Molecular Biology, IGEN Inc., Rockville, MD 20852
| | - R Massey
- Department of Molecular Biology, IGEN Inc., Rockville, MD 20852
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45
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Fairweather-Tait SJ, Fox TE, Wharf SG, Eagles J, Crews HM, Massey R. Apparent zinc absorption by rats from foods labelled intrinsically and extrinsically with 67Zn. Br J Nutr 1991; 66:65-71. [PMID: 1931907 DOI: 10.1079/bjn19910010] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A variety of foods (peas (Pisum sativum), chicken meat, eggs, goat's milk, human milk) enriched with the stable isotope 67Zn were prepared by means of intrinsic- and extrinsic-labelling procedures. They were fed to rats and apparent absorption of 67Zn determined from faecal excretion measurements using thermal ionization mass spectrometry. There were significant differences in the absorption of the extrinsic and intrinsic label which differed in magnitude between the foods tested. The extrinsic 67Zn was less well absorbed in peas, chicken meat, eggs, and human milk than intrinsic 67Zn, but in goat's milk the extrinsic 67Zn was better absorbed than the intrinsic label. These results demonstrate that extrinsically-added stable Zn isotopes do not fully exchange with endogenous Zn in many foods, and illustrate the need for caution when using extrinsic labels for Zn bioavailability studies.
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46
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Abstract
Four human RAS-like cDNAs and a mouse genomic DNA fragment were used to define novel mouse Ras-like genes and gene families. Inheritance of DNA restriction fragment length variants associated with these genes in recombinant inbred and backcross mice allowed definition of 12 genetic loci, nine of which were mapped, to chromosomes (Chr) 2, 4, 7, 8, 9, and 17. Two possible clusters of Ras-like and/or G protein genes were identified, on Chrs 9 and 17.
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Affiliation(s)
- G Drivas
- Department of Biochemistry, New York University Medical Center, New York 10016
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Abstract
Massive pulmonary embolus resulting in cardiac arrest and doubtful cerebral status may result in indecision as to whether to proceed to pulmonary embolectomy, especially if there is continuing cardiorespiratory instability. A case is reported on the use of fibrinolysis and cardiopulmonary bypass, allowing for the cerebral status of the patient to become more clearly defined while maintaining cardiopulmonary stability and attempting to treat the underlying pathological process.
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Affiliation(s)
- F A Frizelle
- General Surgery Department, Dunedin Hospital, New Zealand
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Massey R, Dennis MJ, Pointer M, Key PE. An investigation of the levels of N-nitrosodimethylamine, apparent total N-nitroso compounds and nitrate in beer. Food Addit Contam 1990; 7:605-15. [PMID: 2253805 DOI: 10.1080/02652039009373926] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Over 170 retail samples of beer have been analysed for N-nitrosodimethylamine (NDMA), apparent total N-nitroso compounds (ATNC) and nitrate. Levels of NDMA ranged from below 0.1 up to 1.2 micrograms/kg with a mean of 0.2 micrograms/kg. ATNC was detected in 42% of the samples in concentrations of up to 569 micrograms (N-NO)/kg. The levels of nitrate ranged from less than 0.2 up to 143 mg/kg with a mean of 16.8 mg/kg. There was no correlation between the amounts of NDMA and ATNC found in the retail beers. Samples taken during the course of fermentation showed that NDMA was unaffected by the bacterial reduction of nitrate which causes ATNC formation. HPLC studies using a photolysis/chemiluminescence detector revealed that the ATNC in beer are highly polar species of as yet unknown identity.
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Affiliation(s)
- R Massey
- Ministry of Agriculture, Fisheries and Food, Food Safety Directorate, Norwich, UK
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49
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Abstract
The levels of trait anxiety and trait anger were compared for adult clients in residential treatment with primary diagnoses of alcoholism, cannabis dependence, cocaine abuse and opioid dependence. With a sample of 809 clients results suggested each of these groups to have significantly elevated anxiety and anger scores, compared to non-client samples. However, there were no significant differences on either anxiety or anger scores based on drug of choice.
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50
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Massey R. Handbook of Neurological Investigations in Children. Journal of Neurology, Neurosurgery & Psychiatry 1990. [DOI: 10.1136/jnnp.53.2.183-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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