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Lewis D, Marya S, Carrasco R, Sabou S, Leach J. Comparative Outcome Data Using Different Techniques for Posterior Lumbar Fusion: A Large Single-Center Study. Asian Spine J 2023; 17:807-817. [PMID: 37788973 PMCID: PMC10622816 DOI: 10.31616/asj.2022.0448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/06/2023] [Accepted: 04/03/2023] [Indexed: 10/05/2023] Open
Abstract
STUDY DESIGN Retrospective single-center study. PURPOSE This study aims to evaluate perioperative and intermediate-term clinical outcomes of patients undergoing different lumbar fusion techniques. OVERVIEW OF LITERATURE Various open and minimally invasive techniques for lumbar fusion are available, but previous studies comparing lumbar fusion techniques have heterogeneous data, making interpretation challenging. METHODS Between 2011 and 2018, data from 447 consecutive patients undergoing one/two-level lumbar fusion were analyzed. Posterior lumbar interbody fusion (PLIF) with bilateral muscle strip or Wiltse approach, open transforaminal lumbar interbody fusion (TLIF) and minimally invasive TLIF, and posterolateral fusion only were among the surgical techniques used. Core outcomes measure index (COMI) questionnaires were distributed before surgery and at 3 months, 1 year, and 2 years postoperatively to establish patient selfreported outcome measures. Demographic data (age, gender, and body mass index [BMI]) for each patient were also collected in addition to surgical indication, previous operative history, perioperative outcomes, and complications, and whether later revision surgery was required. Pearson's chi-square test, Kruskal-Wallis test, repeated measure mixed-effects models, and ordinal logistic regression were used for statistical analysis. RESULTS Postoperative COMI scores improved across all procedures compared with pre-surgery (p<0.001). There was no significant difference between different postoperative COMI scores. Significant predictors of higher postoperative COMI score included higher pretreatment COMI score (p≤0.001), previous surgery (p≤0.04), younger age (p≤0.05), higher BMI (p≤0.005), and the indications of lytic spondylolisthesis (p=0.02) and degenerative disc disease (p<0.001). Patients undergoing minimally invasive TLIF had a significantly shorter post-surgery stay than patients undergoing open PLIF (Kruskal-Wallis test, p=0.03). CONCLUSIONS At 2 years postoperatively, there was no significant difference in clinical outcomes between open and minimally invasive techniques. These findings suggest that the main determinant of surgical approach should be surgeon preference and training.
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Affiliation(s)
- Daniel Lewis
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester,
UK
- Geoffrey Jefferson Brain Research Centre, University of Manchester, Manchester,
UK
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester,
UK
| | - Shivan Marya
- Department of Spinal Surgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Trust, Manchester Academic Health Science Centre, Manchester,
UK
| | - Roberto Carrasco
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester,
UK
| | - Silviu Sabou
- Department of Spinal Surgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Trust, Manchester Academic Health Science Centre, Manchester,
UK
| | - John Leach
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester,
UK
- Geoffrey Jefferson Brain Research Centre, University of Manchester, Manchester,
UK
- Department of Spinal Surgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Trust, Manchester Academic Health Science Centre, Manchester,
UK
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Targarona J, Rivero L, Coayla G, Roman G, Rivas D, Legua S, Carrasco R. [Survival of patients with pancreatic ductal adenocarcinoma]. Rev Gastroenterol Peru 2023; 43:300-308. [PMID: 38228295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
OBJECTIVE The objective of this study is to analyze the epidemiological presentation and survival of patients with pancreatic ductal adenocarcinoma according to their clinical stage and the type of intervention performed, in a cohort of patients treated at a clinic in Lima, Peru. MATERIALS AND METHODS A retrospective cohort study evaluated patients diagnosed with pancreatic ductal adenocarcinoma from January 2015 to February 2021, considering various epidemiological factors, radiological findings, oncological staging, receipt of neoadjuvant or adjuvant chemotherapy, undergoing surgery, and post-intervention survival. RESULTS Out of the 249 patients analyzed, 75 of them required resective surgery. Among the main findings, it was observed that those with a CA 19-9 level below 200 U/mL had a higher median survival compared to those with a CA 19-9 level above 200 U/mL (HR: 1.96; 95% CI: 0.18-0.53; p≤0.001). Furthermore, when comparing patients according to their stage, those with resectable tumors had a median survival of 37.72 months, while those with locally advanced tumors had a median survival of 13.47 months, and those with metastatic tumors had a median survival of 7.69 months (HR: 0.87; 95% CI: 0.31-0.25; p≤0.001). Additionally, receiving neoadjuvant treatment was associated with a better prognosis of survival for patients (HR: 0.32; 95% CI: 0.19-0.53; p≤0.001). Furthermore, 5 pancreatectomies with metastatic resection were performed in oligometastatic patients treated with salvage chemotherapy, and the median survival for these patients was 22.51 months. CONCLUSION Resective surgery at an early clinical stage, CA 19-9 levels below 200 U/mL, and receiving neoadjuvant chemotherapy are statistically correlated with a higher overall survival.
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Affiliation(s)
| | - Luis Rivero
- Cirugía General y Digestiva, Clínica Delgado AUNA. Lima, Perú; Cirugía General y Digestiva, Hospital Nacional Edgardo Rebagliati Martins, EsSalud. Lima, Perú
| | - Guillermo Coayla
- Cirugía General y Digestiva, Clínica Delgado AUNA. Lima, Perú; Cirugía General y Digestiva, Hospital Nacional Edgardo Rebagliati Martins, EsSalud. Lima, Perú
| | - Gilbert Roman
- Cirugía General y Digestiva, Clínica Delgado AUNA. Lima, Perú; Cirugía General y Digestiva, Hospital Nacional Edgardo Rebagliati Martins, EsSalud. Lima, Perú
| | - Diego Rivas
- Cirugía General y Digestiva, Clínica Delgado AUNA. Lima, Perú
| | - Sebastián Legua
- Cirugía General y Digestiva, Hospital Nacional Edgardo Rebagliati Martins, EsSalud. Lima, Perú
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Carrasco R, Lapayese F, de la Peña A, Medrano M, Mota F, Soleto A, Pereira A, Pastor C, Rodríguez C, Rincón E, Cabrera S, Fernández A, Ramos F, Queral V, Letellier L, Guern FL, Piqueras J. Tests on the prototype of the Optical Hinge for the Wide Angle Viewing System to ITER gamma radiation conditions. Fusion Engineering and Design 2023. [DOI: 10.1016/j.fusengdes.2023.113680] [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: 03/29/2023]
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4
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Pereira A, Medrano M, Leon-Gutierrez E, Pastor C, Mota F, Vila R, Rodriguez C, Carrasco R, Lapayese F, de la Peña A, Soleto A, Rincón E, Cabrera S, Queral V, Fernández A, López-Heredero R, Torquemada C, Rodrigo T, Gómez L, Belenguer T, Vermeeren L, Leysen W, Piqueras J, Le-Guern F, Alén-Cordero C. Radiation effects in optical coatings for ITER diagnostics. Fusion Engineering and Design 2023. [DOI: 10.1016/j.fusengdes.2023.113438] [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: 01/15/2023]
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5
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Mengual L, Ingelmo-Torres M, Roldán F, Carrasco R, Ajami T, Padullés B, Sureda J, Matheu R, Mas J, Ribal M, Izquierdo L, Alcaraz A. Bladder EpiCheck methylation test predicts short- and long-term HG events in bladder cancer patients treated with bacillus Calmette-Guérin. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00468-2] [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: 02/12/2023]
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6
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Mohammed R, Carrasco R, Verma R, Siddique I, Mohammad S, Elmalky M. Does Instrumentation of the Fractured Level in Thoracolumbar Fixation Affect the Functional and Radiological Outcome? Global Spine J 2023; 13:53-59. [PMID: 33530726 PMCID: PMC9837517 DOI: 10.1177/2192568221991106] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN Retrospective comparative study. OBJECTIVES To compare radiological and functional outcomes of patients with fixation constructs utilizing pedicle screw stabilization at the fracture level (FL group) versus patients with non-fracture level (NFL group) fixation in single level fractures of the thoracolumbar junction (T11-L1). METHODS 53 patients of whom fracture level screw was used in 34 (FL group) were compared to 19 patients in NFL group. Radiological parameters analyzed were sagittal index, bi-segmental kyphosis (Cobb) angle and degree of vertebral height restoration. Prospectively collected patient reported functional outcomes and post-operative complications were also studied. Stepwise regression analysis adjusted by age, gender and functional scores was performed to account for the small numbers and unequal sizes of the groups. RESULTS Back pain score was significantly lower in the FL group (P < 0.025). Core Outcome Measures Index scores and leg pain scores, though low in the FL group, were not statistically significant. The regression analysis showed that the inclusion of the fracture-level screw was independently associated with a greater change in sagittal index and vertebral height restoration post-operatively. Sagittal index was maintained through to final follow up as well. The bi-segmental Cobb's angle correction was not associated with fracture-level screw construct. There was no significant difference between the groups for revision surgery, deep infection, implant failure or length of hospital stay. CONCLUSION The inclusion of the fracture-level pedicle screws in the fixation construct significantly improves the immediate and final measured radiological parameters, with improved functional scores in single level unstable vertebral fractures of the thoracolumbar junction.
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Affiliation(s)
- Riaz Mohammed
- Salford Royal NHS Foundation Trust,
Salford, United Kingdom,Riaz Mohammed, Department of Complex Spine
Surgery, Salford Royal Hospital, Manchester M6 8HD, United Kingdom.
| | - Roberto Carrasco
- Division of Population Health, Health
Sciences Research and Primary Care, University of Manchester, Manchester, United
Kingdom
| | - Rajat Verma
- Salford Royal NHS Foundation Trust,
Salford, United Kingdom
| | - Irfan Siddique
- Salford Royal NHS Foundation Trust,
Salford, United Kingdom
| | - Saeed Mohammad
- Salford Royal NHS Foundation Trust,
Salford, United Kingdom
| | - Mahmoud Elmalky
- Salford Royal NHS Foundation Trust,
Salford, United Kingdom,Faculty of Medicine, Menoufia
University, Egypt
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Arivalagan P, Delgado D, Carrasco R, Nugaeva N, Fahim F. EARLY DETECTION OF POLYNEUROPATHY IN PATIENTS WITH HEREDITARY TRANSTHYRETIN AMYLOIDOSIS CARDIOMYOPATHY. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.109] [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: 11/02/2022] Open
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8
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Carrasco R, Sooriyakanthan M, Arivalagan P, Nugaeva N, Fahim F, Thavendiranathan P, Delgado D. EFFECT OF TAFAMIDIS ON GLOBAL LONGITUDINAL STRAIN USING A CORRECTION METHOD IN TRANSTHYRETIN CARDIAC AMYLOIDOSIS. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.041] [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: 11/02/2022] Open
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9
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Pascual JM, Carrasco R, Barrios L, Prieto R. Duct-like Recess in the Infundibular Portion of Third Ventricle Craniopharyngiomas: An MRI Sign Identifying the Papillary Type. AJNR Am J Neuroradiol 2022; 43:1333-1340. [PMID: 35953277 PMCID: PMC9451635 DOI: 10.3174/ajnr.a7602] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/20/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Papillary craniopharyngiomas (PCPs) are particularly challenging lesions requiring accurate diagnosis to plan the best therapy. Our aim was to define a narrow duct-like recess identified on MR imaging at the base of papillary craniopharyngiomas with a strict third ventricle location. MATERIALS AND METHODS A duct-like recess at the infundibular portion of craniopharyngiomas was observed on conventional T1WI and T2WI in 3 strict third ventricle papillary craniopharyngiomas in our craniopharyngioma series (n = 125). We systematically investigated this finding on the MR imaging of 2582 craniopharyngiomas and 10 other categories of third ventricle tumors (n = 690) published in the modern era (1986-2020). The diagnostic value and significance of this finding are addressed. RESULTS The duct-like recess was recognized in 52 papillary craniopharyngiomas, including 3 of our own cases, as a narrow canal-shaped cavity invaginated at the tumor undersurface, just behind the optic chiasm. This structure largely involves papillary craniopharyngiomas with a strict third ventricle topography (96%), follows the same diagonal trajectory as the pituitary stalk, and finishes at a closed end. The duct-like recess sign identifies the papillary craniopharyngioma type with a specificity of 100% and a sensitivity of 38% in the overall craniopharyngioma population. This finding can also establish the strictly intra-third ventricle location of the lesion with a 90% specificity and 33% sensitivity. These recesses appear as hypointense circular spots on axial/coronal T1WI and T2WI. Their content apparently corresponds to CSF freely flowing within the suprasellar cistern. CONCLUSIONS The presence of a duct-like recess at the infundibular portion of a third ventricle tumor represents a distinctive hallmark of papillary craniopharyngiomas that can be used as a simple MR imaging sign to reliably diagnose these lesions.
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Affiliation(s)
- J M Pascual
- From the Department of Neurosurgery (J.M.P), La Princesa University Hospital, Madrid, Spain
| | - R Carrasco
- Department of Neurosurgery (R.C.), Ramón y Cajal University Hospital, Madrid, Spain
| | - L Barrios
- Statistics Department (L.B.), Computing Center, Spanish National Research Council, Madrid, Spain
| | - R Prieto
- Department of Neurosurgery (R.P.), Puerta de Hierro University Hospital, Madrid, Spain
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10
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Noguerales C, Álvarez A, Ascasibar E, Carrasco R, Liniers M, Medrano M, Rodríguez-Rodrigo L, Vico A. RADIOPROTECTION SURVEILLANCE OF THE TJ-II OPERATION BY TLD. Radiat Prot Dosimetry 2022; 198:843-852. [PMID: 35780317 DOI: 10.1093/rpd/ncac148] [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] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 05/05/2022] [Accepted: 05/30/2022] [Indexed: 06/15/2023]
Abstract
The TJ-II stellarator presently in operation at the National Laboratory of Fusion is subject to radiological surveillance in compliance with the Spanish Nuclear Regulation. During its pulsed operation hard X-rays are emitted by the runaway electrons, and soft X-rays are generated by bremsstrahlung of thermalized electrons. Inside the experimental hall, the plasma heating systems and some active diagnostics are additional sources of radiation. Outside the experimental hall, some auxiliary systems, such as high-voltage power supplies, must be checked for radiological influence. In order to verify the adequate radiological classification of the different working areas, 15 dosemeters are distributed in radiologically controlled areas close to the machine, as well as in areas of public use in the TJ-II building. The integrated dose equivalent is analyzed to help establish the range of radiological influence of the stellarator. The results of the period 2015-20 are presented and analyzed.
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Affiliation(s)
- C Noguerales
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, CIEMAT, Madrid, Spain
| | - A Álvarez
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, CIEMAT, Madrid, Spain
| | - E Ascasibar
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, CIEMAT, Madrid, Spain
| | - R Carrasco
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, CIEMAT, Madrid, Spain
| | - M Liniers
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, CIEMAT, Madrid, Spain
| | - M Medrano
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, CIEMAT, Madrid, Spain
| | - L Rodríguez-Rodrigo
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, CIEMAT, Madrid, Spain
| | - A Vico
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, CIEMAT, Madrid, Spain
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Lopez CC, Berg A, Clayton B, Siddique I, Carrasco R, Horner D, Angus M. 787 Evaluation of the role of anal tone and perianal sensation examination in the assessment of suspected cauda equina syndrome. Emerg Med J 2022. [DOI: 10.1136/emermed-2022-rcem.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Aims/Objectives/BackgroundCauda equina syndrome (CES) can present with a varied constellation of clinical signs and symptoms, which together with the time sensitive nature of the condition and risk of catastrophic clinical outcome, presents a significant challenge to those assessing patients with this suspected diagnosis. Anal tone is commonly tested during initial assessment using a digital rectal examination (DRE). This study aims to evaluate the diagnostic value of anal tone and perianal sensation assessment in patients with suspected CES and report modern prevalence data on CES within a neurosciences centre.Methods/DesignConsecutive patients with suspected CES presenting over a three-year period to the Emergency Department (ED) of a busy tertiary centre were included in the study. History and examination findings, documented in the ED notes, were assessed and these variables were correlated with the presence or absence of cauda equina compression on subsequent magnetic resonance imaging (MRI).Results/ConclusionsOut of 1005 patients with suspected CES, 117 (11.6%) had MRI confirmed cauda equina compression (MRI +ve CES). 35% of MRI +ve patients and 31% of MRI -ve patients had reduced anal tone. Using univariate and multivariable logistic regression analyses, no associations were found between abnormal anal tone and MRI +ve CES for patients of all ages. The univariate logistic regression analysis identified altered perianal sensation to be significantly associated with MRI +ve CES in patients ≤ 42 years old. This association was no longer present when an adjusted multivariable logistic regression was performed.The prevalence of MRI +ve CES was 11.6%. Our findings suggest that the clinical finding of reduced anal tone has no demonstrable diagnostic value for those with suspected CES, either in itself or in combination with other clinical findings. Further studies are needed to confirm the diagnostic efficacy of assessing perianal sensation in this context.
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12
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Mengual L, Ingelmo-Torres M, Carrasco R, Roldan F, Garcia M, Alcaraz A, Izquierdo L, Ribal M. Utility of bladder EpiCheck methylation test for the surveillance of bladder cancer patients treated with bacillus Calmette-Guérin. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00165-8] [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: 11/04/2022]
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13
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Yoza M, Carrasco R, Li B, Bustios C, Contardo C, Palacios F, Miyagui J, Niebuhr J, Canales O, Monge V. [Characteristics of Helicobacter pylori infection in a private hospital in Lima, 2019 experience and literature review]. Rev Gastroenterol Peru 2022; 42:7-12. [PMID: 35896067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Digestive diseases are the fourth leading cause of outpatient care in Peruvian healthcare centers, with gastritis and peptic ulcers being the most common. This is a retrospective, cross-sectional, descriptive study of secondary analysis of medical record data to evaluate the prevalence of Helicobacter pylori in patients undergoing upper digestive endoscopy during 2019 at Clinica Delgado, Lima, Peru. An association between males (PRa 1.27, 95% CI 1.10-1.48, p<0.001), age categories and upper digestive endoscopy (PRa 2.53, 95% CI 2.16-2.97, p<0.001) was reported. Based on these findings, it is recommended that other causes of gastritis be identified, especially in young women with deep chronic gastritis. Furthermore, we present a review of the scientific literature of Peru on factors associated with the positivity of Helicobacter pylori in the results of superior digestive endoscopy.
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Curtis Lopez C, Berg AJ, Clayton B, Siddique I, Carrasco R, Horner D, Angus M. Evaluation of the role of anal tone and perianal sensation examination in the assessment of suspected cauda equina syndrome. Br J Neurosurg 2021:1-5. [PMID: 34796788 DOI: 10.1080/02688697.2021.2005775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/25/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Cauda equina syndrome (CES) can present with a varied constellation of clinical signs and symptoms, which together with the time-sensitive nature of the condition and risk of catastrophic clinical outcome, presents a significant challenge to those assessing patients with this suspected diagnosis. Anal tone is commonly tested during initial assessment using a digital rectal examination (DRE). This study aims to evaluate the diagnostic value of anal tone and perianal sensation assessment in patients with suspected CES and report modern prevalence data on CES within a neurosciences centre. MATERIALS AND METHODS Consecutive patients with suspected CES presenting over three years to the Emergency Department (ED) of a busy tertiary centre were included in the study. History and examination findings, documented in the ED notes, were assessed and these variables were correlated with the presence or absence of cauda equina compression on subsequent magnetic resonance imaging (MRI). RESULTS Out of 1005 patients with suspected CES, 117 (11.6%) had MRI confirmed cauda equina compression (MRI + ve CES). 35% of MRI + ve patients and 31% of MRI -ve patients had reduced anal tone. Using univariate and multivariable logistic regression analyses, no associations were found between abnormal anal tone and MRI + ve CES for patients of all ages. The univariate logistic regression analysis identified altered perianal sensation to be significantly associated with MRI + ve CES in patients ≤42 years old. This association was no longer present when an adjusted multivariable logistic regression was performed. CONCLUSION The prevalence of MRI + ve CES was 11.6%. Our findings suggest that the clinical finding of reduced anal tone has no demonstrable diagnostic value for those with suspected CES, either in itself or in combination with other clinical findings. Further studies are needed to confirm the diagnostic efficacy of assessing perianal sensation in this context.
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Affiliation(s)
- Carlos Curtis Lopez
- University of Manchester, Manchester, England
- Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Bethan Clayton
- University of Manchester, Manchester, England
- Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Roberto Carrasco
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Daniel Horner
- Division of Population Health, Health Services Research & Primary Care, School of Biological Sciences, The University of Manchester, Manchester, UK
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Angus M, Curtis-Lopez CM, Carrasco R, Currie V, Siddique I, Horner DE. Determination of potential risk characteristics for cauda equina compression in emergency department patients presenting with atraumatic back pain: a 4-year retrospective cohort analysis within a tertiary referral neurosciences centre. Emerg Med J 2021; 39:emermed-2020-210540. [PMID: 34642235 DOI: 10.1136/emermed-2020-210540] [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: 08/17/2020] [Accepted: 10/02/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Atraumatic back pain is an increasingly common presentation to the ED. A minority of these cases will have significant structural pathology, resulting in acute cauda equina compression (CEC). Although clinicians often look for 'red flags' to identify potential CEC, the prognostic accuracy of these presenting symptoms and clinical examination findings is unclear. We sought to evaluate the accuracy of individual clinical features in a large cohort of ED patients with atraumatic backpain and reference standard imaging, for the diagnosis of CEC. METHODS A retrospective case note review from 2014 to 2018 within an established ED atraumatic back pain pathway, undertaken at the largest tertiary spinal referral centre in the UK. We analysed routine data, collected prospectively by treating clinicians within a structured electronic health record clinical proforma. Data on signs and symptoms in 996 patients with suspected CEC referred for definitive MRI over a 4-year study period were extracted and compared against a final reference standard diagnosis. RESULTS We identified 111 patients with radiological evidence of CEC within the cohort referred for definitive imaging (111/996, 11.1%), of whom 109 (98.2%) underwent operative intervention. Patients with CEC were more likely to present with bilateral leg pain (OR=2.2), dermatomal sensory loss (OR 1.8) and bilateral absent ankle or ankle and knee jerks (OR=2.9). Subjective weakness was found to be associated with CEC on univariate but not multivariate analysis. We found no relationship between digital rectal examination findings and the diagnosis of CEC. CONCLUSIONS In our cohort, factors independently associated with CEC diagnosis on MRI included bilateral leg pain, dermatomal sensory loss. Loss of lower limb reflexes was strongly suggestive of CES (likelihood ratio 3.4 on multivariate logistic regression). Our findings raise questions about the diagnostic utility of invasive digital rectal examination.
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Affiliation(s)
- Michelle Angus
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Roberto Carrasco
- School of Medicine, The University of Manchester, Manchester, UK
| | - Vicki Currie
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Irfan Siddique
- Complex Spines, Salford Royal NHS Foundation Trust, Salford, UK
| | - Daniel E Horner
- Emergency Department, Salford Royal NHS Foundation Trust, Salford, UK
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16
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Medrano M, Soleto A, Pastor C, Rodríguez C, Carrasco R, Lapayese F, de la Peña A, Pereira A, Rincón E, Cabrera S, Ramos F, de la Cal E, Mota F, Queral V, Lopez-Heredero R, Manzanares A, Alén-Cordero C, Letellier L, Vives S, Martin V, Guern FL, Piqueras J, Kocan M. Design overview of ex-vessel components for the Wide Angle Viewing System diagnostic for ITER Equatorial Port 12. Fusion Engineering and Design 2021. [DOI: 10.1016/j.fusengdes.2021.112651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Carrasco R, Elmalky M, Sabou S, Leach J, Verma R, Mohammad S, Siddique I. Concomitant back and leg pain as predictors for trajectories of poor outcome after single level lumbar micro-decompression alone and with micro-discectomy: a study of 3,308 patients. J Spine Surg 2020; 6:688-702. [PMID: 33447671 PMCID: PMC7797806 DOI: 10.21037/jss-19-462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND Lumbar decompression is the commonest spinal intervention. One in four patients have suboptimal outcome postoperatively, however no large studies identified clear poor outcome predictors. The aim of this study was to study low back pain (LBP) as a predictor of poor outcome following lumbar micro-decompression. METHODS Prospectively collected spinal registry data was analysed for patients who underwent primary, single-level, decompression with or without discectomy at single spinal centre (2011-2017). Based on the response to the Likert global outcome question, we had two outcome groups (good & poor). Percentage of achievement of minimum clinically relevant change (MCRC) for Core Outcome Measures Index (COMI) score, LBP and leg pain (LP) was examined. A two-step approach was adopted. First, COMI score, LBP and LP visual analogue scales (VAS) trajectories were modelled using a discrete mixture model. Second, multinomial logistic regression was used to determine the association between variables and trajectories. RESULTS We included 3,308 patients with mean follow up (1.4 y). MCRC was achieved in COMI score in 63% of cases, 42% in LBP and 62% in LP. A three-group trajectory model was identified: large-improvement (LI) (n=980), moderate-improvement (MI) (n=1,364) and no-improvement (NI) (n=966) with 99.5%, 84.5% and 31.5% of patients presenting good outcome, respectively. Higher pre-operative LBP and COMI score and smoking were strongly associated with MI and NI. In addition, higher LP, post-operative surgical complications, previous surgery at same level, conservative treatment >6 months and anxiety/depression were associated with NI. CONCLUSIONS This is the first large-scale study reporting preoperative LBP severity, spinal stenosis and smoking as predictors for poor functional outcomes post lumbar decompression with or without discectomy. This is very useful while counselling patients for surgery to meet realistic expectations.
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Affiliation(s)
- Roberto Carrasco
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Mahmoud Elmalky
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Greater Manchester, UK
- Faculty of Medicine, Menoufia University, Al Minufya, Egypt
| | - Silviu Sabou
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Greater Manchester, UK
| | - John Leach
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Greater Manchester, UK
| | - Rajat Verma
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Greater Manchester, UK
| | - Saeed Mohammad
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Greater Manchester, UK
| | - Irfan Siddique
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Greater Manchester, UK
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18
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Kobylecki C, Carrasco R, Boca M, Lawton M, Chaudhuri KR, Hu MT, Grosset DG, Silverdale MA. The association between pain and impulse control behaviours in Parkinson's disease. Parkinsonism Relat Disord 2020; 78:53-55. [PMID: 32707457 DOI: 10.1016/j.parkreldis.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 03/14/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Christopher Kobylecki
- Department of Neurology, Salford Royal NHS Foundation Trust, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
| | - Roberto Carrasco
- Division of Population Health, Health Sciences Research and Primary Care, University of Manchester, Manchester, UK
| | - Mihaela Boca
- Department of Neurology, Salford Royal NHS Foundation Trust, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Michael Lawton
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Michele T Hu
- Department of Neurology, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Donald G Grosset
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Monty A Silverdale
- Department of Neurology, Salford Royal NHS Foundation Trust, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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19
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Abstract
Purpose: The purpose of this study was to validate the cauda scale (TCS) in an external population. TCS was proposed as a tool to be used to predict the likelihood of cauda equina compression.Methods: We analysed the presenting condition of consecutive patients attending the emergency department undergoing a magnetic resonance scan with a clinical suspicion of cauda equina syndrome (CES). The findings were graded according to TCS for those with and without radiological compression of the cauda equina. Logistic regression was applied to the data in accordance with the original paper.Results: Patients were included over a 14 month period (n = 313), subsequent imaging revealed CES compression in 34 cases and no CES compression in 279. The TCS proposed that small values meant a more likely diagnosis of CES, the data showed the opposite of this with the highest number of patients with CES scoring a maximal 9 on TCS (mildest symptoms).Conclusions: Our data suggests that TCS has potential limitations in identifying patients with CES and needs further work prior to implementation.
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Affiliation(s)
- Michelle Angus
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, UK
| | - Andrew Berg
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, UK
| | - Roberto Carrasco
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Oxford, UK
| | - Daniel Horner
- Emergency Medicine Department, Salford Royal NHS Foundation Trust, Stott Lane, UK
| | - John Leach
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, UK
| | - Irfan Siddique
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, UK
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20
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Carrasco R, Adams G. 123 Nerve growth factor-induced ovulation in llamas: Evidence of hypothalamic refractoriness to nerve growth factor during the declining phase of the luteinising hormone surge. Reprod Fertil Dev 2020. [DOI: 10.1071/rdv32n2ab123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Nerve growth factor (NGF) in semen is responsible for triggering ovulation after copulation in camelids. Interaction of NGF with its cognate receptors results in a preovulatory luteinising hormone (LH) surge that leads to ovulation, but the pharmacokinetics of NGF and the mechanism by which it mediates LH release are unknown. In an effort to elucidate the site and mechanism of action involved, the objective of this study was to determine whether the decline in the LH surge occurs as a result of pituitary depletion (i.e. diminished response to gonadotrophin-releasing hormone (GnRH)) or as an obtunded response at the level of the hypothalamus (diminished GnRH). Adult nonpregnant, nonlactating llamas (n=18) were synchronized by the administration of an ovulatory dose of a GnRH analogue (100μg IM; Fertiline, Vetoquinol). At 10 to 14 days later, the ovaries were examined to confirm the presence of a dominant follicle measuring ≥ 7mm, and a jugular catheter was put in place. The following day, a pretreatment blood sample was taken, and llamas were treated intravenously with 1mg of purified NGF from llama seminal plasma. Blood samples were taken every 30min for 7h from the time of NGF treatment. After the last blood sample was taken, llamas were treated with NGF (n=6; 1mg IV), GnRH (n=5; 100μg IV), or saline (Sal; IV; n=6), and blood samples were taken every 30min for another 7h. The ovaries were examined 48h after initial NGF treatment, via transrectal ultrasonography, to detect ovulation. Plasma was harvested and stored for analysis of LH concentration by radioimmunoassay. Data were compared using ANOVA for repeated measures, and single-point data were analysed using paired t-tests. As expected, most llamas ovulated in response to the initial NGF treatment (5 out of 5 in NGF-GnRH; 5 of 6 in NGF-NGF; 5 of 6 in NGF-Sal). Compared with pretreatment values, all llamas showed a 4-fold increase in plasma LH concentrations within 2h of the initial NGF treatment (P<0.05). Plasma LH concentrations peaked at 3h after initial NGF treatment and began to decline 4.5 to 5h after treatment (P<0.05). Plasma LH concentrations continued to decline following the second dose of NGF or Sal, whereas a transient elevation of LH was detected in llamas treated with GnRH (P<0.05). The LH concentration returned to basal levels (pretreatment) 8, 12, and 13h after NGF treatment in llamas treated with NGF-Sal, NGF-GnRH, and NGF-NGF, respectively. We conclude that the lack of LH response to the second dose of NGF is not because of pituitary depletion but rather due to diminished GnRH. The latter may be attributed to either a downregulation of NGF receptors within the hypothalamus or to temporary depletion of GnRH at the nerve terminals within the median eminence.
Research was supported by the Natural Sciences and Engineering Research Council of Canada.
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21
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Sabou S, Carrasco R, Verma R, Siddique I, Mohammad S. The clinical and radiological outcomes of multilevel posterior lumbar interbody fusion in the treatment of degenerative scoliosis: a consecutive case series with minimum 2 years follow up. J Spine Surg 2019; 5:520-528. [PMID: 32043002 DOI: 10.21037/jss.2019.12.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Surgical treatment for adult degenerative scoliosis (ADS) is a complex undertaking and is associated with a high complication rate. Our aim was to evaluate the clinical and radiological outcomes, mortality and morbidity of multilevel posterior lumbar interbody fusion (MPLIF) in the treatment in ADS based on the experience of a single tertiary referral center for spinal surgery. Methods We performed a retrospective analysis of prospectively collected data of consecutive patients who had undergone multi-level posterior interbody fusion for degenerative scoliosis. We prospectively recorded patients' demographics, co-morbidities; coronal and sagittal plane deformity assessment and surgical details: number of instrumented levels, and intra-operative and postoperative complications. Functional outcomes and patient-reported complications were entered in our local spine surgery database (part of the Eurospine Spine Tango Registry) and used to collect data on functional scores and patient-reported complications preoperatively and at 6, 12 and 24 months' follow-up. Results Our study involved 13 males and 51 females with a mean age of 70.26 (range 49-90, SD 8.9). MPLIF was performed at five levels in one patient, four levels in 29 patients, three levels in 20 patients, and two levels in 14 patients. There were a total of 14 (21.87%) major, minor and mechanical complications. There were no procedure-related mortalities. The average COMI and Eq5d scores improved significantly post-surgery, and this improvement was maintained at a mean follow-up of up to two years. Conclusions Multilevel posterior interbody fusion is a safe procedure, and in selected cases can result in good clinical and radiological outcomes with improvement in patient quality of life.
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Affiliation(s)
- Silviu Sabou
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Lancashire, UK
| | - Roberto Carrasco
- Division of Population Health, Health Services Research & Primary Care, Manchester, UK.,Biology, Medicine and Health (BMH), The University of Manchester, Manchester, UK
| | - Rajat Verma
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Lancashire, UK
| | - Irfan Siddique
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Lancashire, UK
| | - Saeed Mohammad
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Lancashire, UK
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22
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Filipot JF, Guimaraes P, Leckler F, Hortsmann J, Carrasco R, Leroy E, Fady N, Accensi M, Prevosto M, Duarte R, Roeber V, Benetazzo A, Raoult C, Franzetti M, Varing A, Le Dantec N. La Jument lighthouse: a real-scale laboratory for the study of giant waves and their loading on marine structures. Philos Trans A Math Phys Eng Sci 2019; 377:20190008. [PMID: 31424340 PMCID: PMC6710471 DOI: 10.1098/rsta.2019.0008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/08/2019] [Indexed: 06/10/2023]
Abstract
This paper presents results from an experiment designed to improve the understanding of the relationship between extreme breaking waves and their mechanical loading on heritage offshore lighthouses. The experiment, conducted at La Jument, an iconic French offshore lighthouse, featured several records of wave, current and structure accelerations acquired during severe storm conditions, with individual waves as high as 24 m. Data analysis focuses on a storm event marked by a strong peak in the horizontal accelerations measured inside La Jument. Thanks to stereo-video wave measurements synchronized to the acceleration record we were able to identify and describe the breaking wave responsible for this intense loading. Our observations suggest that this giant wave (19 m high) had a crest elevation high enough to directly hit the lighthouse tower, above the substructure. This paper reveals the potential for conducting ambitious field experiments from offshore lighthouses in order to collect valuable storm waves and wave loading observations. This offers a possible second service life for these heritage structures as in situ laboratories dedicated to the study of the coastal hydrodynamics and its interaction with marine structures. This article is part of the theme issue 'Environmental loading of heritage structures'.
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Affiliation(s)
| | - P. Guimaraes
- Service Hydrographique et Oceanographique de la Marine, Brest, Bretagne, France
| | - F. Leckler
- Service Hydrographique et Oceanographique de la Marine, Brest, Bretagne, France
| | - J. Hortsmann
- Helmholtz-Zentrum Geesthacht HZG Campus Teltow, Geestacht, Germany
| | - R. Carrasco
- Helmholtz-Zentrum Geesthacht HZG Campus Teltow, Geestacht, Germany
| | - E. Leroy
- CEREMA Direction territoriale Ouest, Plouzané, Bretagne, France
| | - N. Fady
- CEREMA Direction territoriale Ouest, Plouzané, Bretagne, France
| | | | | | - R. Duarte
- France Energies Marines, Plouzané, Bretagne, France
| | - V. Roeber
- University of Pau and Pays de l&Adour, Bidart, France
| | | | - C. Raoult
- Service Hydrographique et Oceanographique de la Marine, Brest, Bretagne, France
| | | | - A. Varing
- France Energies Marines, Plouzané, Bretagne, France
| | - N. Le Dantec
- CEREMA Direction territoriale Ouest, Plouzané, Bretagne, France
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23
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Falcon M, Iberico C, Guerra F, Reyes I, Felix E, Flores M, de los Ríos J, Diaz ME, Casas A, Sanchez-Gambetta S, Carrasco R. A pilot study of safety of sulfamethoxazole, trimethoprim and guaifenesin in pediatric and adult patients with acute bronchitis. BMC Res Notes 2019; 12:119. [PMID: 30832720 PMCID: PMC6399863 DOI: 10.1186/s13104-019-4150-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/22/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE This exploratory study assessed the safety of the combination of sulfamethoxazole, trimethoprim and guaifenesin (STG) in adult and pediatric patients with acute bronchitis according to local labelling in Peru. RESULTS We enrolled 51 pediatric and 52 adult participants diagnosed with acute bronchitis and indication of STG. The mean ages were 7.6 years (SD ± 3.2 years) and 42.8 years (SD ± 16.1) and the proportion of female patients were 51% and 65%, respectively. The duration of treatment in pediatric patients was < 5 days in 2% of patients, 5 days in 13.7%, 6-7 days, in 82.4% and > 7 days in 2% while in adults patients it was < 5 days in 17%, 5 days in 69.2%; 6-7 days in 28.8% of patients. Adverse events (AEs) were registered in 9.6% and 19.2% of pediatric and adult patients, respectively. These AEs had definite relation of causality with the study drugs in 2 adults (20% of AEs) and possible causality with the study drugs in 4 pediatric (80% of AEs) and 2 adult cases (20% of AEs). Our results provide valuable data to develop trials of pharmacovigilance where different statistical parameters should be considered to calculate an adequate sample size in studies evaluating STG in pediatric or adult patients. Trial registration NCT02879981 and NCT02902640.
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Affiliation(s)
- Mayer Falcon
- Clínica Internacional, Av. Guardia Civil #385, San Borja, Lima 41, Peru
| | - Carlos Iberico
- Clínica Providencia, Calle Carlos Gonzalez # 250, San Miguel, Lima 32, Peru
| | - Frances Guerra
- Clínica Anglo-Americana, Calle Alfredo Salazar #350, San Isidro, Lima 27, Peru
| | - Isabel Reyes
- Hospital de Emergencias Pediátricas, Prolongación Huamanga #138, La Victoria, Lima 13, Peru
| | - Efraín Felix
- Clínica San Borja, Av. Guardia Civil 337, Lima 41, Peru
| | - Mónica Flores
- Clínica de Especialidades Médicas, Jr.Eduardo Ordoñez #468, Lima 41, Peru
| | - Jorge de los Ríos
- Hospital de Apoyo María Auxiliadora, Av. Miguel Iglesias #968, Lima 29, Peru
| | - Maria E. Diaz
- Roche–Peru, Av Dionisio Derteano #144, San Isidro, Lima 27, Peru
| | - Alberto Casas
- Roche–Peru, Av Dionisio Derteano #144, San Isidro, Lima 27, Peru
| | | | - Roberto Carrasco
- Roche–Peru, Av Dionisio Derteano #144, San Isidro, Lima 27, Peru
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24
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Angus M, Jackson K, Smurthwaite G, Carrasco R, Mohammad S, Verma R, Siddique I. The implementation of enhanced recovery after surgery (ERAS) in complex spinal surgery. J Spine Surg 2019; 5:116-123. [PMID: 31032446 DOI: 10.21037/jss.2019.01.07] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background This paper aims to review the introduction of an enhanced recovery after surgery (ERAS) service within complex spinal surgery, with an aim to assess if this is a cost effective way to improve the overall experience of such complex surgery. Methods The ERAS model was defined and followed within a regional centre for complex spinal surgery in the UK. Outcomes such as length of stay (LOS) and satisfaction were measured before and after implementation of the service. Results LOS was reduced and both patient and staff satisfaction improved following the implementation of the ERAS service. Conclusions The ERAS model can successfully be implemented within complex spinal surgery, to help improve satisfaction and reduce cost.
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Affiliation(s)
- Michelle Angus
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Kelly Jackson
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Glyn Smurthwaite
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Roberto Carrasco
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Saeed Mohammad
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Rajat Verma
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Irfan Siddique
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
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25
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Hanns L, Cordingley L, Galloway J, Norton S, Carvalho LA, Christie D, Sen D, Carrasco R, Rashid A, Foster H, Baildam E, Chieng A, Davidson J, Wedderburn LR, Hyrich K, Thomson W, Ioannou Y. Depressive symptoms, pain and disability for adolescent patients with juvenile idiopathic arthritis: results from the Childhood Arthritis Prospective Study. Rheumatology (Oxford) 2018; 57:1381-1389. [PMID: 29697850 PMCID: PMC6055569 DOI: 10.1093/rheumatology/key088] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Indexed: 12/03/2022] Open
Abstract
Objectives To determine if depressive symptoms assessed near diagnosis associate with future measures of pain, disability and disease for adolescent patients diagnosed with JIA. Methods Data were analysed from JIA patients aged 11–16 years recruited to the Childhood Arthritis Prospective Study, a UK-based inception cohort of childhood-onset arthritis. Depressive symptoms (using the Mood and Feelings Questionnaire; MFQ), active and limited joint count, disability score (Childhood Health Assessment Questionnaire), pain visual analogue scale and patient’s general evaluation visual analogue scale were collected. Associations between baseline measures (first visit to paediatric rheumatologist) were analysed using multiple linear regression. Linear mixed-effect models for change in the clinical measures of disease over 48 months were estimated including MFQ as an explanatory variable. Results Data from 102 patients were analysed. At baseline, median (IQR) age was 13.2 years (11.9–14.2 years) and 14.7% scored over the MFQ cut-off for major depressive disorder. At baseline, depressive symptoms significantly associated with all clinical measures of disease (P ⩽ 0.01). High baseline depressive symptoms scores predicted worse pain (P ⩽ 0.005) and disability (P ⩽ 0.001) 12 months later but not active and limited joint counts. Conclusions Adolescent patients with JIA and depressive symptoms had more active joints, pain and disability at the time of their first specialist appointment. The associations between baseline depression and both pain and disability continued for at least one year, however, this was not the case for active joint count.
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Affiliation(s)
- Laura Hanns
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - Lis Cordingley
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - James Galloway
- Department of Academic Rheumatology, Faculty of Life Sciences & Medicine, London, UK
| | - Sam Norton
- Department of Academic Rheumatology, Faculty of Life Sciences & Medicine, London, UK.,Psychology Department, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
| | - Livia A Carvalho
- Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Deborah Christie
- Child and Adolescent Psychological Services, University College London Hospital NHS Foundation Trust, London, UK
| | - Debajit Sen
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - Roberto Carrasco
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Amir Rashid
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Helen Foster
- Paediatric Rheumatology, Institute Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Baildam
- Department of Rheumatology, Alder Hey Children's Foundation NHS Trust Liverpool, Liverpool, UK
| | - Alice Chieng
- Department of Rheumatology, Royal Manchester Children's Hospital, Manchester, UK
| | - Joyce Davidson
- Department of Rheumatology, Royal Hospital for Children, Glasgow, UK.,Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Lucy R Wedderburn
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK.,UCL GOS Institute of Child Health, University College London, London, UK
| | - Kimme Hyrich
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Wendy Thomson
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Yiannis Ioannou
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
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26
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Rashid A, Cordingley L, Carrasco R, Foster HE, Baildam EM, Chieng A, Davidson JE, Wedderburn LR, Ioannou Y, McErlane F, Verstappen SMM, Hyrich KL, Thomson W. Patterns of pain over time among children with juvenile idiopathic arthritis. Arch Dis Child 2018; 103:437-443. [PMID: 29175824 PMCID: PMC5916104 DOI: 10.1136/archdischild-2017-313337] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/25/2017] [Accepted: 10/25/2017] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Pain is a very common symptom of juvenile idiopathic arthritis (JIA). Disease activity alone cannot explain symptoms of pain in all children, suggesting other factors may be relevant. The objectives of this study were to describe the different patterns of pain experienced over time in children with JIA and to identify predictors of which children are likely to experience ongoing pain. METHODS This study used longitudinal-data from patients (aged 1-16 years) with new-onset JIA. Baseline and up to 5-year follow-up pain data from the Childhood Arthritis Prospective Study (CAPS) were used. A two-step approach was adopted. First, pain trajectories were modelled using a discrete mixture model. Second, multinomial logistic regression was used to determine the association between variables and trajectories. RESULTS Data from 851 individuals were included (4 years, median follow-up). A three-group trajectory model was identified: consistently low pain (n=453), improved pain (n=254) and consistently high pain (n=144). Children with improved pain or consistently high pain differed on average at baseline from consistently low pain. Older age at onset, poor function/disability and longer disease duration at baseline were associated with consistently high pain compared with consistently low pain. Early increases in pain and poor function/disability were also associated with consistently high pain compared with consistently low pain. CONCLUSIONS This study has identified routinely collected clinical factors, which may indicate those individuals with JIA at risk of poor pain outcomes earlier in disease. Identifying those at highest risk of poor pain outcomes at disease onset may enable targeted pain management strategies to be implemented early in disease thus reducing the risk of poor pain outcomes.
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Affiliation(s)
- Amir Rashid
- Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK,NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Lis Cordingley
- Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK
| | - Roberto Carrasco
- Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK
| | - Helen E Foster
- Musculoskeletal Research Group, Institute Cellular Medicine, Newcastle University, Newcastle, UK,Paediatric Rheumatology, Great North Children’s Hospital, Newcastle, UK
| | - Eileen M Baildam
- Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Alice Chieng
- Paediatric Rheumatology, Royal Manchester Children’s Hospital, Manchester, UK
| | - Joyce E Davidson
- Paediatric Rheumatology, Royal Hospital for Children, Glasgow, UK,Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Lucy R Wedderburn
- University College London (UCL) GOS Institute of Child Health, Great Ormond Street Hospital For Children NHS Trust, London, UK,ARUK Centre for Adolescent Rheumatology, University College London, London, UK,The NIHR Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Yiannis Ioannou
- University College London (UCL) GOS Institute of Child Health, Great Ormond Street Hospital For Children NHS Trust, London, UK,ARUK Centre for Adolescent Rheumatology, University College London, London, UK
| | - Flora McErlane
- Paediatric Rheumatology, Great North Children’s Hospital, Newcastle, UK
| | - Suzanne M M Verstappen
- Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK,NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Kimme L Hyrich
- Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK,NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Wendy Thomson
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK,Arthritis Research UK Center for Genetics and Genomics, The University of Manchester, London, UK
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Gullà A, Hideshima T, Bianchi G, Fulciniti M, Kemal Samur M, Qi J, Tai YT, Harada T, Morelli E, Amodio N, Carrasco R, Tagliaferri P, Munshi NC, Tassone P, Anderson KC. Protein arginine methyltransferase 5 has prognostic relevance and is a druggable target in multiple myeloma. Leukemia 2018; 32:996-1002. [PMID: 29158558 PMCID: PMC5871539 DOI: 10.1038/leu.2017.334] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 01/10/2023]
Abstract
Arginine methyltransferases critically regulate cellular homeostasis by modulating the functional outcome of their substrates. The protein arginine methyltransferase 5 (PRMT5) is an enzyme involved in growth and survival pathways promoting tumorigenesis. However, little is known about the biologic function of PRMT5 and its therapeutic potential in multiple myeloma (MM). In the present study, we identified and validated PRMT5 as a new therapeutic target in MM. PRMT5 is overexpressed in patient MM cells and associated with decreased progression-free survival and overall survival. Either genetic knockdown or pharmacological inhibition of PRMT5 with the inhibitor EPZ015666 significantly inhibited growth of both cell lines and patient MM cells. Furthermore, PRMT5 inhibition abrogated NF-κB signaling. Interestingly, mass spectrometry identified a tripartite motif-containing protein 21 TRIM21 as a new PRMT5-partner, and we delineated a TRIM21-dependent mechanism of NF-κB inhibition. Importantly, oral administration of EPZ015666 significantly decreased MM growth in a humanized murine model of MM. These data both demonstrate the oncogenic role and prognostic relevance of PRMT5 in MM pathogenesis, and provide the rationale for novel therapies targeting PRMT5 to improve patient outcome.
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Affiliation(s)
- A Gullà
- Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - T Hideshima
- Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - G Bianchi
- Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - M Fulciniti
- Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - M Kemal Samur
- Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - J Qi
- Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Y-T Tai
- Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - T Harada
- Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - E Morelli
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - N Amodio
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - R Carrasco
- Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - P Tagliaferri
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - N C Munshi
- Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA
- VA Boston Healthcare System, West Roxbury, Boston, MA, USA
| | - P Tassone
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - K C Anderson
- Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA
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Gonzalez Torres L, De Diego C, Nunez Martinez JM, Carrasco R. P432Right-sided radiofrequency ablation performed by peripheral brachial venous approach reduces patient immobilization and hospitalization stay as compared to femoral venous approach. Europace 2018. [DOI: 10.1093/europace/euy015.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Gonzalez Torres
- Arrhythmia Unit Hospital Universitario Torrevieja-Elche Vinalopó, Cardiología, Torrevieja y Elche, Spain
| | - C De Diego
- Arrhythmia Unit Hospital Universitario Torrevieja-Elche Vinalopó, Cardiología, Torrevieja y Elche, Spain
| | - J M Nunez Martinez
- Arrhythmia Unit Hospital Universitario Torrevieja-Elche Vinalopó, Cardiología, Torrevieja y Elche, Spain
| | - R Carrasco
- Arrhythmia Unit Hospital Universitario Torrevieja-Elche Vinalopó, Cardiología, Torrevieja y Elche, Spain
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Carrasco R, Leonardi CE, Singh J, Adams GP. 105 P75 Neuronal Cells and Fibers in the Bovine Ovary. Reprod Fertil Dev 2018. [DOI: 10.1071/rdv30n1ab105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Neurotrophins are molecules involved in the development and survival of neurons and its cellular projections. Results of recent studies have implicated the local role of the high affinity neurotropin receptor, trkA, in bovine ovarian follicle selection and early luteogenesis (Carrasco et al. 2016 Reprod. Biol. Endocrinol. 14, 47), but innervation and neuropeptide control remains an unexplored aspect of ovarian function. P75 is the low-affinity receptor for all neurotrophins and is expressed in ovarian tissue. The objective of this study was to explore the distribution of P75 neurons and fibres within the ovary and to examine the relationship of these components with follicular development. The ovaries of cows (n = 5) were collected at the time of slaughter, 36 h after induced luteolysis (i.e. proestrus). The ovaries were fixed in 4% paraformaldehyde for 48 h, and samples from the ovarian hilus, medulla, and cortex (3 blocks per ovary) were cryo-sectioned (20–50 µm). Tissue sections were incubated for 48 h with a rabbit antibody against rat P75 or a mouse monoclonal antibody against neurofilament. Immunodetection was visualised by an amplification procedure with horseradish peroxidase using nickel DAB as a chromogen. Sections were counterstained with nuclear fast red for follicle identification. Immunoreactive cell bodies were counted in 10 to 20 fields (40×) per section, and data were expressed based on ovarian areas (cortex, medulla, or hilus) as an average count per 40× field per animal. Data among ovarian regions were compared by ANOVA; differences were considered significant when P < 0.05. Antral follicles ≤5 mm displayed strong immunoreactivity in the theca layer, without reaction in the granulosa cells. In contrast, preovulatory follicles were devoid of P75 immuno-reactivity in the theca layer. Oval P75 immunoreactive neuron-like cells were present in all ovarian areas studied. The neuronal nature of the P75 immunoreactive cells was confirmed by the presence of a similar pattern when adjacent sections were stained for neurofilaments, a protein characteristic of neurons. In the stroma of the ovarian cortex and medulla, neurons were present individually (scattered) rather than grouped; however, a dense network of neurons and fibres was detected immediately beneath the ovarian surface epithelium. No differences between the cortex, medulla, and hilus were found in the mean number of immunoreactive cells (10.6 ± 2.8, 14.4 ± 3.6 and 13.9 ± 2.0 cells/40× field, respectively). Immunoreactive neuron-like cells and fibres were in close proximity to blood vessels in the ovarian medulla. Corpora lutea were devoid of P75 immunoreactivity. In conclusion, results document the existence of a neuronal network in the bovine ovary, displaying an association with follicles at different stages of development. The abundance of neuronal components (i.e. neuron cell bodies and axons) in the ovarian stromal and surface epithelium implies a role of innervation (either extrinsic or intrinsic) in the control of ovarian follicular development and function.
Research was supported by the Natural Sciences and Engineering Research Council of Canada.
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Leonardi CEP, Carrasco R, Dias FFC, Adams GP, Singh J. 104 Distribution of Gonadotropin-Releasing Hormone and Kisspeptin Neurons in the Preoptic Area and Hypothalamus During the Estrous Cycle in Cows. Reprod Fertil Dev 2018. [DOI: 10.1071/rdv30n1ab104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Gonadal steroids hormones indirectly regulate gonadotropin-rleasing hormone (GnRH) secretion. Kisspeptin (Kp) co-expresses steroid receptors and modulates GnRH release. The objective of the study was to characterise the number and proportion of GnRH and Kp immunoreactive cells and their association in the preoptic area (POA) and hypothalamus during different phases of the oestrous cycle in cows. Daily ovarian ultrasonography was performed to detect follicle development and ovulation (Day 0) after prostaglandin treatment. On Day 5, cows were assigned randomly to the following groups: proestrus (n = 2), metestrus (n = 2) or diestrus (n = 3). Cows in the diestrus group were killed on Day 8. Cows in the proestrus and metestrus groups were given luteolytic dose of prostaglandin on Day 5.5 and Day 6 and were killed on Day 7 and 24 h after the ensuing ovulation, respectively. Cow heads were perfused with 4% paraformaldehyde via the carotid arteries to fix the brain in situ. The brain-stem (rostral portion of the POA to the mamillary body) was isolated by dissection and placed in 4% paraformaldehyde for 48 h. Following cryoprotection, the tissue block containing the POA and hypothalamus was frozen at –80°C and sectioned serially at a thickness of 50 mm using a cryostat microtome. Every 20th free-floating section was processed for double labelling using 2 sequential immuno-peroxidase reactions and ABC staining; Kp was immuno-labelled with Nickel-DAB at a dilution of 1:10,000 rabbit anti-kisspeptin (AC566, INRA, France), and GnRH was stained with DAB using 1:40,000 rabbit anti-GnRH (LR-5, Dr Benoit). The numbers of neuron cell bodies and fibres were recorded in different areas of the POA and the hypothalamus by brightfield microscopy using 10× and 40× objective lenses. Data were compared among groups by ANOVA. Major aggregations of Kp cells were localised in the mPOA, OVLT, and ARC. Overall, the number of Kp cells was higher in the metestrus v. diestrus group (719 ± 94 v. 378 ± 8; P = 0.01), but was similar to the proestrus group (558 ± 9). The number of Kp cells in the POA (mPOA, OVLT) tended to be higher in the metestrus v. diestrus group (395 ± 56 v. 147 ± 44; P = 0.06), and was intermediate in the proestrus group (206 ± 6). The number of Kp cells in the ARC did not differ among groups (metestrus 310 ± 26, diestrus 206 ± 53, proestrus 321 ± 99; P = 0.4). The number of GnRH cells bodies was not different among groups (metestrus 40 ± 3, diestrus 50 ± 9, proestrus 43 ± 8; combined; P = 0.8), and the distribution was higher in the POA (metestrus 25 ± 2, diestrus 30 ± 3, proestrus 33 ± 2) than hypothalamus. The proportion of GnRH cells in apposition to Kp fibres tended to be highest in the proestrus v. metestrus and diestrus groups (50.5 ± 1% v. 34.1 ± 9% and 31.4 ± 3%; P = 0.09). In conclusion, the number of Kp immunoreactive cells, but not GnRH cells, present in the POA and hypothalamus changed among different phases of the oestrous cycle due primarily to an increase in number of Kp cells in POA during metestrus. The proestrous phase was associated with an increase in apposition between Kp fibres and GnRH cells.
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Sampath S, Sergeant JC, Viatte S, Carrasco R, Cobb J, Smith SL, Hinks A, Wedderburn LR, Beresford MW, Hyrich KL, Thomson W. 16. Clinical Factors Associated with Non-Response to Methotrexate in Children with Juvenile Idiopathic Arthritis: Results from the Childhood Arthritis Response to Treatment Consortium. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex390.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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McErlane F, Carrasco R, Kearsley-Fleet L, Baildam EM, Wedderburn LR, Foster HE, Ioannou Y, Chieng SEA, Davidson JE, Thomson W, Hyrich KL. Growth patterns in early juvenile idiopathic arthritis: Results from the Childhood Arthritis Prospective Study (CAPS). Semin Arthritis Rheum 2017; 48:53-60. [PMID: 29217290 PMCID: PMC6089842 DOI: 10.1016/j.semarthrit.2017.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/17/2017] [Accepted: 11/03/2017] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To investigate early vertical growth patterns and factors associated with poor growth in a modern inception cohort of UK children with juvenile idiopathic arthritis (JIA) using data from the Childhood Arthritis Prospective Study (CAPS). METHODS A study period of 3 years was chosen. Children included in this analysis had a physician diagnosis of JIA and had height measurements available at both baseline and at 3-years of follow-up. Height is presented as z-scores calculated using World Health Organisation growth standards for age and gender. Growth over the 3-year period was assessed using change in z-score and height velocity. Univariable and multivariable linear regressions were used to identify factors associated with height z-score at baseline and change of height z-score at 3 years. RESULTS 568 patients were included; 65% female, median baseline age 7.4 years [interquartile range (IQR) 3.6, 11.2], median symptom duration at presentation 5.5 months [IQR 3.1, 11.6]. Height z-score decreased significantly from baseline to 3 years (p ≤ 0.0001); baseline median height z-score was -0.02 (IQR -0.71, 0.61), decreasing to -0.47 (IQR -1.12, 0.24) at 3 years. Growth restriction, defined as change of height z-score ≤-0.5, was observed in 39% of patients. At 3 years, higher baseline height z-score was the strongest predictor for a negative change in height z-score [-0.3 per unit of baseline height z-score (95% CI: -0.36, -0.24), p < 0.0001]. CONCLUSIONS Although overall height at 3 years after initial presentation to rheumatology is within the population norm, as a cohort, children with JIA experience a reduction of growth in height over the first 3 years of disease. Late presentation to paediatric rheumatology services is associated with lower height at presentation. However, patients with the lowest height z scores at presentation were also the most likely to see an improvement at 3 years. The impact of JIA on growth patterns is important to children and families and this study provides useful new data to support informed clinical care.
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Affiliation(s)
- Flora McErlane
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle Hospitals NHS Trust, Newcastle upon Tyne, UK; Rheumatology, Institute Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Roberto Carrasco
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Division of Musculoskeletal & Dermatological Sciences. Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Lianne Kearsley-Fleet
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Division of Musculoskeletal & Dermatological Sciences. Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Eileen M Baildam
- Paediatric Rheumatology, Alder Hey Children's Hospital, Liverpool, UK
| | - Lucy R Wedderburn
- Arthritis Research UK Centre for Adolescent Rheumatology, Infection, Inflammation and Rheumatology Section, UCL GOS Institute of Child Health, London, UK
| | - Helen E Foster
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle Hospitals NHS Trust, Newcastle upon Tyne, UK; Rheumatology, Institute Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Yiannis Ioannou
- Arthritis Research UK Centre for Adolescent Rheumatology, Division of Medicine, University College London (UCL), London, UK
| | - S E Alice Chieng
- Rheumatology, Royal Manchester Children's Hospital, Manchester, UK
| | - Joyce E Davidson
- Paediatric Rheumatology, Royal Hospital for Children, Glasgow, UK; Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Wendy Thomson
- Arthritis Research UK Center for Genetics and Genomics, Centre for Musculoskeletal Research, Division of Musculoskeletal & Dermatological Sciences. Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Kimme L Hyrich
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Division of Musculoskeletal & Dermatological Sciences. Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
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Puerta-Roldan P, Guillen-Quesada A, Carrasco R, Muchart J, Serrano M, Ferrer E. [Hydrocephalus due to hyperplasia of the choroid plexuses in a patient with trisomy 9 mosaicism. A real diagnostic and therapeutic challenge]. Rev Neurol 2017; 65:112-116. [PMID: 28699153] [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: 06/07/2023]
Abstract
INTRODUCTION Trisomy 9 is an unusual chromosome abnormality in live-born patients, which is frequently accompanied by functional and structural anomalies of the central nervous system. Among many other alterations, several studies have been published in the English-speaking literature that show an association between chromosome 9 abnormality and pathologies affecting the choroid plexuses. CASE REPORT We report the case of a 4-month-old male with trisomy 9 mosaicism associated to hydrocephalus secondary to choroid plexus hyperplasia, who was referred due to a clinical picture of intracranial hypertension. The cerebrospinal fluid (CSF) drainage procedure that was initially chosen caused massive ascites due to an excessive production of CSF, and led to a cascade of multiple surgical interventions, which included endoscopic and drainage procedures. CONCLUSIONS This is another example of an association between choroid plexus pathologies and chromosome 9 abnormality. Due to its scarce incidence, diagnosis of hydrocephalus secondary to plexus hyperplasia is difficult, as is selecting its most suitable treatment. In this type of hydrocephalus there is a double pathophysiological mechanism, which involves an increase in CSF production and a decrease in its reabsorption. Despite taking these considerations into account, the treatment of hydrocephalus secondary to plexus hyperplasia is a real challenge that usually leads to multiple surgical interventions ranging from plexectomy or coagulation of the choroid plexuses to the implantation of CSF drainage devices.
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Affiliation(s)
| | | | - R Carrasco
- Hospital Sant Joan de Deu, Esplugues de Llobregat, Espana
| | - J Muchart
- Hospital Sant Joan de Deu, Esplugues de Llobregat, Espana
| | - M Serrano
- Hospital Sant Joan de Deu, Esplugues de Llobregat, Espana
| | - E Ferrer
- Hospital Sant Joan de Deu, Esplugues de Llobregat, Espana
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Spencer CH, Rouster-Stevens K, Gewanter H, Syverson G, Modica R, Schmidt K, Emery H, Wallace C, Grevich S, Nanda K, Zhao YD, Shenoi S, Tarvin S, Hong S, Lindsley C, Weiss JE, Passo M, Ede K, Brown A, Ardalan K, Bernal W, Stoll ML, Lang B, Carrasco R, Agaiar C, Feller L, Bukulmez H, Vehe R, Kim H, Schmeling H, Gerstbacher D, Hoeltzel M, Eberhard B, Sundel R, Kim S, Huber AM, Patwardhan A. Biologic therapies for refractory juvenile dermatomyositis: five years of experience of the Childhood Arthritis and Rheumatology Research Alliance in North America. Pediatr Rheumatol Online J 2017; 15:50. [PMID: 28610606 PMCID: PMC5470177 DOI: 10.1186/s12969-017-0174-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 05/17/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The prognosis of children with juvenile dermatomyositis (JDM) has improved remarkably since the 1960's with the use of corticosteroid and immunosuppressive therapy. Yet there remain a minority of children who have refractory disease. Since 2003 the sporadic use of biologics (genetically-engineered proteins that usually are derived from human genes) for inflammatory myositis has been reported. In 2011-2016 we investigated our collective experience of biologics in JDM through the Childhood Arthritis and Rheumatology Research Alliance (CARRA). METHODS The JDM biologic study group developed a survey on the CARRA member experience using biologics for Juvenile DM utilizing Delphi consensus methods in 2011-2012. The survey was completed online by the CARRA members interested in JDM in 2012. A second survey was similarly developed that provided more opportunity to describe their experiences with biologics in JDM in detail and was completed by CARRA members in Feb 2013. During three CARRA meetings in 2013-2015, nominal group techniques were used for achieving consensus on the current choices of biologic drugs. A final survey was performed at the 2016 CARRA meeting. RESULTS One hundred and five of a potential 231 pediatric rheumatologists (42%) responded to the first survey in 2012. Thirty-five of 90 had never used a biologic for Juvenile DM at that time. Fifty-five of 91 (denominators vary) had used biologics for JDM in their practice with 32%, 5%, and 4% using rituximab, etanercept, and infliximab, respectively, and 17% having used more than one of the three drugs. Ten percent used a biologic as monotherapy, 19% a biologic in combination with methotrexate (mtx), 52% a biologic in combination with mtx and corticosteroids, 42% a combination of a biologic, mtx, corticosteroids (steroids), and an immunosuppressive drug, and 43% a combination of a biologic, IVIG and mtx. The results of the second survey supported these findings in considerably more detail with multiple combinations of drugs used with biologics and supported the use of rituximab, abatacept, anti-TNFα drugs, and tocilizumab in that order. One hundred percent recommended that CARRA continue studying biologics for JDM. The CARRA meeting survey in 2016 again supported the study and use of these four biologic drug groups. CONCLUSIONS Our CARRA JDM biologic work group developed and performed three surveys demonstrating that pediatric rheumatologists in North America have been using multiple biologics for refractory JDM in numerous scenarios from 2011 to 2016. These survey results and our consensus meetings determined our choice of four biologic therapies (rituximab, abatacept, tocilizumab and anti-TNFα drugs) to consider for refractory JDM treatment when indicated and to evaluate for comparative effectiveness and safety in the future. Significance and Innovations This is the first report that provides a substantial clinical experience of a large group of pediatric rheumatologists with biologics for refractory JDM over five years. This experience with biologic therapies for refractory JDM may aid pediatric rheumatologists in the current treatment of these children and form a basis for further clinical research into the comparative effectiveness and safety of biologics for refractory JDM.
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Affiliation(s)
- CH Spencer
- 0000 0004 0392 3476grid.240344.5Nationwide Children’s Hospital and Ohio State University, Columbus, OH USA
| | - K Rouster-Stevens
- 0000 0001 0941 6502grid.189967.8Emory University School of Medicine, Atlanta, GA USA
| | - H Gewanter
- Pediatric and Adolescent Health Partners, Richmond, VA USA
| | - G Syverson
- 0000 0001 2167 3675grid.14003.36University of Wisconsin-Madison, Madison, WI USA
| | - R Modica
- 0000 0004 1936 8091grid.15276.37University of Florida, Gainesville, FL USA
| | - K Schmidt
- 0000 0001 2113 1622grid.266623.5University of Louisville, Louisville, KY USA
| | - H Emery
- 0000000122986657grid.34477.33Seattle Children’s Hospital, University of Washington, Seattle, WA USA
| | - C Wallace
- 0000000122986657grid.34477.33Seattle Children’s Hospital, University of Washington, Seattle, WA USA
| | - S Grevich
- 0000000122986657grid.34477.33Seattle Children’s Hospital, University of Washington, Seattle, WA USA
| | - K Nanda
- 0000000122986657grid.34477.33Seattle Children’s Hospital, University of Washington, Seattle, WA USA
| | - YD Zhao
- 0000000122986657grid.34477.33Seattle Children’s Hospital, University of Washington, Seattle, WA USA
| | - S Shenoi
- 0000000122986657grid.34477.33Seattle Children’s Hospital, University of Washington, Seattle, WA USA
| | - S Tarvin
- Riley Hospital for Children, Indiana University Medical Center, Indianapolis, IN India
| | - S Hong
- grid.412984.2University of Iowa Health Care, Iowa City, IA USA
| | - C Lindsley
- 0000 0001 2177 6375grid.412016.0University of Kansas Medical Center, Kansas City, KS USA
| | - JE Weiss
- 0000 0004 0407 6328grid.239835.6Sanzari Children’s Hospital, Hackensack University Medical Center, Hackensack, NJ USA
| | - M Passo
- 0000 0000 9075 106Xgrid.254567.7University of South Carolina, Charleston, SC USA
| | - K Ede
- 0000 0001 0381 0779grid.417276.1Phoenix Children’s Hospital, Phoenix, AZ USA
| | - A Brown
- 0000 0001 2200 2638grid.416975.8Texas Children’s Hospital, Houston, TX USA
| | - K Ardalan
- 0000 0004 0388 2248grid.413808.6Lurie Children’s Hospital, Chicago, IL USA
| | - W Bernal
- 0000 0001 2297 6811grid.266102.1University of California, San Francisco, San Francisco, CA USA
| | - ML Stoll
- 0000000106344187grid.265892.2University of Alabama at Birmingham, Birmingham, AL USA
| | - B Lang
- 0000 0004 1936 8200grid.55602.34WK Health Center and Dalhousie University, Halifax, NS Canada
| | - R Carrasco
- Dell Children’s Hospital, Austin, TX USA
| | - C Agaiar
- Children’s Hospital of The Kings Daughter, Norfolk, VA USA
| | - L Feller
- Inland Rheumatology, Waterville, ME USA
| | - H Bukulmez
- 0000 0001 0035 4528grid.411931.fMetro Health Medical Center and Case Western Reserve University, Cleveland, OH USA
| | - R Vehe
- 0000000419368657grid.17635.36University of Minnesota, Minneapolis, MN USA
| | - H Kim
- 0000 0001 2237 2479grid.420086.8National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD USA
| | - H Schmeling
- 0000 0004 1936 7697grid.22072.35Alberta Children’s Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - D Gerstbacher
- 0000000419368956grid.168010.eLucille Packard Children’s Hospital, Stanford University, Stanford, CA USA
| | - M Hoeltzel
- 0000000086837370grid.214458.eMott Children’s Hospital, University of Michigan, Ann Arbor, MI USA
| | - B Eberhard
- grid.415338.8Cohen Children’s Medical Center of New York, New york, USA
| | - R Sundel
- 0000 0004 0378 8438grid.2515.3Boston Children’s Hospital and Harvard Medical School, Boston, MA USA
| | - S Kim
- 0000 0001 2297 6811grid.266102.1University of California, San Francisco, San Francisco, CA USA
| | - AM Huber
- 0000 0004 1936 8200grid.55602.34WK Health Center and Dalhousie University, Halifax, NS Canada
| | - A Patwardhan
- 0000 0001 2162 3504grid.134936.aSchool of Medicine, University of Missouri, Columbia, MO USA
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Castro-Dufourny I, Carrasco R, Prieto R, Barrios L, Pascual JM. The first sixty-five craniopharyngioma operations in France. Rev Neurol (Paris) 2017; 173:180-188. [DOI: 10.1016/j.neurol.2016.12.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 09/13/2016] [Accepted: 12/20/2016] [Indexed: 11/30/2022]
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Davies R, Carrasco R, Foster HE, Baildam EM, Chieng SEA, Davidson JE, Ioannou Y, Wedderburn LR, Thomson W, Hyrich KL. Treatment prescribing patterns in patients with juvenile idiopathic arthritis (JIA): Analysis from the UK Childhood Arthritis Prospective Study (CAPS). Semin Arthritis Rheum 2016; 46:190-195. [PMID: 27422803 PMCID: PMC5052142 DOI: 10.1016/j.semarthrit.2016.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/05/2016] [Accepted: 06/06/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Initial treatment of juvenile idiopathic arthritis (JIA) is largely based on the extent of joint involvement, disease severity and ILAR category. The licensing of biologic therapies for JIA has expanded treatment options. The aims of the study are (1) to describe treatment prescribing patterns in JIA over the first 3 years following first presentation to paediatric rheumatology and (2) to determine whether patterns of treatment have changed as biologics have become more widely available. METHODS Children with at least 3 years of follow-up within the Childhood Arthritis Prospective Study (CAPS) were included. For analysis, children were placed into one of five groups according to their initial presentation to paediatric rheumatology: oligoarthritis (oJIA), polyarthritis (pJIA), systemic (sJIA), enthesitis-related arthritis (ERA) and psoriatic arthritis (PsA). Treatment patterns over 3 years were described. RESULTS Of 1051 children, 58% received synthetic disease-modifying anti-rheumatic drugs (sDMARD) and 20% received biologics over the 3 years. Use of sDMARDs and biologics was higher in more severe disease presentations (sJIA and pJIA); however, 35% and 10% who presented with oJIA were also treated with sDMARDs and biologics, respectively. The number of children receiving sDMARD after 2006 was higher (p = 0.02); however, there was no difference in biologic prescribing before and after 2006 (p = 0.4). CONCLUSIONS A high proportion of children presenting with JIA received sDMARDs plus/minus biologics during 3 years of follow-up. This was most common for patients with severe JIA but was also prescribed for patients with oligoarticular disease, despite the lack of evidence for effectiveness in this category.
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Affiliation(s)
- Rebecca Davies
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Roberto Carrasco
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Helen E Foster
- Musculoskeletal Research Group, Institute Cellular Medicine, Newcastle University and Paediatric Rheumatology, Great North Children׳s Hospital, Newcastle upon Tyne, UK
| | - Eileen M Baildam
- Department of Paediatric Rheumatology, Alder Hey Children׳s Hospital NHS Foundation Trust, Liverpool, UK
| | - S E Alice Chieng
- Department of Rheumatology, Royal Manchester Children׳s Hospital, Manchester, UK
| | - Joyce E Davidson
- Department of Paediatric Rheumatology, Royal Hospital for Children, Glasgow, UK
| | - Yiannis Ioannou
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - Lucy R Wedderburn
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK; Infection, Inflammation, and Rheumatology Section, Institute of Child Health, UCL and Great Ormond Street Hospital NHS Trust, UCL Institute of Child Health, London, UK
| | - Wendy Thomson
- Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University, Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK
| | - Kimme L Hyrich
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University, Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK.
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Zusman M, Carrasco R, Driskell L, Williams S, Golden C. B-71The Relationship Between Different Levels of the MMPI-II F Scale and Performance on the Test of Memory Malingering (TOMM) and SIRS-2 in a Mixed Clinical Sample. Arch Clin Neuropsychol 2016. [DOI: 10.1093/arclin/acw043.146] [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: 11/12/2022] Open
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Hanns L, Cordingley L, Galloway J, Norton S, Carvalho L, Christie D, Sen D, Carrasco R, Rashid A, Foster H, Baildam E, Cheing A, Davidson J, Wedderburn L, Hyrich K, Thomson W, Ioannou Y. OP0300 Do Depressive Symptoms at Disease Onset Associate with Future Disease Activity for Adolescent Patients with Jia? Results from The Childhood Arthritis Prospective Study (CAPS). Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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McErlane F, Foster HE, Carrasco R, Baildam EM, Chieng SEA, Davidson JE, Ioannou Y, Wedderburn LR, Thomson W, Hyrich KL. Trends in paediatric rheumatology referral times and disease activity indices over a ten-year period among children and young people with Juvenile Idiopathic Arthritis: results from the childhood arthritis prospective Study. Rheumatology (Oxford) 2016; 55:1225-34. [PMID: 27016664 PMCID: PMC4911538 DOI: 10.1093/rheumatology/kew021] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Indexed: 11/28/2022] Open
Abstract
Objectives. The medical management of JIA has advanced significantly over the past 10 years. It is not known whether these changes have impacted on outcomes. The aim of this analysis was to identify and describe trends in referral times, treatment times and 1-year outcomes over a 10-year period among children with JIA enrolled in the Childhood Arthritis Prospective Study. Methods. The Childhood Arthritis Prospective Study is a prospective inception cohort of children with new-onset inflammatory arthritis. Analysis included all children recruited in 2001–11 with at least 1 year of follow-up, divided into four groups by year of diagnosis. Median referral time, baseline disease pattern (oligoarticular, polyarticular or systemic onset) and time to first definitive treatment were compared between groups. Where possible, clinical juvenile arthritis disease activity score (cJADAS) cut-offs were applied at 1 year. Results. One thousand and sixty-six children were included in the analysis. The median time from symptom onset and referral to first paediatric rheumatology appointment (22.7–24.7 and 3.4–4.7 weeks, respectively) did not vary significantly (∼20% seen within 10 weeks of onset and ∼50% within 4 weeks of referral). For oligoarticular and polyarticular disease, 33.8–47 and 25.4–34.9%, respectively, achieved inactive disease by 1 year, with ∼30% in high disease activity at 1 year. A positive trend towards earlier definitive treatment reached significance in oligoarticular and polyarticular pattern disease. Conclusion. Children with new-onset JIA have a persistent delay in access to paediatric rheumatology care, with one-third in high disease activity at 1 year and no significant improvement over the past 10 years. Contributing factors may include service pressures and poor awareness. Further research is necessary to gain a better understanding and improve important clinical outcomes.
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Affiliation(s)
- Flora McErlane
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle Hospitals NHS Foundation Trust
| | - Helen E Foster
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle Hospitals NHS Foundation Trust, Rheumatology, Institute Cellular Medicine, Newcastle University, Newcastle upon Tyne
| | - Roberto Carrasco
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Manchester
| | - Eileen M Baildam
- Paediatric Rheumatology, Alder Hey Children's Hospital, Liverpool
| | | | - Joyce E Davidson
- Paediatric Rheumatology, Royal Hospital for Children, Glasgow, Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh
| | - Yiannis Ioannou
- Arthritis Research UK Centre for Adolescent Rheumatology, Division of Medicine, University College London (UCL)
| | - Lucy R Wedderburn
- Infection, Inflammation and Rheumatology Section, and Arthritis Research UK Centre for Adolescent Rheumatology, UCL Institute of Child Health, London
| | - Wendy Thomson
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Manchester, Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Institute for Inflammation and Repair Faculty of Medical and Human Sciences, University of Manchester, and
| | - Kimme L Hyrich
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Carrasco R, Singh J, Adams GP. 135 SHORT-TERM OVARIAN EFFECTS OF UNILATERAL OVARIECTOMY IN COWS. Reprod Fertil Dev 2016. [DOI: 10.1071/rdv28n2ab135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Classical studies established that the removal of one of the paired organs produces a compensatory effect on the remaining organ. In the bovine ovary this aspect has not been examined in detail. We took advantage of follicular and luteal profiles from a previous study to retrospectively examine the effects of ovariectomy before and after ovulation on follicular dynamics of the remaining ovary in cattle. To characterise the prevalence and distribution of tyrosine kinase receptor A in the bovine ovary, the original design involved unilateral ovariectomy of cows at different stages of the periovulatory period. For the purposes of the present study, we combined data into 2 groups, a preovulatory group (n = 6 cows) and a post-ovulatory group (n = 5 cows), to provide sufficient data for statistical interpretation. The cows were examined daily by transrectal ultrasonography to determine the ovarian status. For the preovulatory group, a luteolytic dose of prostaglandin was administered when the dominant follicle of the second follicular wave reached ≥10 mm, and the ovary containing the dominant follicle was removed within 48 h. For the post-ovulatory group, ovariectomy was performed on the ovary containing the newly formed corpus luteum between Days 2 to 6 (Day 0 = ovulation). Unilateral ovariectomy was performed by colpotomy under caudal epidural anaesthesia using a chain ecraseur. After ovariectomy, cows were examined daily by ultrasonography from ovariectomy to the completion of an interovulatory interval (period between 2 ovulations). Single-point data were compared between groups by t-test, and binomial data were compared between groups by Fisher’s exact test. Double ovulations were detected in 3/6 ovariectomized in the preovulatory period and 2/5 ovariectomized in the post-ovulatory period. The first ovulation after ovariectomy tended to occur earlier in the preovulatory group than in the post-ovulatory group (P = 0.08), which was attributed primarily to the development of oversized persistent dominant follicles (~20 mm in diameter for ≥7 days in absence of a corpora lutea) in 2 of 5 cows in the post-ovulatory ovariectomy group. The interovulatory interval after ovariectomy was shorter in the post-ovulatory group than in the preovulatory group (14.6 ± 0.3 v. 20.3 ± 0.6 days; P = 0.01). No distinct patterns were detected in follicular and luteal dynamics between the pre- and post-ovulatory ovariectomy groups. The number of follicles ≥3 mm detected by ultrasonography was greater in the post-ovulatory ovariectomy group than in the preovulatory group on Days 6, 7, 8, and 16 of the first interovulatory interval after ovariectomy. In conclusion, results of this retrospective study support the concept that follicular and luteal effects of removal of one ovary are influenced by the timing of ovariectomy relative to ovulation. A prospective study involving a comparison of ovarian dynamics of the same cows before and after unilateral ovariectomy will provide a better understanding of the disruption that take place and the mechanisms controlling it.
Research was supported by the Natural Sciences and Engineering Research Council of Canada.
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Carrasco R, Pascual JM. On heart migration of the peritoneal catheter. Neurochirurgie 2015; 61:301-3. [PMID: 26428865 DOI: 10.1016/j.neuchi.2015.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/02/2015] [Accepted: 07/30/2015] [Indexed: 11/26/2022]
Affiliation(s)
- R Carrasco
- Department of Neurosurgery, Ramón y Cajal University Hospital, Colmenar Road, Km. 9.100, 28034 Madrid, Spain.
| | - J M Pascual
- Department of Neurosurgery, La Princesa University Hospital, Madrid, Spain
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Álvarez P, Carrasco R, Romero-Dapueto C, Castillo RL. Transfusion-Related Acute Lung Injured (TRALI): Current Concepts. Open Respir Med J 2015; 9:92-6. [PMID: 26312100 PMCID: PMC4541453 DOI: 10.2174/1874306401509010092] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 04/16/2015] [Accepted: 04/16/2015] [Indexed: 02/01/2023] Open
Abstract
Transfusion-related acute lung injury (TRALI) is a life-threatening intervention that develops within 6 hours of transfusion of one or more units of blood, and is an important cause of morbidity and mortality resulting from transfusion. It is necessary to dismiss other causes of acute lung injury (ALI), like sepsis, acute cardiogenic edema, acute respiratory distress syndrome (ARDS) or bacterial infection. There are two mechanisms that lead to the development of this syndrome: immune-mediated and no immune- mediated TRALI. A common theme among the experimental TRALI models is the central importance of neutrophils in mediating the early immune response, and lung vascular injury. Central clinical symptoms are dyspnea, tachypnea, tachycardia, cyanosis and pulmonary secretions, altogether with other hemodynamic alterations, such as hypotension and fever. Complementary to these clinical findings, long-term validated animal models for TRALI should allow the determination of the cellular targets for TRALI-inducing alloantibodies as well as delineation of the underlying pathogenic molecular mechanisms, and key molecular mediators of the pathology. Diagnostic criteria have been established and preventive measures have been implemented. These actions have contributed to the reduction in the overallnumber of fatalities. However, TRALI still remains a clinical problem. Any complication suspected of TRALI should immediately be reported.
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Affiliation(s)
- P Álvarez
- Unidad de Paciente Crítico, Hospital Metropolitano La Florida, Santiago, Chile ; Facultad de Medicina, Universidad Finis Terrae, Chile
| | - R Carrasco
- Departamento de Medicina, Universidad de Chile, Hospital Salvador, Santiago, Chile
| | - C Romero-Dapueto
- Servicio de Medicina Física y Rehabilitación, Clínica Alemana de Santiago, Santiago, Chile
| | - R L Castillo
- Programa de Fisiopatología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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Pascual JM, Prieto R, Castro-Dufourny I, Carrasco R. Topographic Diagnosis of Papillary Craniopharyngiomas: The Need for an Accurate MRI-Surgical Correlation. AJNR Am J Neuroradiol 2015; 36:E55-6. [PMID: 26113067 DOI: 10.3174/ajnr.a4441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- J M Pascual
- Department of Neurosurgery La Princesa University Hospital Madrid, Spain
| | - R Prieto
- Department of Neurosurgery Puerta de Hierro University Hospital Madrid, Spain
| | | | - R Carrasco
- Department of Neurosurgery Ramón y Cajal University Hospital Madrid, Spain
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Davies R, Carrasco R, Foster HE, Baildam E, Chieng A, Davidson JE, Ioannou Y, Wedderburn L, Thomson W, Hyrich K. PP4. Treatment prescribing patterns in a cohort of patients with JIA: data from the Childhood Arthritis Prospective Study. Rheumatology (Oxford) 2015. [DOI: 10.1093/rheumatology/keu497] [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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Rashid A, Holliday K, Cordingley L, Carrasco R, Fu B, Foster HE, Baildum EM, Chieng A, Davidson JE, Wedderburn L, Hyrich KL, Thomson W. PP12. Predicting pain over time in JIA: results from the Childhood Arthritis Prospective Study. Rheumatology (Oxford) 2015. [DOI: 10.1093/rheumatology/keu505] [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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Gutierrez B, Alvarez E, Arrizon A, Carrasco R, Salinas-Chavira J, Zinn R. Influence of high-oil algae biomass as a feed intake and growth-performance enhancer in feedlot cattle during period of high ambient temperature. Journal of Applied Animal Research 2015. [DOI: 10.1080/09712119.2015.1021804] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mora J, Cruz O, Lavarino C, Rios J, Vancells M, Parareda A, Salvador H, Suñol M, Carrasco R, Guillen A, Mañé S, de Torres C. Results of induction chemotherapy in children older than 18 months with stage-4 neuroblastoma treated with an adaptive-to-response modified N7 protocol (mN7). Clin Transl Oncol 2015; 17:521-9. [PMID: 25596034 DOI: 10.1007/s12094-014-1273-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 08/22/2014] [Accepted: 12/24/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE We report the response rate in children older than 18 months with stage 4 Neuroblastoma, using a modified dose-intensive, response-adaptive, induction mN7 protocol. METHODS From 2005 to 2012, 24 patients were treated with the mN7 protocol. Phase 1 included five MSKCC N7 cycles and surgery and two high-dose cyclophosphamide-topotecan (HD-CT) cycles for those who did not achieve complete remission (CR) and negative bone marrow (BM) minimal residual disease (MRD) status (CR+MRD-). Phase 2 consisted of myeloablative doses of topotecan, thiotepa and carboplatin plus hyperfractionated RT. Phase 3 included isotretinoin and 3F8 immunotherapy plus GM-CSF. BM MRD was monitored using GD2 synthase, PHOX2B and cyclin D1 mRNAs. RESULTS After 3 cycles, all patients showed BM complete histological clearance and 6 (25 %) were MRD-. Twenty of 21 s-look surgeries achieved macroscopic complete resection. After 5 cycles and surgery, (123)I-MIBG scan was negative in 15 (62.5 %) cases, BM disease by histology was negative in 23 (96 %) and 10 (42 %) patients were MRD-. Twelve (50 %) pts were in CR, 2 in very good partial response (VGPR), 9 partial response (PR) and one had progressive disease. With 2 HD-CT extra cycles, 17 (71 %) pts achieved CR+MRD- status moving to phase 2. Overall and event-free survival at 3 years for the 17 patients who achieved CR+MRD- is 65 and 53 %, respectively, median follow-up 47 months. Seven (29 %) patients never achieved CR+MRD-. Univariate Cox regression analysis shows CR+MRD- status after mN7 induction as the only statistically significant prognostic factor to predict overall survival. CONCLUSIONS mN7 induction regimen produced a CR+MRD- rate of 71 %. CR+MRD- status following induction was the only predictive marker of long-term survival.
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Affiliation(s)
- J Mora
- Department of Oncology, Hospital Sant Joan de Déu, Barcelona, Passeig Sant Joan de Déu, 2, Esplugues de Llobregat, 08950, Barcelona, Spain,
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Carrasco R, Singh J, Adams GP. 171 EXPRESSION OF THE OVULATION-INDUCING FACTOR/NERVE GROWTH FACTOR HIGH AFFINITY RECEPTOR IN THE OVARIES OF COWS DURING THE PERIOVULATORY PERIOD. Reprod Fertil Dev 2015. [DOI: 10.1071/rdv27n1ab171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Ovulation-inducing factor/nerve growth factor (OIF/NGF) influences ovulation and corpus luteum (CL) size and function in camelids and, remarkably, cows. The ovulation effect in induced ovulators is mediated at the hypothalamo-pituitary-axis, but the site and mechanism of action of the luteotrophic effect is unknown. This mechanism may be an important aspect of OIF/NGF in spontaneous-ovulators. The objective of this experiment was to detect changes in expression of the high affinity OIF/NGF receptor (TrkA) in the ovary during the periovulatory period in cattle. Cows (n = 14) were examined daily by transrectal ultrasonography to determine the day of ovulation (Day 0), and were assigned randomly to be unilaterally ovariectomized on Day 2, 4, 6, or in the preovulatory period before or after the LH surge. Cows assigned to preovulatory groups were given a luteolytic dose of prostaglandin when the dominant follicle of the second follicular wave was ≥10 mm and growing. Cows assigned to the pre-LH group were ovariectomized 24 h after prostaglandin treatment. Cows assigned to the post-LH group were given LH 24 h after prostaglandin treatment and were ovariectomized 18–20 h later. Cows were allowed to rest for one complete interovulatory interval and re-assigned to a different day-group on which the remaining ovary was removed (n = 4 to 5 ovaries/day-group). Ovaries were fixed in paraformaldehyde, and 5-μm sections of ovarian tissue representing the dominant follicle, largest subordinate follicle, and the CL were treated for enzymatic antigen retrieval and blocked in 1% BSA for 1 h. Slides were incubated overnight with the primary antibody (rabbit anti-human TrkA) and for 2 h with the secondary antibody (goat anti-rabbit IgG). Slides were evaluated by fluorescence microscopy. Images of 3 arbitrarily chosen fields (40×) were captured for each structure for each day-group, and the average proportion of immunoreactive cells in the theca layer and luteal tissue was estimated using ImageJ software (National Institutes of Health, Bethesda, MD, USA). The intensity of individual cell immunofluorescence was also scored as no reaction (0), faint (1), weak to moderate (2), or strong (3). Data were compared among groups by two-way ANOVA. The proportion of immunoreactive cells was higher in the dominant follicle than in the subordinate follicle or the CL (P < 0.001); no effect of day-group or interaction was detected. The intensity score increased from faint on Day 2 to strong on Day 6, and remained strong in the pre- and post-LH groups. A discernible pattern of change in intensity score was not evident for the subordinate follicle or the CL. The greater proportion of TrkA positive cells and greater immunoreactive intensity in the maturing dominant follicle support the hypothesis that the luteotrophic effect of OIF/NGF in cattle is a result of a local increase in the expression of TrkA in the theca layer of the dominant follicle.
Research was supported by the Natural Sciences and Engineering Research Council of Canada.
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Davies R, Carrasco R, Foster HE, Baildam E, Chieng A, Davidson JE, Ioannou Y, Wedderburn L, Thomson W, Hyrich K. Treatment prescribing patterns in a cohort of patients with juvenile idiopathic arthritis (JIA). Data from the childhood arthritis prospective study (CAPS). Pediatr Rheumatol Online J 2014. [PMCID: PMC4184207 DOI: 10.1186/1546-0096-12-s1-p23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Mcerlane F, Foster HE, Carrasco R, Baildam E, Chieng SEA, Davidson J, Ioannou Y, Weddurburn LR, Thomson W, Hyrich KL. Trends in paediatric rheumatology referral times and disease activity indices over a ten-year period among children with juvenile idiopathic arthritis: results from the childhood arthritis prospective study. Pediatr Rheumatol Online J 2014. [PMCID: PMC4184186 DOI: 10.1186/1546-0096-12-s1-p13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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