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Benavides M, Alcaide-Garcia J, Torres E, Gil-Calle S, Sevilla I, Wolman R, Durán G, Álvarez M, Reyna-Fortes C, Ales I, Pereda T, Robles M, Kushnir M, Odegaard J, Faull I, Alba E. Clinical utility of comprehensive circulating tumor DNA genotyping compared with standard of care tissue testing in patients with newly diagnosed metastatic colorectal cancer. ESMO Open 2022; 7:100481. [PMID: 35525184 PMCID: PMC9271474 DOI: 10.1016/j.esmoop.2022.100481] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Comprehensive biomarker testing is essential in selecting optimal treatment for patients with metastatic colorectal cancer (mCRC); however, incomplete genotyping is widespread, with most patients not receiving testing for all guideline-recommended biomarkers, in part due to reliance on burdensome sequential tissue-based single-biomarker tests with long waiting times or availability of only archival tissue samples. We aimed to demonstrate that liquid biopsy, associated with rapid turnaround time (TAT) and lower patient burden, effectively identifies guideline-recommended biomarkers in mCRC relative to standard of care (SOC) tissue testing. PATIENTS AND METHODS Prospectively enrolled patients with previously untreated mCRC undergoing physician discretion SOC tissue genotyping submitted pretreatment blood samples for comprehensive circulating tumor DNA (ctDNA) analysis with Guardant360 and targeted RAS and BRAF analysis with OncoBEAM. RESULTS Among 155 patients, physician discretion SOC tissue genotyping identified a guideline-recommended biomarker in 82 patients, versus 88 identified with comprehensive ctDNA (52.9% versus 56.8%, noninferiority demonstrated down to α = 0.005) and 69 identified with targeted PCR ctDNA analysis (52.9% versus 44.5%, noninferiority rejected at α = 0.05). Utilizing ctDNA in addition to tissue increased patient identification for a guideline-recommended biomarker by 19.5% by rescuing those without tissue results either due to tissue insufficiency, test failure, or false negatives. ctDNA median TAT was significantly faster than tissue testing when the complete process from sample acquisition to results was considered (median 10 versus 27 days, P < 0.0001), resulting in accelerated biomarker discovery, with 52.0% biomarker-positive patients identified by ctDNA versus 10.2% by SOC tissue 10 days after sample collection (P < 0.0001). CONCLUSIONS Comprehensive ctDNA genotyping accurately identifies guideline-recommended biomarkers in patients with mCRC at a rate at least as high as SOC tissue genotyping, in a much shorter time. Based on these findings, the addition of ctDNA genotyping to clinical practice has significant potential to improve the care of patients with mCRC.
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Affiliation(s)
- M Benavides
- Medical Oncology Intercenter Unit, Hospital Universitario Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - J Alcaide-Garcia
- Medical Oncology Intercenter Unit, Hospital Universitario Regional y Virgen de la Victoria, IBIMA, Málaga, Spain; Medical Oncology Department, Hospital Costa del Sol, IBIMA, Málaga, Spain.
| | - E Torres
- Medical Oncology Intercenter Unit, Hospital Universitario Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - S Gil-Calle
- Medical Oncology Intercenter Unit, Hospital Universitario Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - I Sevilla
- Medical Oncology Intercenter Unit, Hospital Universitario Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - R Wolman
- Medical Oncology Service, Hospital Xanit, Málaga, Spain
| | - G Durán
- Medical Oncology Intercenter Unit, Hospital Universitario Regional y Virgen de la Victoria, IBIMA, Málaga, Spain; Medical Oncology Department, Hospital Universitario San Cecilio, Granada, Spain
| | - M Álvarez
- Cancer Molecular Biology Laboratory (CIMES), University of Málaga, Málaga, Spain
| | - C Reyna-Fortes
- Medical Oncology Intercenter Unit, Hospital Universitario Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - I Ales
- Medical Oncology Intercenter Unit, Hospital Universitario Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - T Pereda
- Pathology Department, Hospital Costa del Sol, IBIMA, Marbella, Spain
| | - M Robles
- Medical Oncology Department, Hospital Costa del Sol, Marbella, Spain
| | | | | | - I Faull
- Guardant Health Inc, Redwood, USA
| | - E Alba
- Medical Oncology Intercenter Unit, Hospital Universitario Regional y Virgen de la Victoria, IBIMA, CIBERONC, Málaga, Spain
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Benavides M, Alcaide-Garcia J, Torres E, Gil S, Durán G, Reyna C, Wolman R, Alvarez M, Kushnir M, Faull I, Muñoz M, Alba E. 503P Mutational landscape in synchronous unresectable metastatic colorectal cancer (mCRC) according to upfront primary tumour resection (UPTR). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1022] [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: 11/28/2022] Open
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Wyon MA, Wolman R, Martin C, Galloway S. The efficacy of different vitamin D supplementation delivery methods on serum 25(OH)D: A randomised double-blind placebo trial. Clin Nutr 2020; 40:388-393. [PMID: 32703720 DOI: 10.1016/j.clnu.2020.05.040] [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: 03/31/2020] [Revised: 05/20/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The use of vitamin D supplementation has increased due to greater recognition of widespread deficiency. AIMS There has been little research on the effectiveness of different delivery methods and therefore the aim of was to test the efficacy of different delivery methods on serum 25(OH)D. METHODS Using a randomised repeated measures double-blind placebo design (registered under ClinicalTrials.gov Identifier no. NCT03463642), changes in serum 25(OH)D over a 4-week period using a capillary spot method were monitored. 62 female participants blindly chose a number related to a supplementation delivery method: pill placebo, pill, oral liquid, oral liquid placebo, Skin oil application (SOA) placebo, SOA plus vitamin D3 suspension, or SOA plus vitamin D3 suspension with essential oil enhancer; active vitamin D supplements contained 100,000IU. Participants took their allocated supplements over a 24-hr period with serum 25(OH)D retested 4 weeks later. Liquid chromatography-tandem mass spectrometry method was applied to dried blood spot samples by an independent laboratory. RESULTS ANCOVA reported a significant difference between the groups (F1,6 = 146.68; p < 0.001, eta2 = 0.51). Separate analysis within the delivery methods (pill, SOA, oral liquid) indicated significant differences between the active and placebo supplementation groups (p < 0.01). Post hoc analysis of absolute changes indicated vit D pill and SOA + vit D + essential oil had significant increases (p < 0.05) in serum 25(OH)D compared to all other interventions with no significant difference between them. CONCLUSIONS In human participants vitamin D oral pill has the greatest effect on serum 25(OH)D levels. Skin oil application delivery of vitamin D using a penetrator enhancer has also been shown to be an effective method of delivery.
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Affiliation(s)
- M A Wyon
- Sport and Physical Activity Research Centre, Institute of Sport and Health Sciences, University of Wolverhampton, UK
| | - R Wolman
- Department of Rheumatology and Sport and Exercise Medicine, Royal National Orthopaedic Hospital, Stanmore, UK
| | - C Martin
- Worcester Biomedical Science Research Group, Institute of Science and the Environment, St. John's Campus, University of Worcester, Henwick Grove, Worcester, WR2 6AJ, UK.
| | - S Galloway
- Sport and Physical Activity Research Centre, Institute of Sport and Health Sciences, University of Wolverhampton, UK
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Benavides M, Alcaide J, Alvarez M, Torres E, Sevilla I, Gil Calle S, Reyna C, Alés I, Durán G, Wolman R, Cazorla M, Jimenez Gallego P, López I, Cantero A, Godoy A, Lanman RB, Faull I, Odegaard J, Kim IJ, Alba E. Clinical utility of comprehensive circulating tumor DNA (ctDNA) testing compared to standard-of-care (SoC) tissue testing in first-line (1L) metastatic colorectal cancer (mCRC) patients (pts). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
15 Background: Accurate genotyping is mandatory for the management of mCRC pts. Tissue-based testing is still the SoC; however, is not available for all pts. and may be exhausted by serial testing, resulting in incomplete genotyping. We aimed to establish the validity of comprehensive non-invasive ctDNA testing in 1L mCRC pts for whom SoC tissue genotyping was available. Methods: 1L mCRC pts were tested with a comprehensive ctDNA test (Guardant360), a RAS ctDNA test (OncoBeam), and SoC tissue testing at the time of diagnosis. The primary endpoint was NCCN guideline biomarker discovery rate ( KRAS, NRAS, and BRAF mutations, ERBB2 amplification, and microsatellite instability). Results: In 91 evaluable pts, the biomarker discovery rate was 54.9% (50/91) for SoC tissue testing, 59.3% (54/91) for comprehensive ctDNA testing ( p= 0.0318 for non-inferiority vs. SoC), and 42.9% (39/91) for RAS ctDNA testing (inferiority not rejected vs. SoC). Both comprehensive and RAS ctDNA testing showed high positive agreement (85%, 44/52, and 86%, 31/36) and negative agreement (96%, 268/279, and 93%, 93/100) relative to SoC tissue testing at the gene level. Expanding genotyping beyond KRAS codon 12/13 mutations increased biomarker discovery rate by 56% for tissue testing (50/91 vs. 32/91, McNemar’s p< 0.0001) and by 64% for comprehensive ctDNA (54/91 vs. 33/91, McNemar’s p< 0.0001). Turnaround time was significantly shorter for comprehensive ctDNA testing vs. SoC tissue testing (mean 11.7 days vs. 23.0 days, paired T-test p= 0.0002). On retrospective analysis, 92% of biomarker-positive pts would have been identified at 2 weeks using the comprehensive ctDNA test for initial genotyping with reflex to tissue for biomarker-negative pts, whereas initial use of SoC tissue testing would have identified only 85% of positive pts at 4 weeks (Fisher’s exact p< 0.0001). Conclusions: As previously reported for lung cancer, comprehensive ctDNA testing in 1L mCRC identifies at least as many biomarker-positive pts as SoC tissue genotyping with high concordance to tissue and in half the turnaround time.
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Affiliation(s)
- Manuel Benavides
- Hospital Universitario Regional y Virgen de la Victoria, Málaga, Spain
| | | | - Martina Alvarez
- Hospital Universitario Regional y Virgen de la Victoria, Málaga, Spain
| | - Esperanza Torres
- Hospital Universitario Regional y Virgen de la Victoria, Málaga, Spain
| | - Isabel Sevilla
- Hospital Universitario Regional y Virgen de la Victoria, Málaga, Spain
| | - Silvia Gil Calle
- Hospital Universitario Regional y Virgen de la Victoria, Málaga, Spain
| | - Carmen Reyna
- Hospital Universitario Regional y Virgen de la Victoria, Málaga, Spain
| | - Inmaculada Alés
- Hospital Universitario Regional y Virgen de la Victoria, Málaga, Spain
| | - Gema Durán
- Hospital Universitario Regional y Virgen de la Victoria, Málaga, Spain
| | | | - Mireya Cazorla
- Hospital Universitario Regional y Virgen de la Victoria, Málaga, Spain
| | | | - Irene López
- Hospital Universitario Regional y Virgen de la Victoria, Málaga, Spain
| | - Alexandra Cantero
- Hospital Universitario Regional y Virgen de la Victoria, Málaga, Spain
| | - Ana Godoy
- Hospital Universitario Regional y Virgen de la Victoria, Málaga, Spain
| | | | | | | | | | - Emilio Alba
- Hospital Universitario Regional y Virgen de la Victoria, Málaga, Spain
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Weiler R, Ingram M, Wolman R. [Osgood-Schlatter disease]. Praxis (Bern 1994) 2011; 100:1369-1370. [PMID: 22048913 DOI: 10.1024/1661-8157/a000715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- R Weiler
- Arzt für Sport- und Bewegungsmedizin, Homerton University Hospital Foundation Trust, London.
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Wolman R, Keen J, Miller V, Boyd R. Basil Wolman. West J Med 2010. [DOI: 10.1136/bmj.c3832] [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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Abraham R, Walton J, Russell L, Wolman R, Wardley-Smith B, Green JR, Mitchell A, Reeve J. Dietary determinants of post-menopausal bone loss at the lumbar spine: a possible beneficial effect of iron. Osteoporos Int 2006; 17:1165-73. [PMID: 16758136 DOI: 10.1007/s00198-005-0033-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2004] [Accepted: 10/20/2005] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Previous studies suggesting different effects of diet on post-menopausal bone loss may have given conflicting results because they sometimes failed to exclude confounding conditions or used imprecise methodology. DESIGN To identify dietary determinants of bone loss from the lumbar spine after menopause in women not taking hormone replacement who developed no evidence of spondylotic or sclerotic degenerative disease, forty-three women were followed with repeated (mean = 12) measurements of bone mineral density (BMD) at L2-4 for 11-14 years. Eleven developed evidence suggestive of degenerative disease and were excluded. Diet was assessed at the beginning of the study and 2.5 years later using 3-day and 7-day periods of weighed intakes. Nutrients estimated were: carbohydrate, fat, protein, fibre, calcium, magnesium, iron, phosphorus, copper, zinc and six vitamins. We tested the ability of diet to predict post-menopausal bone loss using stepwise regression. RESULTS Each woman's BMD change was described by a single coefficient after log transformation of the BMD data. The best model for BMD loss including dietary factors alone had two significant determinants: daily energy or protein (p=0.0003) intake was adverse, while dietary iron (p=0.002) was predictive of bone maintenance, an effect that persisted if iron was expressed as a ratio to energy intake. Adding body mass index to the model increased the goodness of fit (R (2)adj rose from 0.33 to 0.42) without affecting the statistical significance of the dietary determinants. CONCLUSIONS Diet may influence bone loss after menopause, with dietary iron (or an associated factor) possibly having a protective effect on bone at the spine.
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Abstract
OBJECTIVE Synchronised swimming is a sport that shares certain characteristics with other aesthetically pleasing sports such as gymnastics and dance. The purpose of this investigation was to ascertain whether the highest ranked synchronised swimmers in the United Kingdom experience menstrual abnormalities, a common medical problem seen in these related activities. METHODS Twenty three members of the Great Britain synchronised swimming squad completed a questionnaire on menstrual history. Body composition and VO(2)MAX were measured in the laboratory during regular physiological screening. RESULTS Three of the 23 subjects were oligomenorrhoeic and none were amenorrhoeic. All were postmenarchal. Mean estimated body fat percentage was 23%, and mean VO(2)MAX was 47.2 ml/kg/min. CONCLUSIONS It appears that synchronised swimmers in the United Kingdom are relatively protected from menstrual disturbances for reasons that cannot be explained in isolation.
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Affiliation(s)
- R Ramsay
- British Olympic Medical Centre, London, UK.
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Reeve J, Walton J, Russell LJ, Lunt M, Wolman R, Abraham R, Justice J, Nicholls A, Wardley-Smith B, Green JR, Mitchell A. Determinants of the first decade of bone loss after menopause at spine, hip and radius. QJM 1999; 92:261-73. [PMID: 10615481 DOI: 10.1093/qjmed/92.5.261] [Citation(s) in RCA: 23] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This study documented bone loss at three different sites in the early postmenopausal period, and examined potential predictors. Forty-three women underwent repeated measurements of bone density at the lumbar spine, proximal femur and distal radius for up to 14 years. Individual rates of bone loss were calculated for the spine and hip; for radial trabecular bone, rates were calculated separately for two time periods, earlier and later after menopause. In the spine and radius, initially high rates of loss diminished with time after menopause. No positive correlations for bone loss were found between the three sites, suggesting that faster than average bone loss was specific to individual bones. High body mass index (BMI) was significantly protective against fast bone loss at the spine and radius; in the spine, each unit increase in BMI was associated with a approximately 5% reduction in the rate of bone loss. Of the other variables measured (maximum oxygen consumption, lean body mass, fat mass, mean psoas muscle area at the L3 level, hand grip strength as well as anthropometry) only bone densitometry was sufficiently predictive to help guidance on hormone replacement or other prophylactic therapy. The data suggest that the known relationship between excessive leanness and risk of osteoporosis and vertebral fracture after menopause might in part be due to fast post-menopausal bone loss. Because bulk of psoas muscle was associated with low spine loss rates, the data also support a role for applied muscular loading in local maintenance of bone density.
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Affiliation(s)
- J Reeve
- University of Cambridge Department of Medicine, Northwick Park Hospital, UK.
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10
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Abstract
Exercise is known to have long-term benefits on bone mass, but little is known about the short-term effects of exercise on bone turnover. The purpose of this study was to investigate whether acute effects of exercise on bone remodelling could be detected by measuring blood and urinary markers of bone turnover. We measured biochemical markers of bone turnover in ten healthy, young men before and up to 32 hours after 30 minutes of brisk treadmill walking. Blood samples were taken before, immediately after and at 0.5, 1, 8, 24 and 32 hours after the exercise. These were assayed for osteocalcin and bone specific alkaline phosphatase. Twenty-four hour urine samples were taken over three days (day before, day of and day after exercise) and measured for pyridinoline and deoxypyridinoline crosslinks. Crosslink excretion was standardised for total body bone mineral content (TBBMC) and urinary creatinine. Total body bone mineral density (and content) and body composition were measured by dual energy X-ray absorptiometry. No changes in the levels of either osteocalcin or alkaline phosphatase were seen at any time point following the exercise. Both urinary crosslinks exhibited an increase in levels on the day of the exercise and a further significant increase the day after (pyridinoline 38.7%, p = 0.05; deoxypyridinoline 42.3%, p = 0.025; median, corrected for TBBMC). There were significant negative correlations between the crosslinks, osteocalcin and body fat percentage. In conclusion, the exercise appears to have stimulated bone resorption within 32 hours of moderate exercise, but there was no measurable effect on bone formation after 32 hours. A longer study period may be necessary to detect changes in bone formation.
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Affiliation(s)
- L Welsh
- Imperial College School of Medicine at St. Mary's, London, United Kingdom
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Roach GW, Kanchuger M, Mangano CM, Newman M, Nussmeier N, Wolman R, Aggarwal A, Marschall K, Graham SH, Ley C. Adverse cerebral outcomes after coronary bypass surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. N Engl J Med 1996; 335:1857-63. [PMID: 8948560 DOI: 10.1056/nejm199612193352501] [Citation(s) in RCA: 1215] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Acute changes in cerebral function after elective coronary bypass surgery is a difficult clinical problem. We carried out a multicenter study to determine the incidence and predictors of -- and the use of resources associated with -- perioperative adverse neurologic events, including cerebral injury. METHODS In a prospective study, we evaluated 2108 patients from 24 U.S. institutions for two general categories of neurologic outcome: type I (focal injury, or stupor or coma at discharge) and type II (deterioration in intellectual function, memory deficit, or seizures). RESULTS Adverse cerebral outcomes occurred in 129 patients (6.1 percent). A total of 3.1 percent had type I neurologic outcomes (8 died of cerebral injury, 55 had nonfatal strokes, 2 had transient ischemic attacks, and 1 had stupor), and 3.0 percent had type II outcomes (55 had deterioration of intellectual function and 8 had seizures). Patients with adverse cerebral outcomes had higher in-hospital mortality (21 percent of patients with type I outcomes died, vs. 10 percent of those with type II and 2 percent of those with no adverse cerebral outcome; P<0.001 for all comparisons), longer hospitalization (25 days with type I outcomes, 21 days with type II, and 10 days with no adverse outcome; P<0.001), and a higher rate of discharge to facilities for intermediate- or long-term care (69 percent, 39 percent, and 10 percent ; P<0.001). Predictors of type I outcomes were proximal aortic atherosclerosis, a history of neurologic disease, and older age; predictors of type II outcomes were older age, systolic hypertension on admission, pulmonary disease, and excessive consumption of alcohol. CONCLUSIONS Adverse cerebral outcomes after coronary bypass surgery are relatively common and serious; they are associated with substantial increases in mortality, length of hospitalization, and use of intermediate- or long-term care facilities. New diagnostic and therapeutic strategies must be developed to lessen such injury.
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Affiliation(s)
- G W Roach
- Kaiser Permanente Medical Center, San Francisco, CA, USA
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Newman MF, Wolman R, Kanchuger M, Marschall K, Mora-Mangano C, Roach G, Smith LR, Aggarwal A, Nussmeier N, Herskowitz A, Mangano DT. Multicenter preoperative stroke risk index for patients undergoing coronary artery bypass graft surgery. Multicenter Study of Perioperative Ischemia (McSPI) Research Group. Circulation 1996; 94:II74-80. [PMID: 8901723] [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] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The paradox of present cardiac surgery is that the more elderly and debilitated patients benefit most from cardiac surgery compared with medical therapy, yet they sustain greater overall risk for morbidity and mortality after cardiac surgery. The goal of the present study was to develop a preoperative index predicting major perioperative neurological events in patients undergoing coronary artery bypass graft surgery. METHODS AND RESULTS As part of a prospective, multicenter, observational study (McSPI Research Group), we enrolled 2417 patients at 24 academic medical centers in the United States. Patients who died intraoperatively or had concomitant open-heart procedures were excluded from analysis, resulting in a total of 2107 for analysis. Sixty-eight patients (3.2%) developed adverse neurological events, defined as cerebrovascular accident, transient ischemic attack (TIA), or persistent coma. Bivariate analysis was applied to determine associations between preoperative variables and neurological events. Significant bivariate predictors were identified then logically grouped, and for each cluster, a score was calculated based on principal components. Key predictor variables were age, history of previous neurological disease, diabetes, history of vascular disease, previous coronary artery surgery, unstable angina, and history of pulmonary disease, the coefficients for which were used to develop a preoperative stroke risk index that was validated by bootstrap (c-index = 0.778). Stroke risk could then be determined for each patient, calculating a patient's risk for stroke within 95% confidence intervals. CONCLUSIONS With the McSPI stroke risk index developed in this study, neurological risk can be estimated, and the most appropriate group for perioperative therapy can be identified. Further refinement and validation of this index, however, are necessary and are under way in current studies.
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Affiliation(s)
- M F Newman
- Department of Anesthesiology, Duke Heart Center, Durham, NC, USA.
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Jain U, Body SC, Bellows W, Wolman R, Mangano CM, Mathew J, Youngs E, Wilson R, Zhang A, Mangano DT. Multicenter study of target-controlled infusion of propofol-sufentanil or sufentanil-midazolam for coronary artery bypass graft surgery. Multicenter Study of Perioperative Ischemia (McSPI) Research Group. Anesthesiology 1996; 85:522-35. [PMID: 8853082 DOI: 10.1097/00000542-199609000-00011] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The use of target-controlled infusions of anesthetics for coronary artery bypass graft surgery has not been studied in detail. The effects of target-controlled infusions of propofol or sufentanil, supplemented by infusions of sufentanil or midazolam, respectively, were evaluated and compared. METHODS At 14 clinical sites, 329 patients were given a target-controlled infusion of propofol (n = 165) to produce effect-site concentration (Ce) of > or = 3-micrograms/ml or a target-controlled infusion of sufentanil (n = 164). Sufentanil or midazolam, respectively, also were infused. Systolic hypertension, hypotension, tachycardia, and bradycardia were assessed by measuring heart rate and blood pressure every minute during operation. Myocardial ischemia was assessed perioperatively by monitoring ST segment deviation via continuous three-lead Holter electrocardiography, and it was evaluated during operation by monitoring left ventricular wall motion abnormality via transesophageal echocardiography. RESULTS The measured cardiovascular parameters were satisfactory and usually similar for the patients receiving propofol-sufentanil or sufentanil-midazolam. The primary endpoint of the percentage of patients with intraoperative ST segment deviation (23 +/- 6% vs. 24 +/- 6%, P = 0.86) did not differ significantly between the two groups. The incidence of left ventricular wall motion abnormality shown on transesophageal echocardiography before (19 +/- 4% vs. 26 +/- 4%, P = 0.25) and after (23 +/- 4% vs. 31 +/- 5%, P = 0.32) cardiopulmonary bypass also did not differ significantly for the two groups. Changes in intraoperative target concentration were more frequent with propofol-sufentanil anesthetic than with sufentanil-midazolam (11.7 +/- 7.1 vs. 7.3 +/- 3.6, P < 0.001). The incidence of intraoperative hypotension (77% vs. 55%, P < 0.001), the use of inotropic/vasopressor medications (93% vs. 84%, P = 0.01), and the administration of crystalloids (2.8 +/- 1.4 L vs. 2.4 +/- 1.2 L, P < 0.001) were significantly greater in the propofol-sufentanil group. Conversely, the incidence of intraoperative hypertension (43% vs. 54%, P = 0.05) and the use of antihypertensive/vasodilator medications (70% vs. 90%, P < 0.001) were significantly less in the propofol-sufentanil group. CONCLUSIONS Target-controlled infusions of propofol or sufentanil, supplemented by infusions of sufentanil or midazolam, respectively, were suitable to provide anesthesia for coronary artery bypass graft surgery. Continuous monitoring revealed a high prevalence of hemodynamic abnormalities. Despite greater hypotension in the propofol-sufentanil group and greater hypertension in the sufentanil-midazolam group, episodes of myocardial ischemia were similar for both groups and were not temporally related to episodes of hemodynamic abnormalities.
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Affiliation(s)
- U Jain
- Department of Anesthesia, University of California, San Francisco, USA.
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Harries M, Wolman R. Female athletes: their hormones, muscles, and bones. Lancet 1996; 347:1624. [PMID: 8667890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Jenkins PJ, Ibanez-Santos X, Holly J, Cotterill A, Perry L, Wolman R, Harries M, Grossman A. IGFBP-1: a metabolic signal associated with exercise-induced amenorrhoea. Neuroendocrinology 1993; 57:600-4. [PMID: 7690116 DOI: 10.1159/000126413] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Severe exercise in young females is a potent cause of menstrual irregularity, although the exact pathogenesis is currently unknown. We performed a cross-sectional endocrine and metabolic analysis of a group of elite athletes and dancers in order to establish which variable, if any, was specifically associated with changes in menstruation. By using a step-wise discriminant analysis, two independent predictors, elevated serum cortisol and insulin-like growth factor binding protein 1 (IGFBP-1) levels, were found to account for the majority (67%) of the variance. IGFBP-1 is a hepatic protein which is acutely and inversely regulated by insulin, and is thought to modulate the peripheral actions of IGF-1. While the change in serum cortisol may reflect activation of central stress pathways, these findings suggest for the first time that there is a second peripheral signal, IGFBP-1, which may relate the availability of metabolic fuels to the control of reproduction.
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Affiliation(s)
- P J Jenkins
- Department of Endocrinology, St. Bartholomew's Hospital, London, UK
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17
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Alexander L, Wolman R, Blache C, Grandy RP, Dyess D, Luterman A. Use of morphine sulfate (MS Contin) in patients with burns: a pilot study. J Burn Care Rehabil 1992; 13:581-3. [PMID: 1452594 DOI: 10.1097/00004630-199209000-00013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Morphine sulfate (MS Contin), a proven analgesic in the treatment of cancer pain and chronic benign pain, seems to be a good analgesic for the treatment of burn pain. MS Contin is morphine sulfate incorporated in a wax cellulose matrix delivery system. This wax cellulose delivery system gives MS Contin its duration of action. Ten patients were enrolled in an open-labeled, nonrandomized study. The study was designed to examine the analgesic efficacy of MS Contin in the burn population. Each patient remained in the study for 6 days. The efficacy of the analgesic regimen was subjectively measured by the visual pain scale. The MS Contin group was retrospectively compared with a group of patients who were given continuous intravenous infusions of morphine. The two groups were matched according to age, burn size, surgical procedures, and hospital stay. The analgesic qualities of MS Contin were comparable to those of continuous intravenous morphine sulfate infusions. MS Contin is a possible candidate for the treatment of patients with burn pain because of its analgesic qualities, oral dosing, and duration of action.
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Affiliation(s)
- L Alexander
- Department of Anesthesiology, University of South Alabama, Mobile 36617
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18
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Abstract
This two-group, repeated measures examination of the psychological impact of child custody contests on children reports a subset of data from an ongoing longitudinal study of 95 children and their parents from 43 divorcing families. The authors report clinical observations concerning children's experience of custody litigation, as well as comparisons of baseline and post-test responses of contested and uncontested groups on measures of locus of control, separation anxiety and family concept. Contested children exhibited significantly greater internality of control orientation than the normative sample. Contested children's test scores also suggested significantly less separation anxiety and significantly more positive family concept than the uncontested group at post-test. The implications of these unanticipated findings are discussed.
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Affiliation(s)
- R Wolman
- Child Custody Research Project, Harvard Medical School, Cambridge, Massachusetts 02138
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19
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Affiliation(s)
- N J David
- Department of Internal Medicine, Coronation Hospital, Johannesburg, Republic of South Africa
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20
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Collinson PO, Rosalki SB, Flather M, Wolman R, Evans T. Early diagnosis of myocardial infarction by timed sequential enzyme measurements. Ann Clin Biochem 1988; 25 ( Pt 4):376-82. [PMID: 3214118 DOI: 10.1177/000456328802500409] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Serum samples from patients admitted to a coronary care unit with a history of acute chest pain suggestive of myocardial infarction in the previous 12 h were obtained on admission and at 6 and 12 h, thereafter. Creatine kinase (CK), CK-MB isoenzyme, CK-MM sub-bands, myoglobin, and lactate dehydrogenase (LD) isoenzymes were examined. Changes were evaluated in relation to the diagnosis obtained from clinical examination, serial electrocardiography and 'routine' cardiac enzymes (CK, aspartate transaminase and alpha-hydroxy butyrate dehydrogenase daily for 3 days following admission). The slope of the logarithms of CK, CK-MB activity and CK-MB concentration in the early post infarct period fully distinguished between infarct and non-infarct patients. Measurement of myoglobin and lactate dehydrogenase isoenzymes was less sensitive. Serial estimation of CK-MM sub-band patterns allowed the time from infarction to be estimated. Serial estimation of CK in the 12 h following admission can be substituted for conventional daily enzyme estimations for the diagnosis of acute myocardial infarction in patients with onset of chest pain within the previous 12 h. This could reduce laboratory and in-patient costs.
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Affiliation(s)
- P O Collinson
- Department of Chemical Pathology, Royal Free Hospital, School of Medicine, Hampstead, London, UK
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21
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Abstract
Systemic lupus erythematosus (SLE) is an autoimmune rheumatic disease that can affect most organs or systems. It most frequently involves the joints, skin, and the kidneys. It less commonly involves the central nervous system, heart, and lungs. Acute pancreatitis in SLE is rare. It is usually mild, occurring in association with more severe organ involvement elsewhere. A patient with newly diagnosed SLE is reported who developed acute fulminant pancreatitis unrelated to concomitant drug therapy and who eventually died of complications including a systemic fungal infection related to this.
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Affiliation(s)
- R Wolman
- Bloomsbury Rheumatology Department, Middlesex Hospital, London
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22
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23
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Levine MD, Wolman R, Oberklaid F, Pierson DE. The longitudinal study of findings in childhood. Analysis of an interdisciplinary process. Am J Dis Child 1982; 136:303-9. [PMID: 6176120 DOI: 10.1001/archpedi.1982.03970400021006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The Brookline Early Education Project provided periodic diagnostic assessments and individualized educational programs for approximately 300 children enrolled at birth in an attempt to reduce the prevalence of neglected health needs and school problems. A method, The Longitudinal Study of Findings, was developed to monitor and document diagnostic findings (determinations suggesting a possible service need). Each finding was rated for severity, treatability, and predictive value (potential impact on future function). At the 42-month-old check-point, 87% of children had at least one finding; there was a mean of 3.4 findings per child. Only 15% of findings had a high likelihood of treatability, and 12% were rated as highly predictive of later problems. Only 1.1% of findings were highly predictive and highly treatable. Whole certain categories of findings tended to prevail in isolation, others tended to coexist in the same child.
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24
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Gelfand ML, Hirschorn R, Wolman R, Kronzon I. Mitral-valve prolapse in a patient with translocation of chromosomes 14 and 18. N Engl J Med 1981; 305:1094. [PMID: 7278931 DOI: 10.1056/nejm198110293051820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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25
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Wolman R, Kepecs J. Ego measurements of patients and staff on a medical ward. Compr Psychiatry 1969; 10:334-40. [PMID: 4390222 DOI: 10.1016/0010-440x(69)90009-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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