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Eickman K, Maxwell R, McGinnis LK, Stanczyk F, Legro R, Lindheim SR. Total and bioavailable 25-hydroxyvitamin D is not associated with improved sexual dysfunction following vitamin D supplementation in women with polycystic ovarian syndrome: a pilot study. J Sex Med 2024; 21:240-247. [PMID: 38303661 PMCID: PMC10906494 DOI: 10.1093/jsxmed/qdad176] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 11/13/2023] [Accepted: 12/04/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Vitamin D (Vit D) deficiency has been linked to symptoms of polycystic ovary syndrome (PCOS), yet little is known about Vit D supplementation as a treatment for sexual dysfunction (SDy) in women with PCOS. AIM To explore the implications of serum total 25-hydroxyvitamin D (25[OH]D) and bioavailable 25[OH]D (bio-25[OH]D) status and replacement on women with PCOS and SDy. METHODS Reproductive-age women with PCOS who were not desiring fertility were eligible provided that they also had SDy, as assessed by the Female Sexual Function Index (FSFI), and were without severe depression, as evaluated by the Beck Depression Inventory II (BDI-II). Participants were given the recommended dietary allowance of Vit D (600 IU daily) plus hormonal contraception (HC; cyclic ethinyl estradiol/drospirenone) or no HC for 6 months. Comparisons between groups were analyzed by chi-square test and t-test, and Pearson's correlation coefficient analyzed correlations between FSFI with demographics, BDI-II, androgen levels, and total and bio-25[OH]D. OUTCOMES The outcomes included SDy (FSFI <26.55), total and serum bio-25[OH]D levels, and total and free testosterone. RESULTS A total of 42 women without severe depression completed the FSFI, with 28 (66.7%) having SDy. All FSFI domains, including arousal, lubrication, orgasm, and pain, were significantly lower as compared with women without SDy, with no associations with respect to demographics, total and free testosterone, or total and bio-25[OH]D. Vit D replacement was initiated with HC (n = 18) or no HC (n = 10), and for those completing the study, FSFI improved (score >26.55) in 61% (11/18) regardless of the treatment group. A time-treatment effect showed a significant change for the domain of orgasm, suggesting that HC had more of an impact than Vit D replacement. Improvement in sexual function as a dichotomous variable was not associated with age, body mass index, other demographics, total and free testosterone, total and bio-25[OH]D, or HC use. CLINICAL IMPLICATIONS Due to the prevalence of SDy in women with PCOS, efficacious treatment options are necessary. STRENGTHS AND LIMITATIONS This study is the first to analyze the effect of Vit D supplementation on SDy in women with PCOS. Limitations included the small number of participants who completed the study, thus limiting meaningful conclusions and generalizability. CONCLUSION Vit D status was not associated with SDy and BDI-II. While HC may have played a role, standard Vit D supplementation could not account for the noted improvement in FSFI in women with PCOS.
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Affiliation(s)
- Kira Eickman
- Department of Obstetrics and Gynecology, University of Central Florida, Orlando, FL 32827, United States
| | - Rose Maxwell
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Fairborn, OH 45324, United States
| | - Lynda K McGinnis
- Department of Obstetrics and Gynecology, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, United States
| | - Frank Stanczyk
- Department of Obstetrics and Gynecology, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, United States
| | - Richard Legro
- Department of Obstetrics and Gynecology, College of Medicine, Penn State University, State College, PA 16801, United States
| | - Steven R Lindheim
- Department of Obstetrics and Gynecology, University of Central Florida, Orlando, FL 32827, United States
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Fairborn, OH 45324, United States
- Center for Reproductive Medicine, Renji Hospital; School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
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Favors L, Harrell K, Miles V, Hicks RC, Rippy M, Parmer H, Edwards A, Brown C, Stewart K, Day L, Wilson A, Maxwell R. Analysis of fibrinolytic shutdown in trauma patients with traumatic brain injury. Am J Surg 2024; 227:72-76. [PMID: 37802703 DOI: 10.1016/j.amjsurg.2023.09.034] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/01/2023] [Accepted: 09/25/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Coagulation profiles following major trauma vary depending on injury pattern and degree of shock. The physiologic mechanisms involved in coagulation function at any given time are varied and remain poorly understood. Thromboelastography (TEG) has been used evaluate coagulation profiles in the trauma population with some reports demonstrating a spectrum of fibrinolysis to fibrinolytic shutdown on initial presentation. The objective of this study was to evaluate the fibrinolytic profile of patients with TBI using thromboelastography (TEG). We hypothesized that patients with TBI would demonstrate low fibrinolytic activity. METHODS All trauma activations at an ACS-verified level 1 trauma center received a TEG analysis upon arrival from December 2019 to June 2021. A retrospective review of the results and outcomes was conducted, and TBI patients were compared to patients without TBI. Linear regression was used to evaluate the effect of patient and injury factors on fibrinolysis. Hyperfibrinolysis was defined as LY30 > 7.7%, physiologic fibrinolysis as LY30 0.6-7.7%, and fibrinolytic shutdown as LY30 < 0.6%. RESULTS A total of 1369 patients received an admission TEG analysis. Patients with TBI had a significantly higher median ISS (16 vs. 8, p < 0.001), lower median admission Glasgow Coma Scale (14 vs. 15, p < 0.001), longer intensive care unit length of stay (3 vs. 2 days, p < 0.0001), increased ventilator days (216 vs. 183, p < 0.001), higher mortality (14.6% vs. 5.1%, p < 0.001), but lower shock index (0.6 vs. 0.7, p < 0.0001) compared to those without TBI. Median LY30 was found to be decreased in the TBI group (0.1 vs. 0.2, p = 0.0006). Patients with TBI were found to have a higher rate of fibrinolytic shutdown compared those without TBI (68.7% vs. 63.5%, p = 0.054). ISS, sex, and shock index were found to be predictive of LY30 on linear regression, but TBI was not (Β: 0.09, SE: 0.277, p = 0.745). The rate of DVT/PE did not appear to be elevated in patients with TBI (0.8%) and without TBI (1.2%). CONCLUSIONS Trauma patients with and without TBI were found to have high rates of fibrinolytic shutdown. Although there was a high incidence of fibrinolytic shutdown, it did not appear to have an impact on the rate of thrombotic complications. The clinical significance of these results is unclear and differs significantly from recent reports which demonstrated that TBI is associated with a 25% rate of fibrinolytic shutdown. Further investigation is needed to better define the fibrinolytic pathway in patients with trauma and TBI to develop optimal treatment algorithms.
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Affiliation(s)
- L Favors
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA.
| | - K Harrell
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA.
| | - V Miles
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA.
| | - R C Hicks
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA
| | - M Rippy
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA
| | - H Parmer
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA
| | - A Edwards
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA
| | - C Brown
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA
| | - K Stewart
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA
| | - L Day
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA
| | - A Wilson
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA
| | - R Maxwell
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA.
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Erekson E, Whitcomb EL, Kamdar N, Swift S, Cundiff GW, Yaklic J, Strohbehn K, Adam R, Danford J, Willis-Gray MG, Maxwell R, Edenfield A, Pulliam S, Gong M, Malek M, Hanissian P, Towers G, Guaderrama NM, Slocum P, Morgan D. Performance of Perioperative Tasks for Women Undergoing Anti-incontinence Surgery: Developed by the AUGS Quality Improvement and Outcomes Research Network. Urogynecology (Phila) 2023; 29:660-669. [PMID: 37490706 DOI: 10.1097/spv.0000000000001392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
OBJECTIVES Surgery for the correction of stress urinary incontinence is an elective procedure that can have a dramatic and positive impact on quality of life. Anti-incontinence procedures, like inguinal hernia repairs or cholecystectomies, can be classified as high-volume/low-morbidity procedures. The performance of a standard set of perioperative tasks has been suggested as one way to optimize quality of care in elective high-volume/low-morbidity procedures. Our primary objective was to evaluate the performance of 5 perioperative tasks-(1) offering nonsurgical treatment, (2) performance of a standard preoperative prolapse examination, (3) cough stress test, (4) postvoid residual test, and (5) intraoperative cystoscopy for women undergoing surgery for stress urinary incontinence-compared among surgeons with and without board certification in female pelvic medicine and reconstructive surgery (FPMRS). STUDY DESIGN This study was a retrospective chart review of anti-incontinence surgical procedures performed between 2011 and 2013 at 9 health systems. Cases were reviewed for surgical volume, adverse outcomes, and the performance of 5 perioperative tasks and compared between surgeons with and without FPMRS certification. RESULTS Non-FPMRS surgeons performed fewer anti-incontinence procedures than FPMRS-certified surgeons. Female pelvic medicine and reconstructive surgery surgeons were more likely to perform all 5 perioperative tasks compared with non-FPMRS surgeons. After propensity matching, FPMRS surgeons had fewer patients readmitted within 30 days of surgery compared with non-FPMRS surgeons. CONCLUSIONS Female pelvic medicine and reconstructive surgery surgeons performed higher volumes of anti-incontinence procedures, were more likely to document the performance of the 5 perioperative tasks, and were less likely to have their patients readmitted within 30 days.
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Affiliation(s)
| | | | | | - Steve Swift
- Medical University of South Carolina, Charleston, SC
| | | | - Jerome Yaklic
- University of Texas Medical Branch at Galveston, Galveston, TX
| | | | - Rony Adam
- Vanderbilt University Medical Center
| | | | | | | | | | | | - Merry Gong
- Surrey Memorial Hospital, University of British Columbia, Surrey, British Columbia, Canada
| | | | | | | | | | - Paul Slocum
- Premier Urogynecology of North Texas, Dallas, TX
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Maxwell R, Gunawardena S, Rasp J, Caldwell V. Community Healthy Workers Fill in the Gaps for Participants Who Became Lost to Follow-up in a Healthy Start Program. Matern Child Health J 2021; 25:1829-1835. [PMID: 34652596 DOI: 10.1007/s10995-021-03264-7] [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] [Accepted: 10/07/2021] [Indexed: 11/24/2022]
Abstract
The purpose of this mixed methods study was to solicit information from Community Health Workers (CHWs) in order to further understand reasons for Healthy Start participants becoming lost to follow-up after delivery. Four CHWs from a local Healthy Start Program completed questionnaires for participants in their caseloads who had become lost to follow-up from the program (n = 146) between Sep 2018 and Jan 2020. The questionnaire included open ended items about ease of contact before and after delivery, changes in contact information, compliance with prenatal care visits, other life challenges (such as housing, legal, transportation, and family support), family size, living arrangements, working/student status, and substance use. Participants were categorized by ease of contact throughout participation into Easy (28.8%), Easy then Difficult (11%) and Difficult (60.3%). Responses to questions were reviewed and coded to identify common themes. Groups differed on: having a change in contact information, having challenges with transportation, having lots of help, having other children between 6 and 10 years old, compliance with prenatal care, and race being non-Black. Areas where groups differed may indicate possible reasons for participants becoming lost to follow up after delivery. The descriptive results from this study can help CHWs address these issues with participants during prenatal care, when they are easier to contact, to develop contingency plans for remaining in contact after delivery.
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Affiliation(s)
- Rose Maxwell
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, 128 E. Apple Street, Weber CHE Suite 3800, Dayton, OH, 45409, USA.
| | - Sanuri Gunawardena
- Boonshoft School of Medicine, Wright State University, 3640 Colonel Glenn Hwy, Dayton, OH, 45435, USA
| | - Jordan Rasp
- Boonshoft School of Medicine, Wright State University, 3640 Colonel Glenn Hwy, Dayton, OH, 45435, USA
| | - Varonica Caldwell
- Five Rivers Health Centers, One Wyoming Street, Dayton, OH, 45409, USA
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Wyatt J, Howell E, McCallum H, Maxwell R. OC-0423 Developing quality assurance tests for simultaneous PET-MR imaging for radiotherapy planning. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06910-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Holland C, Wyatt J, Pearson R, Wintle T, Maxwell R. PO-1675 Automated delineation for MR-only prostate radiotherapy using a 2.5D convolutional neural network. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08126-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ruskó L, Czipczer V, Kolozsvári B, Deák-Karancsi B, Czabány R, Gyalai B, Hajnal D, Karancsi Z, Capala M, Verduijn G, Pearson R, Wyatt J, Borzasi E, Kelemen G, Kószó R, Paczona V, Végváry Z, Cozzini C, Tan T, Maxwell R, Hernandez Tamames J, Petit S, Mccallum H, Hideghéty K, Wiesinger F. OC-0093 Automated organ at risk delineation in T2w head and pelvis MR images for MR-only radiation therapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06787-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Challa A, Hayward L, Maxwell R, Burns K, Wijesekera V, Chan W. Emerging Treatment Options for the Systemic Right Ventricle: A Single Centre Experience of Sacubitril/Valsartan in Transposition of Great Arteries. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Maxwell R, Costache MC, Giarrosso A, Bosques C, Amin S. Optimizing interactions between soluble silk fibroin and capryl glucoside for design of a natural and high-performance co-surfactant system. Int J Cosmet Sci 2020; 43:68-77. [PMID: 33259636 DOI: 10.1111/ics.12676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/22/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Because of the strong consumer driver towards more natural or higher sustainability cosmetic products, silk fibroin was evaluated to help develop a formulation with natural and effective ingredients for personal care. In order to exploit the physical properties of silk fibroin, it was evaluated to maximize the surfactant properties of other commercial ingredients to lower surface tension and build up viscosity. A synergistic effect was seen between silk fibroin and capryl glucoside, a sugar surfactant which exhibited a natural and effective co-surfactant system. This system demonstrated better surface tension properties than sodium laureth sulphate (SLES), cocamidopropyl betaine (CAPB), rhamnolipids and sophorolipids, which led to greater foamability and cleansing properties. This system proved to also be compatible with polysaccharide viscosity modifiers to enhance the viscosity of the system. The present study comprises a systematic exploration of natural formulation development of silk proteins and other natural ingredients, which result in high performance such as enhanced foam quality, foam stability and enhanced sebum removal. All of these properties are desirable and may utilized when formulating cleaners and shampoos. METHODS A force tensiometer, Attension Sigma 701, was used to measure the surface tension of the silk protein and its various combinations with biosurfactants and biopolymers. To measure bulk rheology, a traditional mechanical rheometer TA DHR-3 was utilized. Foaming tests and sebum removal assays were also carried out to evaluate the performance of the samples. RESULTS Silk fibroin was evaluated to maximize the surfactant properties of other commercial systems to develop a formulation containing natural and effective ingredients for personal care. The surface activity of silk proteins was seen to be synergistically enhanced in the presence of sugar surfactants such as capryl glucoside, resulting in a surface tension at the air-water interface which is lower than either that of pure silk fibroin or pure capryl glucoside. This surface tension value is additionally lower than that obtained from currently utilized synthetic surfactants like sodium laureth sulphate (SLES) and cocamidopropyl betaine (CAPB). This reduction in surface tension demonstrated greater foamability and cleansing properties than that of the commercial systems. The very low surface tension values obtained through combinations of silk proteins and glucoside resulted in a natural and effective co-surfactant system by forming high-quality stable foams and enhancing sebum removal. The rheological performance of the silk proteins was impacted through microstructure modifications as a result of interactions with biopolymers like carrageenan. This shows that this system is compatible with polysaccharide viscosity modifiers. It was observed that both the flow curve and the absolute viscosity values were significantly impacted in the presence of carrageenan, with higher viscosity generation and significant non-Newtonian/shear thinning behaviour evolution. These results indicate that the silk fibroin can be utilized to build a high-performance natural product and significantly enhance the performance of other natural/sustainable cosmetic formulations through building synergistic interactions with other natural ingredients such as sugar surfactants and biopolymers. These properties exhibited by this system are all desirable for cleansers and shampoos within the cosmetic industry. CONCLUSION Silk fibroin in combination with capryl glucoside outperforms other commercial surfactants that are commonly used in the industry because of its surface-active behaviour and synergy. This system is then enhanced further with polysaccharide rheological modifiers, carrageen and xanthan gum to help build up viscosity. The complex mixture of silk fibroin, sugar surfactant and biopolymer results in a formulation that is all natural, while still having high performance by achieving great foamability and enhanced sebum removal. The mixture can further be used to formulate a fully natural product such as a cleanser or shampoo while still having the same or greater effectiveness as synthetic surfactants and ingredients typically used in cosmetic formulations.
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Affiliation(s)
- Rose Maxwell
- Department of Chemical Engineering, Manhattan College, Riverdale, NY, USA
| | - Marius C Costache
- Evolved by Nature, 196 Boston Ave., Suite 1100, Medford, MA, 02155, USA
| | - Abigail Giarrosso
- Evolved by Nature, 196 Boston Ave., Suite 1100, Medford, MA, 02155, USA
| | - Carlos Bosques
- Evolved by Nature, 196 Boston Ave., Suite 1100, Medford, MA, 02155, USA
| | - Samiul Amin
- Department of Chemical Engineering, Manhattan College, Riverdale, NY, USA
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Lindheim SR, Lincenberg K, Wood MA, Kemner E, Burns MK, Hood DL, Maxwell R, Lee M. The Impact of Hysteroscopic Tissue Removal Systems on Histopathologic Analysis for Benign and Cancerous Endometrial Pathology: An Ex Vivo Study. J Obstet Gynaecol India 2019; 69:182-187. [PMID: 31686754 DOI: 10.1007/s13224-018-1177-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022] Open
Abstract
Objective To assess the impact of hysteroscopic tissue removal systems (TRS) on histopathology tissue diagnosis. Measurements and Methods This is a paired-comparison ex vivo study in which 23 endometrial sections from hysterectomized uteri (13 benign and 10 hyperplasia/cancer) were analyzed in a simulation laboratory center at a university teaching hospital. After routine tissue processing, a section of endometrium was provided for ex vivo TRS with suture mounting to a uterine model (Polly, Remedy). Morcellated specimens using the Hologic® MyoSure hysteroscopic device were processed for histopathologic analysis by two blinded pathologists (Pa and Pb) and compared to the original specimens' tissue diagnoses. Results Sufficient tissue for evaluation was found in 100% (23/23) of TRS specimens by Pa and 91.3% by Pb. TRS specimen diagnoses were concordant with routine histologic diagnosis 86.9% (20/23, k = 0.76) for Pa and 80.9% (17/21, k = 0.68) for Pb. Sensitivity and specificity were 70%/100% for Pa and 80%/91% for Pb, respectively. The false-positive (overdiagnosed) and false-negative rates (underdiagnosed) were 0%/30% and 9%/20% for Pa and Pb. Both Pa and Pb underdiagnosed most specimens confirmed by routine tissue diagnosis. TRS specimen diagnoses between Pa and Pb were concordant in 76.2% (16/21, k = 0.60). Conclusion TRS may adversely impact the ability to provide a histologic tissue analysis. Up to 30% of samples were overdiagnosed and 20% underdiagnosed. If confirmed, pathologists may need to reassess workflows to better offset potential underdiagnosis of malignant specimens as findings may be obscured through TRS. Additionally, surgeons may need to reconsider specimen handling, so highest yield specimens are provided to pathology.
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Affiliation(s)
- Steven R Lindheim
- 1Division of Reproductive Endocrine Infertility, Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, 128 Apple St; Suite 3800 Weber CHE, Dayton, OH 45409 USA
| | - Kimberly Lincenberg
- 1Division of Reproductive Endocrine Infertility, Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, 128 Apple St; Suite 3800 Weber CHE, Dayton, OH 45409 USA
| | - Michelle A Wood
- Camran Nezhat Institute, 900 Welch Road, Palo Alto, CA 94304 USA
| | - Emily Kemner
- 1Division of Reproductive Endocrine Infertility, Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, 128 Apple St; Suite 3800 Weber CHE, Dayton, OH 45409 USA.,2Department of Obstetrics and Gynecology, Wright-Patterson Medical Center, Wright-Patterson Air Force Base, 4881 Sugar Maple Dr, Dayton, OH 45433 USA
| | - Megan K Burns
- Camran Nezhat Institute, 900 Welch Road, Palo Alto, CA 94304 USA
| | - Daniel L Hood
- 4Department of Pathology, Miami Valley Hospital, Dayton, OH USA
| | - Rose Maxwell
- 1Division of Reproductive Endocrine Infertility, Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, 128 Apple St; Suite 3800 Weber CHE, Dayton, OH 45409 USA
| | - Miryoung Lee
- 5Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Brownsville, TX USA
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Gürkov R, Jerin C, Flatz W, Maxwell R. [Superior canal dehiscence syndrome : Diagnosis with vestibular evoked myogenic potentials and fremitus nystagmus. German version]. HNO 2019; 66:390-395. [PMID: 29362817 DOI: 10.1007/s00106-017-0440-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Superior canal dehiscence syndrome (SCDS) is a relatively rare neurotological disorder that is characterized by a heterogeneous clinical picture. Recently, vestibular evoked myogenic potential (VEMP) measurementwas established for the diagnosis of SCDS. In the present study, a case series of patients with SCDS were analyzed, with a focus on VEMP. METHODS Four patients with SCDS were prospectively examined with ocular VEMP (oVEMP) and cervical VEMP (cVEMP). The clinical features and the standard audiovestibular test battery results are summarized and analyzed. The diagnostic accuracy of VEMP testing is evaluated. RESULTS The increased oVEMP amplitudes had a specificity of 100% in this patient population. All patients had normal caloric function and head impulse testing. The Tullio sign was observed in two patients. Three patients had autophony. The airbone gap was not greater than 10 dB in any of the patients. Two patients had marked fremitus nystagmus. All patients had a bony dehiscence of the superior semicircular canal on computed tomography imaging. CONCLUSION The subjective and clinical features in this case series of SCDS patients were heterogeneous. However, objective oVEMP testing had the highest diagnostic value. Furthermore, we describe a new diagnostic clinical sign: fremitus nystagmus.
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Affiliation(s)
- R Gürkov
- Klinik für Hals-Nasen-Ohren-Heilkunde, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
| | - C Jerin
- Klinik für Hals-Nasen-Ohren-Heilkunde, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - W Flatz
- Institut für Klinische Radiologie, Ludwig-Maximilians-Universität München, München, Deutschland
| | - R Maxwell
- Klinik für Hals-Nasen-Ohren-Heilkunde, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
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Wyatt J, Petrides G, Kelly C, Maxwell R, Plummer R, Pearson R. EP-1859 Investigating the feasibility of boosting 18FFLT-PET-CT volumes to 75 Gy in oropharyngeal cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32279-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Campi S, Pandit H, Hooper G, Snell D, Jenkins C, Dodd CAF, Maxwell R, Murray DW. Ten-year survival and seven-year functional results of cementless Oxford unicompartmental knee replacement: A prospective consecutive series of our first 1000 cases. Knee 2018; 25:1231-1237. [PMID: 30150067 DOI: 10.1016/j.knee.2018.07.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 06/11/2018] [Accepted: 07/17/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cementless fixation is an alternative to cemented unicompartmental knee replacement (UKR), with several advantages over cementation. This study reports the ten-year survival and seven-year clinical outcome of cementless Oxford unicompartmental knee replacement (OUKR). METHODS This prospective study describes the clinical outcome and survival of the first 1000 consecutive cementless medial OUKRs implanted at two centres for recommended indications. RESULTS The 10-year survival was 97% (CI 95%: 92-100%), with 25 knees being revised. The commonest reason for revision was progression of arthritis laterally, which occurred in nine knees, followed by primary dislocation of the bearing, which occurred in six knees. There were two dislocations secondary to trauma and a ruptured ACL, and two tibial plateau fractures. Although there were no definite cases of aseptic loosening, two early revisions were related to tibial fixation: one for pain and a radiolucent line and one for incomplete seating of the component with a radiolucent line. There were four revisions for pain, but the cause of the pain was uncertain: in one there was tibial overhang and in two there was patellofemoral degeneration, which possibly contributed to the pain. There were no deep infections. The mean OKS improved from 23 (SD 8) to 42 (SD 7) at a mean follow-up of 7.0 years (p < 0.001). There was no significant difference in survival or clinical outcome between the designer and independent centre. CONCLUSIONS The cementless OUKR is a safe and reproducible procedure with excellent 10-year survival and clinical results in the hands of both designer and independent surgeons.
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Affiliation(s)
- S Campi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom.
| | - H Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - G Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - D Snell
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - C Jenkins
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - C A F Dodd
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - R Maxwell
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - D W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom; Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Maxwell R, Luksik A, Garzon-Muvdi T, Hung A, Kim E, Wu A, Xia Y, Belcaid Z, Gorelick N, Theodros D, Jackson C, Ye X, Tran P, Redmond K, Brem H, Pardoll D, Kleinberg L, Lim M. Impact of Corticosteroids on the Efficacy of Anti-PD-1 Therapy for Tumors Located Within or Outside the Central Nervous System. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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15
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Deng Z, Xu X, Belcaid Z, Garzon-Muvdi T, Luksik A, Maxwell R, Iordachita I, Yu J, Lim M, Wong J, Wang K. EP-2098: Bioluminescence tomography-guided radiation therapy for GBM in vivo. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32407-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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16
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Pearson R, Pieniazek P, Thelwall P, Maxwell R, Plummer R, Frew J. Diffusion-weighted MRI for Early Response Assessment in the Treatment of Bladder Cancer. Clin Oncol (R Coll Radiol) 2018. [DOI: 10.1016/j.clon.2017.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Lwin M, Challa A, Maxwell R, Radford D, Hayward E, Chan W. Intermittent Levosimendan to Maintain Quality of Life in an Ambulatory Patient with End-Stage Heart Failure with Complex Congenital Heart Disease. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Chan W, Maxwell R, Malpas T, Radford D. The Prevalence of Obesity in an Australian Cohort of Adult Patients With Congenital Heart Disease. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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20
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Affiliation(s)
- M G Brush
- Department of Gynecology, St Thomas's Hospital Medical School, London SE1
| | - R Maxwell
- Department of Gynecology, St Thomas's Hospital Medical School, London SE1
| | - J Scherer
- Department of Gynecology, St Thomas's Hospital Medical School, London SE1
| | - R W Taylor
- Department of Gynecology, St Thomas's Hospital Medical School, London SE1
| | - G Tye
- Department of Gynecology, St Thomas's Hospital Medical School, London SE1
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Robertshaw IM, Sroga JM, Batcheller AE, Martinez AM, Winter TC, Sinning K, Maxwell R, Lindheim SR. Hysterosalpingo-Contrast Sonography With a Saline-Air Device Is Equivalent to Hysterosalpingography Only in the Presence of Tubal Patency. J Ultrasound Med 2016; 35:1215-1222. [PMID: 27126400 DOI: 10.7863/ultra.15.08008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/08/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To compare hysterosalpingo-contrast sonography with a saline-air device to hysterosalpingography for evaluating tubal patency. METHODS Eighty women undergoing infertility evaluations were recruited for this prospective cohort study. All patients underwent both office-based hysterosalpingo-contrast sonography with a saline-air device and hysterosalpingography as the reference standard, and the fallopian tubes were individually assessed for tubal patency in each procedure. The Cohen κ coefficient was used to assess agreement between each procedure, and the Student t test and χ(2) test were used to compare differences in time, pain, and procedural preference. RESULTS In total, 75 patients with 148 fallopian tubes were evaluated. Tubal patency on hysterosalpingo-contrast sonography with the saline-air device was noted in 85.8% (n = 127) of tubes compared to 92.5% (n = 137) on hysterosalpingography, with a positive predictive value of 95.2%. Tubal occlusion was noted in 21 tubes (14.2%) on hysterosalpingo-contrast sonography compared to 11 (7.4%) on hysterosalpingography, with a negative predictive value of 23.8% (24 of 28). Overall, hysterosalpingo-contrast sonography agreed with hysterosalpingography in 126 of 148 fallopian tubes (85.1%; κ = 0.47; P < .001). The procedural time and pain scores were significantly greater for hysterosalpingo-contrast sonography compared to hysterosalpingography. CONCLUSIONS There was a significant degree of agreement between hysterosalpingo-contrast sonography with a saline-air device and hysterosalpingography when the fallopian tube was patent but not when it was occluded. In the absence of patency, further evaluations with hysterosalpingography may be indicated to avoid false-positive results. Although the procedure time and degree of pain appear to be greater, avoidance of radiation exposure by using hysterosalpingo-contrast sonography with a saline-air device may outweigh the drawbacks.
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Affiliation(s)
- Isela M Robertshaw
- Department of Obstetrics and Gynecology, University of Cincinnati Medical Center, Cincinnati, Ohio USA
| | - Julie M Sroga
- Department of Obstetrics and Gynecology, University of Cincinnati Medical Center, Cincinnati, Ohio USA
| | - April E Batcheller
- Department of Obstetrics and Gynecology, University of Cincinnati Medical Center, Cincinnati, Ohio USA
| | - Alan M Martinez
- Reproductive Science Center of New Jersey, Lawrenceville, New Jersey USA
| | - Thomas C Winter
- Department of Radiology, University of Utah, Salt Lake City, Utah USA
| | - Kristin Sinning
- Department of Obstetrics and Gynecology, Wright State University, Boonshoft School of Medicine, Dayton, Ohio USA
| | - Rose Maxwell
- Department of Obstetrics and Gynecology, Wright State University, Boonshoft School of Medicine, Dayton, Ohio USA
| | - Steven R Lindheim
- Department of Obstetrics and Gynecology, Wright State University, Boonshoft School of Medicine, Dayton, Ohio USA
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Abstract
This study reports on the first 150 consecutive Oxford cementless unicompartmental knee arthroplasties (UKA) performed in an independent centre (126 patients). All eligible patients had functional scores (Oxford knee score and high activity arthroplasty score) recorded pre-operatively and at two- and five-years of follow-up. Fluoroscopically aligned radiographs were taken at five years and analysed for any evidence of radiolucent lines (RLLs), subsidence or loosening. The mean age of the cohort was 63.6 years (39 to 86) with 81 (53.1%) males. Excellent functional scores were maintained at five years and there were no progressive RLLs demonstrated on radiographs. Two patients underwent revision to a total knee arthroplasty giving a revision rate of 0.23/100 (95% confidence interval 0.03 to 0.84) component years with overall component survivorship of 98.7% at five years. There were a further four patients who underwent further surgery on the same knee, two underwent bearing exchanges for dislocation and two underwent lateral UKAs for disease progression. This was a marked improvement from other UKAs reported in New Zealand Joint Registry data and supports the designing centre's early results.
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Affiliation(s)
- N Hooper
- University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - D Snell
- University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - G Hooper
- University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - R Maxwell
- University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - C Frampton
- University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
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Havemann L, Maxwell R. A Genetic Need for Menopause: Reflections and New Perspectives. Womens Health Issues 2016. [DOI: 10.4172/2325-9795.1000218] [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: 11/09/2022]
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24
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Skanes-DeVold H, Duke J, Maxwell R, Clemons J, Yaklic J, Lindheim S. Preliminary findings on the influences of ethnicity on perceptions of contraceptive use in post-partum women with unintended pregnancies in an urban mid-west setting. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2015.07.253] [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: 11/26/2022]
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25
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Judge A, Murphy RJ, Maxwell R, Arden NK, Carr AJ. Temporal trends and geographical variation in the use of subacromial decompression and rotator cuff repair of the shoulder in England. Bone Joint J 2014; 96-B:70-4. [PMID: 24395314 DOI: 10.1302/0301-620x.96b1.32556] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We explored the trends over time and the geographical variation in the use of subacromial decompression and rotator cuff repair in 152 local health areas (Primary Care Trusts) across England. The diagnostic and procedure codes of patients undergoing certain elective shoulder operations between 2000/2001 and 2009/2010 were extracted from the Hospital Episode Statistics database. They were grouped as 1) subacromial decompression only, 2) subacromial decompression with rotator cuff repair, and 3) rotator cuff repair only. The number of patients undergoing subacromial decompression alone rose by 746.4% from 2523 in 2000/2001 (5.2/100 000 (95% confidence interval (CI) 5.0 to 5.4) to 21 355 in 2009/2010 (40.2/100 000 (95% CI 39.7 to 40.8)). Operations for rotator cuff repair alone peaked in 2008/2009 (4.7/100 000 (95% CI 4.5 to 4.8)) and declined considerably in 2009/2010 (2.6/100 000 (95% CI 2.5 to 2.7)). Given the lack of evidence for the effectiveness of these operations and the significant increase in the number of procedures being performed in England and elsewhere, there is an urgent need for well-designed clinical trials to determine evidence of clinical effectiveness.
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Affiliation(s)
- A Judge
- University of Oxford, Oxford NIHR Musculoskeletal Biomedical Research Unit, Windmill Road, Headington, Oxford, OX3 7LD, UK
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26
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Hooper GJ, Gilchrist N, Maxwell R, March R, Heard A, Frampton C. The effect of the Oxford uncemented medial compartment arthroplasty on the bone mineral density and content of the proximal tibia. Bone Joint J 2013; 95-B:1480-3. [DOI: 10.1302/0301-620x.95b11.31509] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We studied the bone mineral density (BMD) and the bone mineral content (BMC) of the proximal tibia in patients with a well-functioning uncemented Oxford medial compartment arthroplasty using the Lunar iDXA bone densitometer. Our hypothesis was that there would be decreased BMD and BMC adjacent to the tibial base plate and increased BMD and BMC at the tip of the keel. There were 79 consecutive patients (33 men, 46 women) with a mean age of 65 years (44 to 84) with a minimum two-year follow-up (mean 2.6 years (2.0 to 5.0)) after unilateral arthroplasty, who were scanned using a validated standard protocol where seven regions of interest (ROI) were examined and compared with the contralateral normal knee. All had well-functioning knees with a mean Oxford knee score of 43 (14 to 48) and mean Knee Society function score of 90 (20 to 100), showing a correlation with the increasing scores and higher BMC and BMD values in ROI 2 in the non-implanted knee relative to the implanted knee (p = 0.013 and p = 0.015, respectively). The absolute and percentage changes in BMD and BMC were decreased in all ROIs in the implanted knee compared with the non-implanted knee, but this did not reach statistical significance. Bone loss was markedly less than reported losses with total knee replacement. There was no significant association with side, although there was a tendency for the BMC to decrease with age in men. The BMC was less in the implanted side relative to the non-implanted side in men compared with women in ROI 2 (p = 0.027), ROI 3 (p = 0.049) and ROI 4 (p = 0.029). The uncemented Oxford medial compartment arthroplasty appears to allow relative preservation of the BMC and BMD of the proximal tibia, suggesting that the implant acts more physiologically than total knee replacement. Peri-prosthetic bone loss is an important factor in assessing long-term implant stability and survival, and the results of this study are encouraging for the long-term outcome of this arthroplasty. Cite this article: Bone Joint J 2013;95-B:1480–3.
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Affiliation(s)
- G. J. Hooper
- University of Otago Christchurch, Department
of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch, PO
Box 4345, Christchurch, New
Zealand
| | - N. Gilchrist
- The Princess Margaret Hospital, CGM
Research trust, Private Bag, Christchurch, New
Zealand
| | - R. Maxwell
- University of Otago Christchurch, Department
of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch, PO
Box 4345, Christchurch, New
Zealand
| | - R. March
- The Princess Margaret Hospital, CGM
Research trust, Private Bag, Christchurch, New
Zealand
| | - A. Heard
- The Princess Margaret Hospital, CGM
Research trust, Private Bag, Christchurch, New
Zealand
| | - C. Frampton
- University of Otago Christchurch, Department
of Medicine, Christchurch, PO
Box 4345, Christchurch, New
Zealand
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27
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Wasserberg G, White L, Bullard A, King J, Maxwell R. Oviposition site selection in Aedes albopictus (Diptera: Culicidae): are the effects of predation risk and food level independent? J Med Entomol 2013; 50:1159-1164. [PMID: 24180122 DOI: 10.1603/me12275] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
For organisms lacking parental care and where larval dispersal is limited, oviposition site selection decisions are critical fitness-enhancing choices. However, studies usually do not consider the interdependence of the two. In this study, we evaluated the effect of food level on the oviposition behavior of Aedes albopictus (Skuse) in the presence or the absence of a nonlethal predator (caged dragonfly nymph). We also attempted to quantify the perceived cost of predation to ovipositioning mosquitoes. Mosquitoes were presented with oviposition cups containing four levels of larval food (fermented leaf infusion) with or without a caged libellulid nymph. By titrating larval food, we estimated the amount of food needed to attract the female mosquito to oviposit in the riskier habitat. As expected, oviposition rate increased with food level and decreased in the presence of a predator. However, the effect of food level did not differ between predator treatments. By calculating the difference in the amount of food for points of equal oviposition rate in the predator-present and predator-absent regression lines, we estimated the cost of predation risk to be 1950 colony-forming-units per milliliter. Our study demonstrated the importance of considering the possible interdependence of predation risk and food abundance for oviposition-site-seeking insects. This study also quantified the perceived cost of predation and found it to be relatively low, a fact with positive implications for biological control.
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Affiliation(s)
- Gideon Wasserberg
- Biology Department, University of North Carolina at Greensboro, 321 MeIver St., Greensboro, NC 27402-6170, USA.
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Chatterjee S, Frew J, Mott J, McCallum H, Stevenson P, Maxwell R, Wilsdon J, Kelly C. Variation in Radiotherapy Target Volume Definition, Dose to Organs at Risk and Clinical Target Volumes using Anatomic (Computed Tomography) versus Combined Anatomic and Molecular Imaging (Positron Emission Tomography/Computed Tomography): Intensity-modulated Radiotherapy Delivered using a Tomotherapy Hi Art Machine: Final Results of the VortigERN Study. Clin Oncol (R Coll Radiol) 2012; 24:e173-9. [DOI: 10.1016/j.clon.2012.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 09/03/2012] [Accepted: 09/05/2012] [Indexed: 10/27/2022]
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Maxwell R, Ata S, Wanless EJ, Moreno-Atanasio R. Computer simulations of particle-bubble interactions and particle sliding using Discrete Element Method. J Colloid Interface Sci 2012; 381:1-10. [PMID: 22717086 DOI: 10.1016/j.jcis.2012.05.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 05/09/2012] [Accepted: 05/10/2012] [Indexed: 11/17/2022]
Abstract
Three dimensional Discrete Element Method (DEM) computer simulations have been carried out to analyse the kinetics of collision of multiple particles against a stationary bubble and the sliding of the particles over the bubble surface. This is the first time that a computational analysis of the sliding time and particle packing arrangements of multiple particles on the surface of a bubble has been carried out. The collision kinetics of monodisperse (33 μm in radius) and polydisperse (12-33 μm in radius) particle systems have been analysed in terms of the time taken by 10%, 50% and 100% of the particles to collide against the bubble. The dependencies of these collision times on the strength of hydrophobic interactions follow relationships close to power laws. However, minimal sensitivity of the collision times to particle size was found when linear and square relationships of the hydrophobic force with particles radius were considered. The sliding time for single particles has corroborated published theoretical expressions. Finally, a good qualitative comparison with experiments has been observed with respect to the particle packing at the bottom of the bubble after sliding demonstrating the usefulness of computer simulations in the studies of particle-bubble systems.
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Affiliation(s)
- R Maxwell
- Centre for Advanced Particle Processing and Transport, School of Engineering, University of Newcastle, Callaghan, NSW 2308, Australia
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Wu D, Ma F, Thomas M, Maxwell R, Lindheim S, Gagneux P. Detection of xenoglycan N-glycolylneuraminic acid (NEU5GC) On human sperm and directed anti-NEU5GC antibodies in seminal fluid. Fertil Steril 2011. [DOI: 10.1016/j.fertnstert.2011.07.905] [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]
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31
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Wu D, Leung YK, Thomas M, Maxwell R, Ho SM. Bisphenol A (BPA) confers direct genotoxicity to sperm with increased sperm DNA fragmentation. Fertil Steril 2011. [DOI: 10.1016/j.fertnstert.2011.07.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Wu D, Leung YK, Liao C, Thomas M, Maxwell R, Ho SM. Detectable levels of bispenol A (BPA) in human semen: a cause for concern? Fertil Steril 2011. [DOI: 10.1016/j.fertnstert.2011.07.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Wu DH, Reynolds K, Maxwell R, Lindheim SR, Aubuchon M, Thomas MA. Age does not influence the effect of embryo fragmentation on successful blastocyst development. Fertil Steril 2011; 95:2778-80. [DOI: 10.1016/j.fertnstert.2011.05.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 05/09/2011] [Accepted: 05/10/2011] [Indexed: 11/27/2022]
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McCormick BA, Wilburn RD, Thomas MA, Williams DB, Maxwell R, Aubuchon M. Endometrial thickness predicts endometrial hyperplasia in patients with polycystic ovary syndrome. Fertil Steril 2011; 95:2625-7. [DOI: 10.1016/j.fertnstert.2011.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 03/31/2011] [Accepted: 04/01/2011] [Indexed: 10/18/2022]
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Abstract
Depression is accompanied by an increase in activity in the amygdala and a decrease in the rostral anterior cingulate cortex (rACC), with the former attributed to a failure of the latter to exert its normal inhibitory influence. This failure is likely due to regression of synaptic connections between the rACC and the amygdala, a process reversed in part by selective serotonin reuptake inhibitors (SSRIs). The present work presents a hypothesis as to how SSRIs might bring about this process and hence normalization of activity, at least in patients that are responsive to SSRIs. Serotonin receptors of the excitatory 5-HT(2A)R class increase N-methyl-D-aspartate receptor (NMDAR) efficacy, while those of the inhibitory 5-HT(1A)R class decrease NMDAR efficacy. A decrease of 5-HT transporter (5-HTT) efficacy, either during human development through functional polymorphisms, or in animals through 5-HTT transgenic knockouts, is accompanied by a decrease in 5-HT(1A)R and hence an increase in excitability and NMDAR efficacy which drives an increase in synaptic spines in the amygdala. As the limbic region of the brain normally possesses high levels of 5-HT(1A)R the effect of loss of these is to increase excitation in this region, as is observed. Changes in the level of extracellular 5-HT in adult animals also modulates the density of synaptic spines, with these increasing with an increase in 5-HT, possibly as a consequence of increases in 5-HT(2A)R activity over that of 5-HT(1A)R. Increasing extracellular levels of 5-HT with SSRIs would then lead to an increase in excitability and in synaptic spines for afferents in the dorsal rostral anterior cingulate cortex but not in the ventral regions such as the amygdala that have few 5-HT(2A)R. This allows dorsal regions to once more exert their inhibitory influence over ventral regions. In this way, SSRIs may exert their effect in normalizing dorsal hypometabolism and ventral hypermetabolism in those suffering from depression.
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Affiliation(s)
- Maxwell R Bennett
- Brain & Mind Research Institute, University Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia.
| | - R Maxwell
- University Chair, Scientific Director Brain & Mind Research Institute, University Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia
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Habli M, Bombrys A, Lewis D, Lim FY, Polzin W, Maxwell R, Crombleholme T. Incidence of complications in twin-twin transfusion syndrome after selective fetoscopic laser photocoagulation: a single-center experience. Am J Obstet Gynecol 2009; 201:417.e1-7. [PMID: 19788973 DOI: 10.1016/j.ajog.2009.07.046] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [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: 02/25/2009] [Revised: 06/14/2009] [Accepted: 07/16/2009] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the incidence of complications after selective fetoscopic laser photocoagulation for twin-twin transfusion syndrome (TTTS). STUDY DESIGN One hundred fifty-two cases of TTTS were treated with selective fetoscopic laser photocoagulation from 2005-2008. Complications were TTTS recurrence, amniotic band syndrome, iatrogenic monoamnionicity, and twin anemia-polycythemia sequence. Data were placed in the following categories: no complications; early complications < or =7 days; late complications >7 days; both early and late complications. RESULTS The incidence of early, late, and both early and late complications was 31%, 39%, and 10%. Complications included 2 cases (1.3%) of monoamnionicity, 3 cases (2.0%) of recurrent TTTS, 3 cases (2.0%) of twin anemia-polycythemia sequence, and 5 cases (3.3%) of amniotic band syndrome. Cases with TTTS with early complications had a lower number of superficial arteriovenous vascular anastomoses and 1 or both fetus survival (70.2% vs 96.7%; P < .001), compared with no complications. Fetal survival was 238 of 307 cases (77.5%), with 1 or both twins surviving in 134 of 152 (88%) of pregnancies. CONCLUSION The incidence of early, late, and both early and late complications was 31%, 39%, and 10%, respectively. Close postoperative surveillance is important.
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Affiliation(s)
- Mounira Habli
- The Fetal Care Center of Cincinnati, Cincinnati, OH, USA
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Green CJ, Maxwell R, Verne J, Martin RM, Blazeby JM. The influence of NICE guidance on the uptake of laparoscopic surgery for colorectal cancer. J Public Health (Oxf) 2009; 31:541-5. [DOI: 10.1093/pubmed/fdp027] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [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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Haddad G, Saguan DA, Maxwell R, Thomas MA. Intramuscular route of progesterone administration increases pregnancy rates during non-downregulated frozen embryo transfer cycles. J Assist Reprod Genet 2007; 24:467-70. [PMID: 17721816 PMCID: PMC3455070 DOI: 10.1007/s10815-007-9168-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Accepted: 08/02/2007] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The optimal route of progesterone (P4) administration in embryo transfer (FET) cycles remains to be determined. The objective of this study is to compare the pregnancy outcomes between intramuscular (IM) and vaginal progesterone (PV) administration for endometrial preparation in non-donor FET cycles. STUDY DESIGN A retrospective clinical study in a private practice infertility setting. RESULTS No significant differences in patient demographics and embryo characteristics were noted between the two groups. The clinical pregnancy rate as well as the live birth rate were significantly higher in the IM arm compared to the PV arm (38.2% vs 28%, 34.5 % vs 22.8%, respectively). CONCLUSION Although both routes of progesterone administration had similar rates of initial positive pregnancy tests, the IM route had a significantly higher live birth rate. The exact reason for this difference remains to be determined.
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Affiliation(s)
- Ghassan Haddad
- University of Cincinnati Medical Center, Cincinnati, OH, USA.
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Bombrys A, Neiger R, Hawkins S, Sonek JD, Croom C, Mckenna D, Ventolini G, Habli M, How H, Maxwell R, Sibai B. Perinatal outcome associated with isolated single umbilical artery: A case control study. Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.10.118] [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: 11/26/2022]
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Costantine M, How H, Coppage K, Maxwell R, Sibai B. Does peripartum infection increase the incidence of cerebral palsy in extremely low birth weight infants? Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.10.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- D A Lawlor
- Department of Social Medicine, University of Bristol, Bristol UK.
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Woodward C, Grant K, Maxwell R. Applications of sensitivity analysis to uncertainty quantification in variably saturated flow. Computational Methods in Water Resources, Proceedings of the XIVth International Conference on Computational Methods in Water Resources (CMWR XIV) 2002. [DOI: 10.1016/s0167-5648(02)80047-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Conley EL, Coley KC, Pollock BG, Dapos SV, Maxwell R, Branch RA. Prevalence and risk of thrombocytopenia with valproic acid: experience at a psychiatric teaching hospital. Pharmacotherapy 2001; 21:1325-30. [PMID: 11714204 DOI: 10.1592/phco.21.17.1325.34418] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To investigate the prevalence and potential risk factors of thrombocytopenia in hospitalized patients receiving valproic acid (VPA) for psychiatric indications (excluding epilepsy). DESIGN Retrospective study SETTING University-affiliated psychiatric facility. PATIENTS Two hundred sixty-four patients treated with VPA. INTERVENTION Data from patients hospitalized between January 1, 1994, and December 31, 1998, who were receiving VPA and had at least one platelet count recorded. MEASUREMENTS AND MAIN RESULTS Of 264 VPA-treated patients, 31 (12%) met our criteria for thrombocytopenia. Mild thrombocytopenia (platelet count of 101-150 x 10(3)/mm3) occurred in 25 (9%) patients, and moderate thrombocytopenia (platelet count of 40-100 x 103/mm3) occurred in 6 (2%) patients. Age older than 65 years (p=0.02) and VPA dosage greater than 1,000 mg/day (p<0.001) were identified as significant risk factors for developing thrombocytopenia. CONCLUSION The estimated prevalence of thrombocytopenia is 12% in the general psychiatric population receiving VPA, with the elderly at greatest risk.
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Affiliation(s)
- E L Conley
- School of Pharmacy, University of Pittsburgh, PA 16261, USA
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Goodman NW, O'Kelly SW, Maxwell R. Implementing clinical governance. West J Med 2001. [DOI: 10.1136/bmj.323.7315.753a] [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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O'Kelly SW, Maxwell R. Implementing clinical governance. Medical training should include project management. BMJ 2001; 323:753. [PMID: 11675730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Verma S, Orengo CA, Maxwell R, Kunik ME, Molinari VA, Vasterling JJ, Hale DD. Contribution of PTSD/POW history to behavioral disturbances in dementia. Int J Geriatr Psychiatry 2001; 16:356-60. [PMID: 11333421 DOI: 10.1002/gps.333] [Citation(s) in RCA: 20] [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: 11/12/2022]
Abstract
As many World War II and Korean Conflict veterans suffering from posttraumatic stress disorder (PTSD) grow older, increasing numbers will be diagnosed with dementia. We retrospectively analyzed patients with dementia, comparing the behavioral disturbances of those with PTSD to those without PTSD. We hypothesized that due to the additive effect of the neurobiological and behavioral changes associated with PTSD and dementia, the dementia with PTSD group would show more agitation and disinhibition than the dementia without PTSD group. Sixteen patients with diagnoses of dementia and PTSD were matched on age and Mini-Mental States Examination (MMSE) scores to 16 patients with dementia without PTSD. Demographic characteristics, co-morbid diagnoses, global Assessment of Functioning (GAF), Cohen-Mansfield Agitation Inventory (CMAI), and paranoid items of Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Syndrome Scale for Schizophrenia (PANSS) were assessed. The patients with diagnoses of dementia with PTSD did not differ significantly in their clinical presentation, hospital course, and condition at discharge from patients with dementia without PTSD. Chi-square analysis showed that significantly more subjects in the PTSD group were prescribed anti-depressants compared to the non-PTSD group. Interestingly, within the PTSD group, the subgroup of patients who were former prisoners of war had a significantly higher mean score for paranoia and significantly less verbal agitation. This pilot study reveals that a diagnosis of PTSD alone is not sufficient to influence behavior in veterans with dementia; however, we also present provocative results that patients with more severe trauma (POW) do have changes in their behavior.
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Affiliation(s)
- S Verma
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, TX 77030, USA
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Maxwell R, Carter WB, Smith RM, Perry RR. Multiple ectopic parathyroid glands. Am Surg 2000; 66:1028-31. [PMID: 11090012] [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: 02/18/2023]
Abstract
Parathyroid surgery to correct primary hyperparathyroidism is successful in 80 to 97 per cent of initial explorations. Failures are often linked to inability to locate ectopic parathyroid glands. Although ectopic parathyroid glands are relatively common (15%) multiple ectopic glands are rarely reported. We describe a case of multiple ectopic parathyroid glands and the intraoperative approach to their localization and review the anatomy and embryology of ectopic parathyroid glands. A 39-year-old woman presented with fatigue, lethargy, and depression. On biochemical evaluation she was noted to be hypercalcemic and hyperparathyroid. Preoperative parathyroid localization failed to identify abnormal parathyroid glands. At exploration three of four parathyroid glands, including an adenoma, were located in ectopic positions by a meticulous and systematic dissection. A careful exploration coupled with a thorough knowledge of parathyroid anatomy and embryology will produce successful surgical correction of primary hyperparathyroidism in greater than 95 per cent of patients even in the few patients with multiple ectopic parathyroid glands.
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Affiliation(s)
- R Maxwell
- Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia 23507-1912, USA
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Loan W, McCune K, Kelly B, Maxwell R. Wiskott-Aldrich syndrome: life-threatening haemorrhage from aneurysms within the liver, small bowel mesentery and kidney, requiring both surgical and radiological intervention. J R Coll Surg Edinb 2000; 45:326-8. [PMID: 11077782] [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: 02/18/2023]
Abstract
Wiskott-Aldrich syndrome (WAS) is a rare, generally X-linked recessive condition, originally described by Wiskott in 1937 as a triad of discharging ears, eczema and thrombocytopoenia. Aldrich included bloody diarrhoea in his report of 1954, with severe immunodeficiency and predisposition to malignancy being recognised subsequently. The incidence currently quoted is approximately 4 per million live male births, although there is some regional variation. We report the case of a long-term survivor who had massive haemorrhage from an intrahepatic aneurysm and, on a separate occasion, the right kidney.
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Affiliation(s)
- W Loan
- Department of Radiology, Royal Victoria Hospital, Belfast.
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Majeed A, Moser K, Maxwell R. Age, sex and practice variations in the use of statins in general practice in England and Wales. J Public Health Med 2000; 22:275-9. [PMID: 11077897 DOI: 10.1093/pubmed/22.3.275] [Citation(s) in RCA: 39] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Statins are highly effective in reducing the risk of sudden cardiac death and other acute coronary events in patients with pre-existing ischaemic heart disease or with raised blood cholesterol levels. However, relatively little is known about how statins are used in primary care. The objectives of this study were to investigate age, sex and inter-practice variations in the prescribing of statins. METHODS This was an observational study of statin prescribing rates in 288 general practices in England and Wales that contributed data to the General Practice Research Database in 1996. RESULTS In 1996, 0.7 per cent of men and 0.5 per cent of women received a prescription for a statin. In the subgroup of patients with a general practitioner (GP) diagnosis of ischaemic heart disease, 13.3 per cent of men and 8.2 per cent of women received a prescription for a statin in 1996. Below the age of 65 years, men with ischaemic heart disease were more likely to be prescribed a statin than were women. Patients aged 75 years and over with ischaemic heart disease were unlikely to be prescribed a statin irrespective of their sex. The percentage of patients prescribed statins in individual practices varied from 0.1 to 2.3 per cent in men and from 0 to 2.3 per cent in women. The recorded prevalence of ischaemic heart disease explained only 12 per cent of this variation in men and 7 per cent in women. CONCLUSIONS There are large age, sex and inter-practice variations in the use of statins in primary care, which are poorly explained by measures of health need. Developing and implementing clinical guidelines to accompany the introduction of new drugs for the management of common chronic disorders should be seen as a priority for GPs, primary care groups and the National Institute of Clinical Excellence.
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Affiliation(s)
- A Majeed
- Office for National Statistics, London.
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Coley KC, Carter CS, DaPos SV, Maxwell R, Wilson JW, Branch RA. Effectiveness of antipsychotic therapy in a naturalistic setting: a comparison between risperidone, perphenazine, and haloperidol. J Clin Psychiatry 1999; 60:850-6. [PMID: 10665632 DOI: 10.4088/jcp.v60n1208] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [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: 10/19/2022]
Abstract
BACKGROUND Therapeutic ineffectiveness and noncompliance with antipsychotic agents are major contributors to rehospitalization in patients with psychotic disorders. It is unknown whether risperidone's favorable side effect profile compared with that of the conventional antipsychotics results in improved compliance and reduced hospitalizations in a naturalistic setting. The purpose of this study was to test the hypothesis that treatment with risperidone reduces readmission rates and associated costs when compared with treatment with perphenazine or haloperidol. METHOD Inpatients prescribed either risperidone, perphenazine, or haloperidol between January 1, 1995, and December 31, 1995, as a single oral antipsychotic at discharge were retrospectively identified. Data were collected for that index hospitalization and for a 1-year follow-up period. Primary outcome measures included re-admission rates, changes in antipsychotic therapy, anticholinergic drug use, and costs. RESULTS There were 202 evaluable patients (81 treated with risperidone, 78 with perphenazine, and 43 with haloperidol). Baseline demographics were similar between groups except that more patients in the risperidone group had a primary diagnosis of psychotic disorder or had been hospitalized in the year prior to study. The percentage of patients readmitted during the 1-year follow-up period was similar among drug groups (41% risperidone, 26% perphenazine, and 35% haloperidol) when controlled for baseline differences in diagnosis and hospitalization history (p = .32). Anticholinergic drug use was more common in the haloperidol group (p = .004). Mean yearly cost (drug + hospitalization) in the risperidone group was $20,317, nearly double that in the other treatment groups (p < .001). CONCLUSION The results from this naturalistic study indicate that the high cost of risperidone is not offset by a reduction in readmission rates when compared with conventional antipsychotics.
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Affiliation(s)
- K C Coley
- Center for Clinical Pharmacology, University of Pittsburgh Medical Center, PA 15213, USA
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