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Sideris K, Weir CR, Schmalfuss C, Hanson H, Pipke M, Tseng PH, Lewis N, Sallam K, Bozkurt B, Hanff T, Schofield R, Larimer K, Kyriakopoulos CP, Taleb I, Brinker L, Curry T, Knecht C, Butler JM, Stehlik J. Artificial intelligence predictive analytics in heart failure: results of the pilot phase of a pragmatic randomized clinical trial. J Am Med Inform Assoc 2024; 31:919-928. [PMID: 38341800 PMCID: PMC10990545 DOI: 10.1093/jamia/ocae017] [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: 08/25/2023] [Revised: 12/20/2023] [Accepted: 01/17/2024] [Indexed: 02/13/2024] Open
Abstract
OBJECTIVES We conducted an implementation planning process during the pilot phase of a pragmatic trial, which tests an intervention guided by artificial intelligence (AI) analytics sourced from noninvasive monitoring data in heart failure patients (LINK-HF2). MATERIALS AND METHODS A mixed-method analysis was conducted at 2 pilot sites. Interviews were conducted with 12 of 27 enrolled patients and with 13 participating clinicians. iPARIHS constructs were used for interview construction to identify workflow, communication patterns, and clinician's beliefs. Interviews were transcribed and analyzed using inductive coding protocols to identify key themes. Behavioral response data from the AI-generated notifications were collected. RESULTS Clinicians responded to notifications within 24 hours in 95% of instances, with 26.7% resulting in clinical action. Four implementation themes emerged: (1) High anticipatory expectations for reliable patient communications, reduced patient burden, and less proactive provider monitoring. (2) The AI notifications required a differential and tailored balance of trust and action advice related to role. (3) Clinic experience with other home-based programs influenced utilization. (4) Responding to notifications involved significant effort, including electronic health record (EHR) review, patient contact, and consultation with other clinicians. DISCUSSION Clinician's use of AI data is a function of beliefs regarding the trustworthiness and usefulness of the data, the degree of autonomy in professional roles, and the cognitive effort involved. CONCLUSION The implementation planning analysis guided development of strategies that addressed communication technology, patient education, and EHR integration to reduce clinician and patient burden in the subsequent main randomized phase of the trial. Our results provide important insights into the unique implications of implementing AI analytics into clinical workflow.
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Affiliation(s)
- Konstantinos Sideris
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States
| | - Charlene R Weir
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84108, United States
| | - Carsten Schmalfuss
- Cardiology Section, Medical Service, Malcom Randall VA Medical Center, Gainesville, FL 32608, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL 32610, United States
| | - Heather Hanson
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States
| | - Matt Pipke
- PhysIQ, Inc., Chicago, IL 60563, United States
| | - Po-He Tseng
- PhysIQ, Inc., Chicago, IL 60563, United States
| | - Neil Lewis
- Cardiology Section, Medical Service, Hunter Holmes McGuire Veterans Medical Center, Richmond, VA 23249, United States
- Department of Internal Medicine, Division of Cardiovascular Disease, Virginia Commonwealth University, Richmond, VA 23249, United States
| | - Karim Sallam
- Cardiology Section, Medical Service, VA Palo Alto Health Care System, Palo Alto, CA 94304, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Biykem Bozkurt
- Cardiology Section, Medical Service, Michael E. DeBakey VA Medical Center, Houston, TX 77030, United States
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, United States
| | - Thomas Hanff
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States
| | - Richard Schofield
- Cardiology Section, Medical Service, Malcom Randall VA Medical Center, Gainesville, FL 32608, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL 32610, United States
| | | | - Christos P Kyriakopoulos
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States
| | - Iosif Taleb
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States
| | - Lina Brinker
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States
| | - Tempa Curry
- Cardiology Section, Medical Service, Malcom Randall VA Medical Center, Gainesville, FL 32608, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL 32610, United States
| | - Cheri Knecht
- Cardiology Section, Medical Service, Malcom Randall VA Medical Center, Gainesville, FL 32608, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL 32610, United States
| | - Jorie M Butler
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84108, United States
| | - Josef Stehlik
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States
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Curry T, Barrameda ME, Thomas TC, Esfandiarei M. In vivo phenotypic vascular dysfunction extends beyond the aorta in a mouse model for fibrillin-1 (Fbn1) mutation. Sci Rep 2024; 14:5779. [PMID: 38461168 PMCID: PMC10924961 DOI: 10.1038/s41598-024-56438-y] [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: 11/23/2023] [Accepted: 03/06/2024] [Indexed: 03/11/2024] Open
Abstract
In individuals with Marfan Syndrome (MFS), fibrillin-1 gene (FBN1) mutations can lead to vascular wall weakening and dysfunction. The experimental mouse model of MFS (Fbn1C1041G/+) has been advantageous in investigating MFS-associated life-threatening aortic aneurysms. It is well established that the MFS mouse model exhibits an accelerated-aging phenotype in elastic organs like the aorta, lung, and skin. However, the impact of Fbn1 mutations on the in vivo function and structure of various artery types with the consideration of sex and age, has not been adequately explored in real-time and a clinically relevant context. In this study, we investigate if Fbn1 mutation contributes to sex-dependent alterations in central and cerebral vascular function similar to phenotypic changes associated with normal aging in healthy control mice. In vivo ultrasound imaging of central and cerebral vasculature was performed in 6-month-old male and female MFS and C57BL/6 mice and sex-matched 12-month-old (middle-aged) healthy control mice. Our findings confirm aortic enlargement (aneurysm) and wall stiffness in MFS mice, but with exacerbation in male diameters. Coronary artery blood flow velocity (BFV) in diastole was not different but left pulmonary artery BFV was decreased in MFS and 12-month-old control mice regardless of sex. At 6 months of age, MFS male mice show decreased posterior cerebral artery BFV as compared to age-matched control males, with no difference observed between female cohorts. Reduced mitral valve early-filling velocities were indicated in MFS mice regardless of sex. Male MFS mice also demonstrated left ventricular hypertrophy. Overall, these results underscore the significance of biological sex in vascular function and structure in MFS mice, while highlighting a trend of pre-mature vascular aging phenotype in MFS mice that is comparable to phenotypes observed in older healthy controls. Furthermore, this research is a vital step in understanding MFS's broader implications and sets the stage for more in-depth future analyses, while providing data-driven preclinical justification for re-evaluating diagnostic approaches and therapeutic efficacy.
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Affiliation(s)
- T Curry
- College of Medicine-Phoenix, University of Arizona, Phoenix, AZ, USA
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - M E Barrameda
- Biomedical Sciences Program, College of Graduate Studies, Midwestern University, 19555 N 59th Ave., Glendale, AZ, 85308, USA
| | - T Currier Thomas
- College of Medicine-Phoenix, University of Arizona, Phoenix, AZ, USA.
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA.
- Biomedical Sciences Program, College of Graduate Studies, Midwestern University, 19555 N 59th Ave., Glendale, AZ, 85308, USA.
- Arizona State University, Tempe, AZ, USA.
- Phoenix VA Health Care System, Phoenix, AZ, USA.
| | - M Esfandiarei
- College of Medicine-Phoenix, University of Arizona, Phoenix, AZ, USA.
- Biomedical Sciences Program, College of Graduate Studies, Midwestern University, 19555 N 59th Ave., Glendale, AZ, 85308, USA.
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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3
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Curry T, Barrameda ME, Currier Thomas T, Esfandiarei M. In Vivo Phenotypic Vascular Dysfunction Extends Beyond the Aorta in a Mouse Model for Fibrillin-1 ( FBN1 ) Mutation. bioRxiv 2023:2023.11.18.567641. [PMID: 38014144 PMCID: PMC10680800 DOI: 10.1101/2023.11.18.567641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
In individuals with Marfan Syndrome (MFS), fibrillin-1 gene ( FBN1 ) mutations can lead to vascular wall weakening and dysfunction. The experimental mouse model of MFS ( FBN1 C1041G/+ ) has been advantageous in investigating MFS-associated life-threatening aortic aneurysms. Although the MFS mouse model presents an accelerated-aging phenotype in elastic organs (e.g., lung, skin), the impact of FBN1 mutations on other central and peripheral arteries function and structure with the consideration of the impact of sex remains underexplored. In this study, we investigate if FBN1 mutation contributes to sex-dependent alterations in central and cerebral vascular function similar to phenotypic changes associated with normal aging in healthy control mice. In vivo ultrasound imaging of central and cerebral vasculature was performed in 6-month-old male and female MFS and C57BL/6 mice and sex-matched 12-month-old (middle-aged) healthy control mice. Our findings confirm aortic enlargement (aneurysm) and wall stiffness in MFS mice, but with exacerbation in male diameters. Coronary artery blood flow velocity (BFV) in diastole was not different but left pulmonary artery BFV was decreased in MFS and 12-month-old control mice regardless of sex. At 6 months of age, MFS male mice show decreased posterior cerebral artery BFV as compared to age-matched control males, with no difference observed between female cohorts. Reduced mitral valve early-filling velocities were indicated in MFS mice regardless of sex. Male MFS mice also demonstrated left ventricular hypertrophy. Overall, these results underscore the significance of biological sex in vascular function and structure in MFS mice, while highlighting a trend of pre-mature vascular aging phenotype in MFS mice that is comparable to phenotypes observed in older healthy controls.
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Curry T, Egeto P, Wang H, Podnos A, Wasserman D, Yeomans J. Dopamine receptor D2 deficiency reduces mouse pup ultrasonic vocalizations and maternal responsiveness. Genes Brain Behav 2013; 12:397-404. [PMID: 23521753 DOI: 10.1111/gbb.12037] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 01/28/2013] [Accepted: 03/20/2013] [Indexed: 12/30/2022]
Abstract
Dopamine signalling facilitates motivated behaviours, and the D2 dopamine receptor (D2R) is important in mother-infant interactions. D2R antagonists disrupt maternal behaviour and, in isolated rat pups, reduce ultrasonic vocalizations (USVs) that promote maternal interaction. Here, we examined the effects of genetic D2R signalling deficiency on pup-dam interaction with Drd2 knockout (D2R KO) mice. Using heterozygous (HET) cross littermates, the effect of pup genotype on isolation-induced USVs was quantified. Independent of parental genotype, D2R-deficient pups emitted fewer USVs than wild type (WT) littermates in a gene dose-dependent manner. Using reciprocal D2R KO-WT crosses, we examined how parental genotype affects pup USVs. Heterozygous pups from D2R KO dams produced fewer USVs than HET pups from WT dams. Also, exposure to USV-emitting pups increased plasma prolactin levels in WT dams but not in D2R KO dams, and KO dams showed delayed pup retrieval and nest building. These findings indicate the importance of the interaction between pup and dam genotypes on behaviour and further support the role of D2R signalling in maternal care.
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Affiliation(s)
- T Curry
- Department of Cell and Systems Biology, University of Toronto, Toronto, ON, Canada
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5
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Wojna V, Curry T, Haughey N, Bandaru V, Skolasky R, Hachavarria R, Mayo R, Bryant C, Anderson C, Fernandez M, Velez J, Nath A. Gonadal Hormone Dysfunction Modulates CSF Oxidative Stress Markers in HIV-Seropositive Women with Cognitive Impairment (S37.002). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s37.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
This study investigated if self-reports of alcohol use correlated with estradiol and testosterone levels in adolescent females. Ninety-four female senior high school student volunteers from 2 schools completed a questionnaire regarding alcohol use. Twenty cc of blood was assayed for estradiol, testosterone, progesterone, and FSH. Total estradiol levels were higher in females who reported current alcohol use (p < or = 0.05), and females with higher levels of both testosterone and estradiol were more likely to be using alcohol currently (p < or = 0.05). Hormonal relationships associated with adolescent alcohol use may be related to future health risks of alcohol use and/or increased risk of alcohol use.
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Affiliation(s)
- C A Martin
- Department of Psychiatry, University of Kentucky, Lexington, USA.
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7
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Leddy JJ, Roberts A, Moalem J, Curry T, Lundgren CE. Effects of water immersion on pulmonary function in asthmatics. Undersea Hyperb Med 2001; 28:75-82. [PMID: 11908698] [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: 05/23/2023]
Abstract
Immersion induces air trapping in the lungs, as does asthma. Consequently, when using diving apparatus, asthmatics may face greater risk than non-asthmatics of pulmonary barotrauma (PBT) during ascent. We studied the pulmonary airflows and closing capacities (CC = closing volume + residual volume) in subjects with exercise-induced asthma (A, n = 12) and in healthy controls (C, n = 11) under four conditions: dry and immersed, both before and after exercise (treadmill running, non-immersed). Immersed, both C and A had significant and equivalent reductions in vital capacity, FEV1, FEV1/FVC, and FEF25%-75%. Post-exercise and immersed, pulmonary airflows deteriorated further in A but were better in C: FEV1 (A, 3.6 +/- 0.8 liter vs. 3.3 +/- 0.8 liter, P = 0.001; C, 3.9 +/- 0.5 liter vs. 4.1 +/- 0.6 liter, P = 0.006), FEF25-75% (A, 3.5 +/- 1.0 liter x s(-1) vs. 3.0 +/- 0.8 liter x s(-1). P < 0.05; C, 4.0 +/- 0.9 liter x s(-1) vs. 4.3 +/- 0.9 liter x s(-1), P < 0.05). Therefore, in contrast to C, A subjects had reduced pulmonary airflows during immersion after exercise. Furthermore, A subjects more often had no closing volume phase IV when immersed after exercise than C (P = 0.005). Interpreting the absence of phase IV as indicative of more air trapping in the asthmatics during immersion after exercise would be consistent with the reductions in airflow.
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Affiliation(s)
- J J Leddy
- Center for Research and Education in Special Environments, Department of Physiology and Biophysics, State University of New York at Buffalo, USA
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8
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De Wing MD, Curry T, Stephenson E, Palmieri T, Greenhalgh DG. Cost-effective use of helicopters for the transportation of patients with burn injuries. J Burn Care Rehabil 2000; 21:535-40. [PMID: 11194808 DOI: 10.1097/00004630-200021060-00011] [Citation(s) in RCA: 29] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We performed a retrospective review to analyze the use of helicopters for the transportation of patients with burn injuries to determine whether a more cost-effective approach could be developed without impairing the quality or delivery of health care. Charts were reviewed for all patients with burn injuries who were transported by helicopter to our hospitals during a 2-year period. Patients with inhalation injuries, with burn injuries received more than 24 hours before admission or more than 200 miles from our burn center, with more than 30% total body surface area (TBSA) burned, or with associated trauma injuries were excluded. Control patients with burn injuries who were transported by ambulance were identified and matched to the patients with burn injuries transported by helicopter for the percentage of TBSA burned, the percentage of third-degree burns, transport mileage, and age. The outcome was evaluated by comparison of length of stay, days on ventilator, and mortality rate. Comparisons were performed with Student t test. The transportation charge was determined for the patients transported by helicopter who we believed were eligible for transport by ambulance. Forty-seven of 85 patients transported by helicopter matched the inclusion criteria and had survived. There was no statistically significant difference between the percentage of TBSA burned, the percentage of third-degree burns, length of stay, days on ventilator, age, or transport mileage. There was, however, a significant difference in the time from the injury to admission to the hospital, as well as in the charge for transportation. Patients who had less than 30% TBSA thermal cutaneous injuries without evidence of inhalation injury, and who are less than 200 miles from a burn center may be safely transported by ambulance. Ambulance transportation may take additional time; however, stricter protocols for helicopter transportation of patients with burn injuries will result in potentially substantial savings without affecting outcomes for patients.
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Affiliation(s)
- M D De Wing
- Shriners Hospital for Children, Northern California, Sacramento 95817, USA
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Affiliation(s)
- C A Martin
- Department of Psychiatry, University of Kentucky College of Medicine, Lexington 40536-0284, USA
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10
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Abstract
Peroxisomal bifunctional enzyme complex deficiency is a recently recognized abnormality of fatty acid metabolism. We herein present the association of a flecked retina with peroxisomal bifunctional enzyme deficiency, a clinical association not previously reported. We suggest the finding of a flecked retina in an infant presenting with hypotonia, seizures, and failure to thrive is highly suggestive of this diagnosis.
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Affiliation(s)
- H S Eustis
- Department of Ophthalmology, Ochsner Clinic, New Orleans, LA 70121, USA
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11
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Curry T. One minute wisdom. You don't have to strike to take industrial protest action. Nurs Stand 1993; 7:51. [PMID: 8217643 DOI: 10.7748/ns.7.51.51.s61] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Muse K, Lentini G, Curry T, Pedigo N, Vernon M, London S. Pregnancy from cryopreserved embryos: an important new aspect of assisted reproduction. J Ky Med Assoc 1991; 89:442-5. [PMID: 1753183] [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: 12/28/2022]
Abstract
Assisted Reproduction techniques have become well-established methods of treating infertility in the decade since their inception. The gradually improving efficacy of these procedures has made the risks of multiple pregnancy a serious concern. Cryopreservation of "extra" embryos has been developed to counter this problem, but has led to new difficulties. Assisted Reproduction in Kentucky has kept pace with progress worldwide; the first Kentucky live birth from transfer of cryopreserved embryos is reported.
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Affiliation(s)
- K Muse
- Department of Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington
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Salomon D, Brunson M, Vansickler J, Pfaff W, Howard R, Peterson J, Curry T, Thompson R, Squiers E. A retrospective analysis of late renal graft function: correlation with mean cyclosporine levels and lack of evidence for chronic cyclosporine toxicity. Transplant Proc 1991; 23:1018-9. [PMID: 1989143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- D Salomon
- University of Florida Kidney Transplant Program, Department of Medicine, Gainesville
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Vernon M, Wilson E, Muse K, Estes S, Curry T. Successful pregnancies from men with retrograde ejaculation with the use of washed sperm and gamete intrafallopian tube transfer (GIFT). Fertil Steril 1988; 50:822-4. [PMID: 3181496 DOI: 10.1016/s0015-0282(16)60325-4] [Citation(s) in RCA: 23] [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] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Viable sperm were collected from men suffering from retrograde ejaculation by the technique of rapid washing of semen/urine in a buffered collection solution. The utilization of washed semen/urine from two men with retrograde ejaculation in the GIFT procedure lead to successful conceptions and the birth of two healthy female babies. Thus, the technique of rapid washing of sperm from retrograde ejaculating men coupled with GIFT represents a viable alternative for the attainment of pregnancy.
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Affiliation(s)
- M Vernon
- Department of Obstetrics and Gynecology, University of Kentucky School of Medicine, Lexington 40536
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Preminger GM, Miller RH, Curry T. Entrapment of renal calculi by Malecot nephrostomy tubes. Br J Radiol 1988; 61:81-3. [PMID: 3349244 DOI: 10.1259/0007-1285-61-721-81] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- G M Preminger
- Department of Radiology, University of Texas Health Science Center, Dallas 75235
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16
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Abstract
The change in the position of the kidney during percutaneous nephrostomy is a major concern to urologists who participate in percutaneous stone removal. We report that the majority of kidneys ascend an average of 2.2 cm. when the patient turns from a supine to a prone position. This change in position is more marked on the right side and is more common in male patients. Knowledge of this anatomical variation is important to determine which patients are suitable candidates for percutaneous nephrostolithotomy and to plan a percutaneous approach to a renal or ureteral calculus.
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Abstract
Technical advances and operator experience have resulted in a rapid and marked streamlining of the percutaneous approach to renal calculi. The development of nephrostomy tract balloon dilators, improved grasping instruments and the use of assisted local anesthesia have been integral in reducing the morbidity and cost of the procedure. We report our initial favorable experience in the use of percutaneous stone removal on an outpatient basis. All 5 patients underwent an uncomplicated 1-stage stone removal. Cost for outpatient percutaneous stone removal was substantially less than for surgery or extracorporeal shock wave lithotripsy.
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Preminger GM, Clayman RV, Hardeman SW, Franklin J, Curry T, Peters PC. Percutaneous nephrostolithotomy vs open surgery for renal calculi. A comparative study. JAMA 1985; 254:1054-8. [PMID: 4021044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
To evaluate the impact of the percutaneous removal of renal calculi we compared 41 patients who had undergone open renal surgery to 88 patients who had a one- or two-stage percutaneous nephrostolithotomy for symptomatic urolithiasis. The two groups were similar with regard to stone size, stone location, treatment success, and complication rates. However, for patients with calculi 2.5 cm or smaller in diameter, the percutaneous procedure resulted in lower postoperative morbidity, more rapid convalescence, less hospital cost, and greater patient satisfaction. For patients with calculi larger than 2.5 cm in diameter, the percutaneous approach was slightly more expensive than open surgery but resulted in a markedly shortened convalescent period. In our experience, percutaneous nephrostolithotomy performed in a single stage under assisted local anesthesia was the most efficacious and least expensive of the percutaneous approaches.
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Abstract
We describe a case of direct percutaneous ureterolithotomy in which the combination of antegrade control, a ureteral stent and precise fluoroscopic imaging resulted in a successful outcome. This technique may be helpful when other more traditional methods for percutaneous ureteral stone removal fail.
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Hull A, Peters P, Dickerman R, Helderman H, Atkins C, Prati R, Long D, Parker T, Rinner S, White M, Vergne-Marini P, Stastny P, Curry T. Comparisons of dialysis and transplant results from one center. Transplant Proc 1979; 11:125-6. [PMID: 377619] [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] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Goodman M, Curry T, Russell T. Xanthogranulomatous pyelonephritis (XGP): a local disease with systemic manifestations. Report of 23 patients and review of the literature. Medicine (Baltimore) 1979; 58:171-81. [PMID: 431402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The clinical, pathological and radiographic findings of 135 cases of xanthogranulomatous pyelonephritis have been reviewed. It is a form of renal suppuration and obstruction most commonly seen in middle aged women although all ages and both sexes may be affected. There is no race predilection. Gram-negative organisms are usually present and bilateral involvement has not been reported. The most common offending organism is Proteus mirabilis. Hepatic dysfunction is seen and appears to normalize with removal of the XGP process. Preoperative angiography may increase the accuracy of differentiating this disorder from hypernephroma and may aid the surgeon in planning his approach to kidney resection depending upon the staging of XGP. Chronic renal failure is not usually a feature of XGP and nephrectomy is curative without any incidence of recurrence.
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Hull A, Peters P, Dickerman R, Helderman H, Atkins C, Prati R, Long D, Parker T, Rinner S, White M, Vergne-Marini P, Stephens M, Emmett M, Stastny P, Curry T. Comparison of hemodialysis (HD) and renal transplantation (RT) from one center. Proc Clin Dial Transplant Forum 1978; 8:82-6. [PMID: 386325] [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: 12/15/2022]
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Conrad MR, Dickerman R, Love IL, Curry T, Peters P, Hull A, Lerman M, Helderman H. New observations in renal transplants using ultrasound. AJR Am J Roentgenol 1978; 131:851-5. [PMID: 101043 DOI: 10.2214/ajr.131.5.851] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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