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Lodha A, Moser JJ, Walker A, Lodha A, Tang S, McAllister D. Association of epidural analgesia in labor with neurodevelopmental outcomes in premature infants born at <29 weeks of gestational age. J Perinatol 2024; 44:548-553. [PMID: 38355736 DOI: 10.1038/s41372-024-01893-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To explore associations between epidural administration to mothers in labor with neurodevelopmental outcomes at 3 years corrected age in preterm infants born <29 weeks gestational age. STUDY DESIGN Infants born <29 weeks gestational age between 2006 and 2012 were included. Our primary outcome was a composite of death or neurodevelopmental impairment at 3 years corrected age. Infants were divided into those whose mothers did or did not receive epidural analgesia in labor. Univariable and multivariable regression was used for analysis. RESULTS There were 548 infants in the no epidural analgesia group and 121 in the epidural analgesia group. The adjusted odds ratio (95%CI) of neurodevelopmental impairment or death in the epidural group was 1.25 (0.82-1.93). Propensity score-matched results were 1.32 (0.79-2.22). CONCLUSION Preterm infants born <29 weeks gestational age to mothers who received epidural analgesia during labor were not associated with poor neurodevelopmental outcomes at 3 years corrected age.
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Affiliation(s)
- Arijit Lodha
- Medical Student, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - J J Moser
- Clinical Assistant Professor, Department of Anesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - A Walker
- Senior Consultant, Department of Anesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - A Lodha
- Professor, Department of Pediatrics & Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - S Tang
- Analyst, Department of Obstetrics & Gynecology and Alberta Children's Hospital Neonatal Follow-up Clinic, Alberta Health Services, Calgary, Alberta, Canada
| | - D McAllister
- Clinical Associate Professor, Department of Anesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Baghirzada L, Walker A, Yu HC, Endersby R. The analgesic effect of transversalis fascia plane block after caesarean section under spinal anaesthesia with intrathecal morphine: a randomised controlled trial. Anaesthesia 2024; 79:63-70. [PMID: 37961945 DOI: 10.1111/anae.16173] [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] [Accepted: 10/16/2023] [Indexed: 11/15/2023]
Abstract
We aimed to test whether bilateral injection of bupivacaine 0.25% in the transversalis fascia plane reduced 24 h opioid dose after singleton caesarean section, under spinal anaesthesia with intrathecal morphine, compared with saline 0.9% injectate. We allocated randomly 52 women to bilateral injection of 20 ml saline 0.9% on arrival in the post-anaesthesia care unit and 54 women to bilateral injection of 20 ml bupivacaine 0.25% (with adrenaline 2.5 μg.ml-1 ). Mean (SD) cumulative morphine equivalent opioid dose 24 h after saline injection was 32.3 (28.3) mg and 18.7 (20.2) mg after bupivacaine injection, a mean (95%CI) difference of 13.7 (4.1-23.2) mg (p = 0.006). Median (IQR [range]) time to first postoperative opioid dose was 3.0 (1.5-10.3 [0.0-57.4]) h after saline 0.9% and 8.2 (2.7-29.6 [0.2-55.4]) h after bupivacaine 0.25% (p = 0.054). Transversalis fascia plane with bupivacaine 0.25% with adrenaline reduced postoperative pain at rest during 48 h (0-10-point scale) by a mean (95%CI) of 0.9 (0.2-1.6) points (p = 0.013) and on movement by 1.2 (0.4-2.1) points (p = 0.004). We conclude that transversalis fascia plane bupivacaine 0.25% with adrenaline reduces pain and opioid dose after caesarean section compared with saline 0.9%.
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Affiliation(s)
- L Baghirzada
- Department of Anaesthesiology, Perioperative and Pain Medicine, University of Calgary, Canada
| | - A Walker
- Department of Anaesthesiology, Perioperative and Pain Medicine, University of Calgary, Canada
| | - H C Yu
- Department of Anaesthesiology, Perioperative and Pain Medicine, University of Calgary, Canada
| | - R Endersby
- Department of Anaesthesiology, Perioperative and Pain Medicine, University of Calgary, Canada
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Clarke K, Wilde C, Walker A, Nghiem AZ, Little S, Osborne SF. Combined upper lid skin crease and endoscopic approach to frontal sinus mucocoeles. Orbit 2023:1-8. [PMID: 38032741 DOI: 10.1080/01676830.2023.2287638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE This case series describes the ophthalmic manifestations of frontal sinus mucoceles and reports the long-term surgical outcomes of a combined endoscopic and upper-lid skin crease drainage approach carried out jointly with otorhinolaryngology. METHODS We present a retrospective case review of 18 orbits and 15 patients presenting with frontal sinus mucocoeles, all of whom underwent drainage via an adapted anterior orbitotomy approach between January 2015 and July 2023. Data collection included preoperative and postoperative examination findings (visual acuity, extraocular motility, lid retraction, and lagophthalmos), mucocoele recurrence, cosmetic satisfaction, and surgical complications. Patients were followed up for an average of 22 months. RESULTS All patients underwent successful frontal mucocoele drainage via a modified anterior orbitotomy and simultaneous endonasal approach. At presentation, three (20%) had extraocular restriction leading to diplopia, and six (40%) had proptosis in the eye adjacent to the mucocoele. One patient presented acutely with no light perception in the affected eye due to compressive optic neuropathy. All patients who had reduced extraocular motility before surgery regained full motility post-operatively. Treatment was successful in all cases, and there was no documented mucocoele recurrence during follow-up. Satisfactory aesthetic outcomes were achieved in all cases. Reported complications included temporary forehead numbness and ptosis of the affected eyelid, which resolved without intervention. CONCLUSION The modified anterior orbitotomy approach to frontal mucocoeles allows optimal frontal sinus access and mucocoele treatment while preserving cosmesis.
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Affiliation(s)
- Kirsty Clarke
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Caroline Wilde
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Abigail Walker
- Adnexal Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Allan Z Nghiem
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Sarah Little
- Adnexal Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sarah F Osborne
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Michelet F, Smyth M, Lall R, Noordali H, Starr K, Berridge L, Yeung J, Fuller G, Petrou S, Walker A, Mark J, Canaway A, Khan K, Perkins GD. Randomised controlled trial of analgesia for the management of acute severe pain from traumatic injury: study protocol for the paramedic analgesia comparing ketamine and morphine in trauma (PACKMaN). Scand J Trauma Resusc Emerg Med 2023; 31:84. [PMID: 38001541 PMCID: PMC10668487 DOI: 10.1186/s13049-023-01146-1] [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: 03/24/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Prehospital analgesia is often required after traumatic injury, currently morphine is the strongest parenteral analgesia routinely available for use by paramedics in the United Kingdom (UK) when treating patients with severe pain. This protocol describes a multi-centre, randomised, double blinded trial comparing the clinical and cost-effectiveness of ketamine and morphine for severe pain following acute traumatic injury. METHODS A two arm pragmatic, phase III trial working with two large NHS ambulance services, with an internal pilot. Participants will be randomised in equal numbers to either (1) morphine or (2) ketamine by IV/IO injection. We aim to recruit 446 participants over the age of 16 years old, with a self-reported pain score of 7 or above out of 10. Randomised participants will receive a maximum of 20 mg of morphine, or a maximum of 30 mg of ketamine, to manage their pain. The primary outcome will be the sum of pain intensity difference. Secondary outcomes measure the effectiveness of pain relief and overall patient experience from randomisation to arrival at hospital as well as monitoring the adverse events, resource use and cost-effectiveness outcomes. DISCUSSION The PACKMAN study is the first UK clinical trial addressing the clinical and cost-effectiveness of ketamine and morphine in treating acute severe pain from traumatic injury treated by NHS paramedics. The findings will inform future clinical practice and provide insights into the effectiveness of ketamine as a prehospital analgesia. TRIAL REGISTRATION ISRCTN, ISRCTN14124474. Registered 22 October 2020, https://www.isrctn.com/ISRCTN14124474.
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Affiliation(s)
- F Michelet
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
| | - M Smyth
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - R Lall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - H Noordali
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - K Starr
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - L Berridge
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - J Yeung
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
- Critical Care Directorate, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - G Fuller
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - A Walker
- West Midlands Ambulance Services NHS Trust, Brierley Hill, Dudley, UK
| | - J Mark
- Yorkshire Ambulance Services NHS Trust, Wakefield, UK
| | - A Canaway
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - K Khan
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - G D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
- Critical Care Directorate, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Liu ZY, Wong M, Brahmabhatt P, Walker A, Earnshaw J, Cervin A. Navigating the post-operative nose as a primary care physician. Aust J Gen Pract 2023; 52:787-792. [PMID: 37935152 DOI: 10.31128/ajgp-03-23-6755] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Rhinology procedures represent a wide and diverse category of procedures, which, on the surface, can appear very similar. Thus, it is difficult to navigate postoperative presentations in the general practice setting. OBJECTIVE This article provides a comprehensive guide to managing acute presentations that might arise in primary care settings following common rhinology surgeries. It outlines common complications, their potential aetiology and first-aid measures that might be employed to temporise patients prior to escalation. It also provides a guide as to potential red flag symptomatology, and when and how to escalate specific presentations. DISCUSSION Most acute postoperative complications can be effectively managed, or at the very least temporised, in the community setting. When in doubt, discuss with your local otolaryngologist or nearest centre with otolaryngology cover.
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Affiliation(s)
- Zhen Yu Liu
- MBBS (Hons), Otolaryngology Trainee, Royal Brisbane and Women@s Hospital, Brisbane, Qld
| | - Michael Wong
- MD, Otolaryngology Principal House Officer, Royal Brisbane and Women@s Hospital, Brisbane, Qld
| | - Pranter Brahmabhatt
- MBBS, FRCS (ORL-HNS), Rhinology Fellow, Royal Brisbane and Women@s Hospital, Brisbane, Qld
| | - Abigail Walker
- MBChB, FRCS (ORL-HNS), Otolaryngology Consultant, Royal Brisbane and Women@s Hospital, Brisbane, Qld
| | - James Earnshaw
- MBBS, FRACS (ENT), Rhinology Consultant, Royal Brisbane and Women@s Hospital, Brisbane, Qld
| | - Anders Cervin
- MD, PhD, Professor in Otorhinolaryngology at University of Queensland, Qld
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Sabo MT, Walker A, Elmi Assadzadeh G, Hildebrand KA. Rotator cuff outcomes and mental health indices: Correlation or causation? Shoulder Elbow 2023; 15:108-118. [PMID: 37974603 PMCID: PMC10649477 DOI: 10.1177/17585732221076027] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/12/2021] [Accepted: 12/22/2021] [Indexed: 11/19/2023]
Abstract
Background Psychological factors such as catastrophizing, anxiety, and depression influence clinical outcomes in many conditions. Our purpose was to examine trends and associations between these and outcomes of rotator cuff surgery. Methods 148 patients (76 W:72 M, 55.1 ± 8.2 years) with unilateral symptomatic rotator cuff syndrome were followed for 1 year after surgery. The Western Ontario Rotator Cuff Score (WORC), the Pain Catastrophizing Score (PCS), and the Hospital Anxiety and Depression Score (HADS) were administered. Evolution and associations of WORC, HADS and PCS scores were examined using uni- and multivariate analyzes. Results At 1 year, PCS, HADS-A, and HADS-D scores negatively correlated with WORC score (R = -0.6, -0.61, -0.69). The strength of correlation was lower between baseline PCS, HADS-A, and HADS-D scores and 1-year WORC score (R = -0.38, -0.43, -0.42). Prior anxiety diagnosis was associated with higher HADS-A scores at 2- and 6- weeks post-op (p = 0.013, 0.011). 106 participants experienced an improving HADS-D over the year of follow-up. Worse pre-op pain, WORC, PCS, HADS-A, HADS-D, cardiovascular disease and current smoking were associated with non-improving HADS-D. Discussion Patient-reported outcomes of rotator cuff surgery are associated with patient-reported anxiety, depression, and pain catastrophizing. In many, all outcome scores improved over time suggesting a two-way association between shoulder condition and psychological parameters. Level of evidence II.
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Affiliation(s)
- MT Sabo
- SCRUBS Research Unit, University of Calgary, Calgary, AB, Canada
| | - A Walker
- Department of Anaesthesia, University of Calgary, Calgary, AB, Canada
| | | | - KA Hildebrand
- Department of Surgery, University of Calgary, Calgary, AB, Canada
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Tang Y, Van Parys M, Walker A, Drelick A, Liang X, Dean B, Chen L. A universal surrogate matrix assay for urea measurement in clinical pharmacokinetic studies of respiratory diseases. Biomed Chromatogr 2023; 37:e5713. [PMID: 37544926 DOI: 10.1002/bmc.5713] [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: 06/19/2023] [Revised: 07/07/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
Abstract
In pharmacokinetic studies for respiratory diseases, urea is a commonly used dilution marker for volume normalization of various biological matrices, owing to the fact that urea diffuses freely throughout the body and is minimally affected by disease states. In this study, we developed a convenient liquid chromatography-tandem mass spectrometry (LC-MS/MS) surrogate matrix assay for accurate urea quantitation in plasma, serum and epithelial lining fluid. Different mass spectrometer platforms and ionization modes were compared in parallel. The LC method and mass spectrometer parameters were comprehensively optimized to reduce interferences, to smooth the baseline and to maximize the signal-to-noise ratio. Saline was selected as the surrogate matrix, and its suitability was confirmed by good parallelism and accurate quality control sample measurements. Reliable and robust assay performance was demonstrated by precision and accuracy, dilution integrity, sensitivity, recovery and stability, all of which met bioanalysis requirements to support clinical studies. The assay performance was also verified and better understood by comparing it with a colorimetric assay and to a surrogate analyte assay. The newly developed surrogate matrix assay has the potential to be further expanded for urea quantitation in numerous physiological matrices.
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Affiliation(s)
- Yang Tang
- Department of Drug Metabolism and Pharmacokinetics, Genentech Inc., South San Francisco, California, USA
| | - Michael Van Parys
- Department of Bioanalytical Chemistry, LabCorp Early Drug Development, Madison, Wisconsin, USA
| | - Abigail Walker
- Department of Bioanalytical Chemistry, LabCorp Early Drug Development, Madison, Wisconsin, USA
| | - Alexandra Drelick
- Department of Bioanalytical Chemistry, LabCorp Early Drug Development, Madison, Wisconsin, USA
| | - Xiaorong Liang
- Department of Drug Metabolism and Pharmacokinetics, Genentech Inc., South San Francisco, California, USA
| | - Brian Dean
- Department of Drug Metabolism and Pharmacokinetics, Genentech Inc., South San Francisco, California, USA
| | - Liuxi Chen
- Department of Drug Metabolism and Pharmacokinetics, Genentech Inc., South San Francisco, California, USA
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Liu ZY, Vaira LA, Boscolo-Rizzo P, Walker A, Hopkins C. Post-viral olfactory loss and parosmia. BMJ Med 2023; 2:e000382. [PMID: 37841969 PMCID: PMC10568123 DOI: 10.1136/bmjmed-2022-000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/26/2023] [Indexed: 10/17/2023]
Abstract
The emergence of SARS-CoV-2 has brought olfactory dysfunction to the forefront of public awareness, because up to half of infected individuals could develop olfactory dysfunction. Loss of smell-which can be partial or total-in itself is debilitating, but the distortion of sense of smell (parosmia) that can occur as a consequence of a viral upper respiratory tract infection (either alongside a reduction in sense of smell or as a solo symptom) can be very distressing for patients. Incidence of olfactory loss after SARS-CoV-2 infection has been estimated by meta-analysis to be around 50%, with more than one in three who will subsequently report parosmia. While early loss of sense of smell is thought to be due to infection of the supporting cells of the olfactory epithelium, the underlying mechanisms of persistant loss and parosmia remain less clear. Depletion of olfactory sensory neurones, chronic inflammatory infiltrates, and downregulation of receptor expression are thought to contribute. There are few effective therapeutic options, so support and olfactory training are essential. Further research is required before strong recommendations can be made to support treatment with steroids, supplements, or interventions applied topically or injected into the olfactory epithelium in terms of improving recovery of quantitative olfactory function. It is not yet known whether these treatments will also achieve comparable improvements in parosmia. This article aims to contextualise parosmia in the setting of post-viral olfactory dysfunction, explore some of the putative molecular mechanisms, and review some of the treatment options available.
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Affiliation(s)
- Zhen Yu Liu
- Department of ENT Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Luigi Angelo Vaira
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Sardegna, Italy
| | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical, and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Abigail Walker
- Department of ENT, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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Kennedy J, Parker M, Seaborne M, Mhereeg M, Walker A, Walker V, Denaxas S, Kennedy N, Katikireddi SV, Brophy S. Healthcare use attributable to COVID-19: a propensity-matched national electronic health records cohort study of 249,390 people in Wales, UK. BMC Med 2023; 21:259. [PMID: 37468884 PMCID: PMC10354936 DOI: 10.1186/s12916-023-02897-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 05/10/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND To determine the extent and nature of changes associated with COVID-19 infection in terms of healthcare utilisation, this study observed healthcare contact 1 to 4 and 5 to 24 weeks following a COVID-19 diagnosis compared to propensity-matched controls. METHODS Two hundred forty nine thousand three hundred ninety Welsh individuals with a positive reverse transcription-polymerase chain reaction (RT-PCR) test were identified from data from national PCR test results. After elimination criteria, 98,600 positive individuals were matched to test negative and never tested controls using propensity matching. Cohorts were split on test location. Tests could be taken in either the hospital or community. Controls were those who had tested negative in their respective environments. Survival analysis was utilised for first clinical outcomes which are grouped into primary and secondary. Primary outcomes include post-viral-illness and fatigue as an indication of long-COVID. Secondary outcomes include clinical terminology concepts for embolism, respiratory conditions, mental health conditions, fit notes, or hospital attendance. Increased instantaneous risk for positive individuals was quantified using hazard ratios (HR) from Cox regression, while absolute risk (AR) and relative risk were quantified using life table analysis. RESULTS Analysis was conducted using all individuals and stratified by test location. Cases are compared to controls from the same test location. Fatigue (HR: 1.77, 95% CI: 1.34-2.25, p = < 0.001) and embolism (HR: 1.50, 95% CI: 1.15-1.97, p = 0.003) were more likely to occur in all positive individuals in the first 4 weeks; however, anxiety and depression (HR: 0.83, 95% CI: 0.73-0.95, p = 0.007) were less likely. Positive individuals continued to be more at risk of fatigue (HR: 1.47, 95% CI: 1.24-1.75, p = < 0.001) and embolism (HR: 1.51, 95% CI: 1.13-2.02, p = 0.005) after 4 weeks. All positive individuals are also at greater risk of post-viral illness (HR: 4.57, 95% CI: 1.77-11.80, p = 0.002). Despite statistical association between testing positive and several conditions, life table analysis shows that only a small minority of the study population were affected. CONCLUSIONS Community COVID-19 disease is associated with increased risks of post-viral-illness, fatigue, embolism, and respiratory conditions. Despite elevated risks, the absolute healthcare burden is low. Subsequently, either very small proportions of people experience adverse outcomes following COVID-19 or they are not presenting to healthcare.
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Affiliation(s)
- J Kennedy
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
| | - M Parker
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK.
| | - M Seaborne
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
| | - M Mhereeg
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
| | - A Walker
- Datalab, Nuffield Dept of Primary Care Health Science, Radcliffe Primary Care Building, Oxford, OX2 6GG, UK
| | - V Walker
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - S Denaxas
- Institute for Health Informatics, UCL, London, UK
| | - N Kennedy
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
| | - S V Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S Brophy
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
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Steele D, Walker A. 'Vancowax' for haemostasis and topical antibiotic post sternotomy. Ann R Coll Surg Engl 2023; 105:385. [PMID: 36239947 PMCID: PMC10066641 DOI: 10.1308/rcsann.2022.0105] [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] [Accepted: 04/27/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- D Steele
- Blackpool Teaching Hospitals NHS Foundation Trust, UK
| | - A Walker
- Blackpool Teaching Hospitals NHS Foundation Trust, UK
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Posadas Ruiz J, Walker A, Zhu H, Bota-Rabassedas N, Wijeratne S, Connolly C, Wynes M, Sanchez-Espiridion B, Dacic S, Wistuba I, Lee J. PP01.53 Pathologic Response Assessment Tool – Architecting a Cloud-Based Tool to Streamline Logistics for Shipping, Tracking, Scoring, and Reporting. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2022.09.079] [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: 01/30/2023]
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Bota-Rabassedas N, Wijeratne S, Connolly C, Wynes M, Sanchez-Espiridion B, Fujimoto J, Posadas J, Walker A, Zhu H, Dacic S, Travis W, Lee J, Kerr K, Glass C, Saqui A, Sholl L, Cooper W, Roden A, Poleri C, Chung JH, Lopez-Martin J, Borczuk A, Weissferdt A, Wistuba I. PP01.39 Infrastructure for Interobserver Variability Assessment of Pathologic Response (PR), in Surgical Resection Specimens Following Neoadjuvant Immune Check Point Inhibitor (ICI) Therapies in Early Stage NSCLC. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2022.09.065] [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: 01/30/2023]
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13
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Pell R, Walker A, Ganti L, Quinones A, Vera A, Rosario J, Ragusa A. 196 An Infographic Utilized as a Just-In-Time Tool for Paramedic EKG Interpretation. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.220] [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: 11/01/2022]
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Abstract
INTRODUCTION Mucosal melanoma (MM) is a rare disease, accounting for approximately 1.4% of all melanomas and only 0.03% of all new cancer diagnoses. Traditionally, it has been associated with a poor prognosis, with an overall 5-year survival rate of <25%. Progress in treatment has been hindered by its rarity and lack of evidence. However, studies on the treatment of subcutaneous melanoma with immunotherapy have demonstrated significant improvement in survival rates and have become a core part of oncological strategies. This paper discusses the revision of the evidence for the use of immunotherapy in the head and neck. METHODS This systematic review was conducted on January 19, 2019. The Medline and Embase databases were searched. In total, 509 articles were collated and screened. Inclusion criteria for the study included treatment-naive cohorts, cohorts with recurrent disease, primary outcomes with overall survival and disease-free survival at 5 years and at the longest follow-up, and studies of adults with MM in whom immunotherapy was reported as a treatment strategy. The exclusion criteria included duplicate papers, anatomical sites other than the head and neck, case reports, and those not published in English. RESULTS Fifty-two papers out of the 509 collated papers met the inclusion criteria. The results are shown as a comparison of yearly survival rates following different treatment modalities (immunotherapy vs nonimmunotherapy) at 2, 3, and 5 years. It was found that, with immunotherapy, survival rates at all intervals were higher than those without immunotherapy. DISCUSSION Immunotherapy outcomes in small studies have shown good data for increasing survival rates at yearly intervals in MM of the head and neck. Larger clinical trials are needed to accurately distinguish the efficacy and survival outcomes of immunotherapy when compared with treatment modalities, excluding immunotherapy. However, the ability to perform larger trials is limited by the rarity of MM of the head and neck.
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Affiliation(s)
- Jad Wehbe
- St George’s University of London, – Chelsea and Wesminster Hospital, London, United Kingdom
- *Correspondence: Jad Wehbe, Chelsea and Wesminster Hospital, London, United Kingdom (e-mail: )
| | | | - Abigail Walker
- University of Glasgow, Royal Brisbane Hospital, Australia
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15
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Chen H, Walker A, Schollaert-Fitch K, Torok K, Jacobe H. 191 Clinical characteristics associated with functional abnormalities in pediatric and adult morphea: A cross-sectional study. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Walker A, Black S, Walocko F, Li X, Chong B. 181 Development of systemic lupus in patients with cutaneous lupus: A comparison of three classification criteria. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.188] [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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17
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Walker A, Teske N, Zigler C, Jacobe H. 162 Validation of a patient-reported outcome measure in adults with morphea. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.169] [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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18
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Wang A, Walker A, Niven D, Mirakhur A. Abstract No. 156 Fibrinogen level as a predictor of bleeding risk during catheter-directed thrombolysis. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.237] [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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19
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Affiliation(s)
- Abigail Walker
- General Surgery, St George's Hospital, Tooting SW17 0QT, UK
| | | | | | - Claire Hopkins
- ENT Department, Guy's and St Thomas' Hospitals, London SE1 9RT, UK
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20
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Abstract
CASE HISTORY A 1-year-old Border Terrier presented with acute onset of neurological signs and neck pain. CLINICAL FINDINGS Severe generalised ataxia, muscle tremors and cranial nerve deficits were noted. Multifocal brain lesions were suspected based on neurological examination. Computed tomography revealed an abdominal mass and cerebellar herniation through the foramen magnum. LABORATORY AND PATHOLOGICAL FINDINGS Cytological and histopathological analysis of the abdominal mass revealed necrotising and granulomatous lymphadenitis with intralesional algal elements most consistent with Prototheca spp.. Culture of a sample from the mesenteric lymph node confirmed the presence of Prototheca spp. which was identified as P. bovis based on sequencing of a DNA fragment amplified by PCR. Following inadequate response to symptomatic therapy and poor prognosis, the dog was subjected to euthanasia. Histopathological evaluation of the central nervous system lesions, identified granulomatous meningitis and ventriculitis with the presence of intralesional algae. DIAGNOSIS Disseminated protothecosis with granulomatous meningitis and ventriculitis caused by Prototheca bovis (formerly P. zopfii gen. 2). CLINICAL RELEVANCE This is the first case report of disseminated protothecosis with central nervous system involvement in a dog in New Zealand.
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Affiliation(s)
- A Walker
- Veterinary Specialist Aotearoa, Auckland, New Zealand
| | - I MacEwan
- Veterinary Specialist Aotearoa, Auckland, New Zealand
| | - T Fluen
- Veterinary Specialist Aotearoa, Auckland, New Zealand
| | - M Hardcastle
- Gribbles Veterinary Pathology, Auckland, New Zealand
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21
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Abstract
Allergic rhinitis affects 20% of the population of the UK. It confers a significant health burden upon the individual as it affects the patient's quality of life and is associated with serious comorbidities including asthma, sinusitis and conjunctivitis. Owing to its prevalence, it has a significant economic impact through its effects on education, productivity and use of healthcare resources. This review focuses on the management of allergic rhinitis and potential future treatments, because of the lack of clear national guidelines and because this illness is often misdiagnosed and mismanaged. The article provides a comprehensive overview of allergic rhinitis and illustrates the assessment criteria for various subcategories.
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Affiliation(s)
- ZA Siddiqui
- Department of Ear, Nose and Throat Surgery, University Hospital Lewisham, London, UK
| | - A Walker
- Department of Ear, Nose and Throat Surgery, University Hospital Lewisham, London, UK
| | - MM Pirwani
- Department of Life Sciences and Medicine, King's College London, London, UK
| | - M Tahiri
- Department of Life Sciences and Medicine, King's College London, London, UK
| | - I Syed
- Department of Ear, Nose and Throat Surgery, University Hospital Lewisham, London, UK
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22
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Hopkins C, Surda P, Walker A, Wolf A, Speth MM, Jacques T, Hox V, Van Gerven L, Santamaria-Gadea A, Segboer C, Lourijsen E, Turri-Zanoni M, Huart C, Rennie C, Green R, The Samter's Society TSS, Kelly CE, Knill A, Lund VJ, Fokkens WJ. EPOS 4 Patients. Rhinology 2021; 0:2946. [PMID: 34762718 DOI: 10.4193/rhin20.950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
EPOS2020 is the 4th and most recent version of the European Position Paper on Rhinosinusitis and Nasal Polyps which was first published in 2005. It aims to provide the most up to date scientifically robust information on the topic published in the literature which has been critically analysed by an international group of clinicians drawn from all disciplines dealing with these problems together with patients. The guidelines offer evidence-based recommendations and care pathways for acute and chronic rhinosinusitis in both adults and children. Management of these diseases from the patients' perspective is an important part of EPOS2020. Not only is this included in the main document but, for the first time, we have produced a separate supplement dedicated to and in collaboration with patients, EPOS4Patients, which aims to provide information in an accessible format, to answer frequently asked questions about these diseases and their treatment options as well as including useful patient resources and websites. It has never been more important for patients to be actively involved in their care. Being well informed helps you to make the best decisions together with your doctor.
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Affiliation(s)
- C Hopkins
- Guy's and St Thomas' NHS Hospitals Trust, UK
| | - P Surda
- Guy's and St Thomas' NHS Hospitals Trust, UK
| | - A Walker
- St George's University Hospitals NHS Foundation Trust, UK
| | - A Wolf
- Medical University Graz, Graz, Austria
| | - M M Speth
- Klinik für Hals-, Nasen-, Ohren- Krankheiten, Hals-und Gesichtschirurgie, Kantonsspital Aarau, Switzerland
| | - T Jacques
- St George's University Hospitals NHS Foundation Trust, UK
| | - V Hox
- Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - L Van Gerven
- Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium
| | | | - C Segboer
- Dijklander Hospital, Hoom and Purmerend, The Netherlands
| | - E Lourijsen
- Department of Otorhinolaryngology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - M Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - C Huart
- Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - C Rennie
- Imperial College Healthcare NHS Trust, UK
| | - R Green
- Ninewells Hospital, Dundee, UK
| | | | | | - A Knill
- Patient representative, Opuscomms, London
| | - V J Lund
- Royal National Throat, Nose and Ear Hospital, UCLH Foundation Trust, London, UK
| | - W J Fokkens
- Department of Otorhinolaryngology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
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23
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Shah K, Modi V, Gandhi H, Thyagaturu H, Walker A, Shirani J. Predictors of cardiac implantable electronic device infection in the United States. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Cardiac implantable electronic devices (CIED) are important tools for managing arrhythmias, improving hemodynamics, and preventing sudden cardiac death. Device infection (DI) remains a significant complication of CIED and is associated with high morbidity, mortality, and healthcare cost.
Purpose
To analyze predictors of DI and its in-hospital outcomes.
Methods
National Inpatient Sample 2011–2018 database was analyzed for admissions for CIED implantation or DI. Baseline and hospital level characteristics were derived. The Chi-square test and student t-test were used for comparison of categorical and continuous variables respectively. Variables with p<0.20 from univariate analysis were included in the multivariate logistic regression to identify independent predictors of DI.
Results
A total of 1,604,173 admissions for CIED implantations and 71,007 (4.4%) admissions for DI were reported during 2011–2018. There was no significant change in annual admissions for DI (range 8550 to 9307, p for trend=0.98). Those with DI were more likely to be male (69.3 vs 57%, p<0.001) and had higher Charlson comorbidity index score ≥3 (46.6%-vs-36.8%, p<0.001). Multivariate analysis identified post-procedural hematoma (odds ratio (OR)=3.96; 95% Confidence Interval (CI)=3.46–4.54), congestive heart failure (CHF; OR=2.80, 95% CI=2.66–2.96), age group 45–60 years (OR=2.46, 95% CI=2.30–2.63), malnutrition (OR=1.99, 95% CI=1.85–2.15), coagulopathy (OR=1.75, 95% CI=1.64–1.86), end-stage renal disease (OR=1.65, 95% CI=1.53–1.78), atrial fibrillation (OR=1.42; 95% CI=1.35–1.49), non-Hispanic race (OR=1.25; 95% CI=1.16–1.36), coronary artery disease (OR=1.21; 95% CI=1.15–1.26), and thyroid disease (OR=1.15; 95% CI=1.09–1.12) [all p<0.001] as independent predictors of DI. Prevalence of CHF, malnutrition, and atrial fibrillation increased in those admitted with DI over the observation period as shown in Figure 1 (p for trend <0.001). Prevalence of diabetes mellitus also increased during the observation period although it was not an independent predictor of DI (p for trend <0.001). Pulmonary embolism and deep vein thrombosis were most common complications in those with DI (4.1 and 3.6% respectively). Annual in-hospital mortality ranged from 3.9 to 5.7% (mean 4.4%, p for trend=0.07).
Conclusion
DI is relatively common and continues to be associated with high morbidity and mortality. Prevalence of DI has not changed significantly despite technical and technological advances in device implantation. Evaluation of risk factors for DI and management of modifiable comorbidities may be needed to reduce the incidence of this important complication of CIED implantation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Shah
- St. Luke's University Hospital, Bethlehem, United States of America
| | - V Modi
- St. Luke's University Hospital, Bethlehem, United States of America
| | - H Gandhi
- Monmouth Medical Center, Long Branch, United States of America
| | - H Thyagaturu
- Bassett Medical Center, Cooperstown, United States of America
| | - A Walker
- Lewis Katz School of Medicine at Temple University, Philadelphia, United States of America
| | - J Shirani
- St. Luke's University Hospital, Bethlehem, United States of America
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24
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Hox V, Beyaert S, Bullens D, Couto M, Langer D, Hellings P, Huart C, Rombaux P, Seys SF, Surda P, Walker A, Steelant B. Tackling nasal symptoms in athletes: Moving towards personalized medicine. Allergy 2021; 76:2716-2729. [PMID: 33605430 DOI: 10.1111/all.14786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 02/05/2021] [Accepted: 02/15/2021] [Indexed: 01/16/2023]
Abstract
Adequate nasal breathing is indispensable for athletes, and nasal symptoms have been shown to interfere with their subjective feeling of comfortable breathing and quality of life. Nasal symptoms are caused by either structural abnormalities or mucosal pathology. Structural pathologies are managed differently from mucosal disease, and therefore, adequate diagnosis is of utmost importance in athletes in order to choose the correct treatment option for the individual. Literature suggests that nasal symptoms are more prevalent in athletes compared to the general population and certain sports environments might even trigger the development of symptoms. Given the high demands of respiratory function in athletes, insight into triggering factors is of high importance for disease prevention. Also, it has been suggested that athletes are more neglectful to their symptoms and hence remain undertreated, meaning that special attention should be paid to education of athletes and their caregivers. This review aims at giving an overview of nasal physiology in exercise as well as the possible types of nasal pathology. Additionally, diagnostic and treatment options are discussed and we focus on unmet needs for the management and prevention of these symptoms in athletes within the concept of precision medicine.
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Affiliation(s)
- Valerie Hox
- Department of Otorhinolaryngology Cliniques Universitaires Saint‐Luc Brussels Belgium
- Institute of Experimental and Clinical Research Pole of Pulmonology, Otorhinolaryngology and Dermatology UCLouvain Brussels Belgium
| | - Simon Beyaert
- Department of Otorhinolaryngology Cliniques Universitaires Saint‐Luc Brussels Belgium
| | - Dominique Bullens
- Clinical Division of Pediatrics University Hospitals Leuven Belgium
- Allergy and Clinical Immunology Research Group Department of Microbiology, Immunology and Transplantation KU Leuven Belgium
| | - Mariana Couto
- Allergy Unit Hospital CUF Descobertas, Lisbon, Portugal Lisbon Portugal
| | - Daniel Langer
- Respiratory Rehabilitation and Respiratory Division University Hospitals Leuven, KU Leuven Leuven Belgium
| | - Peter‐Willem Hellings
- Allergy and Clinical Immunology Research Group Department of Microbiology, Immunology and Transplantation KU Leuven Belgium
- Clinical Division of Ear, Nose and Throat Disease, Head and Neck Surgery University Hospitals Leuven Belgium
| | - Caroline Huart
- Department of Otorhinolaryngology Cliniques Universitaires Saint‐Luc Brussels Belgium
| | - Philippe Rombaux
- Department of Otorhinolaryngology Cliniques Universitaires Saint‐Luc Brussels Belgium
| | - Sven F. Seys
- Allergy and Clinical Immunology Research Group Department of Microbiology, Immunology and Transplantation KU Leuven Belgium
| | - Pavol Surda
- Department of Otorhinolaryngology Guy’s and St‐Thomas’ University Hospital London UK
| | - Abigail Walker
- Department of Ear, Nose and Throat Disease St‐George Hospital London UK
| | - Brecht Steelant
- Allergy and Clinical Immunology Research Group Department of Microbiology, Immunology and Transplantation KU Leuven Belgium
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25
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Sangaraju D, Shi Y, Van Parys M, Ray A, Walker A, Caminiti R, Milanowski D, Jaochico A, Dean B, Liang X. Robust and Comprehensive Targeted Metabolomics Method for Quantification of 50 Different Primary, Secondary, and Sulfated Bile Acids in Multiple Biological Species (Human, Monkey, Rabbit, Dog, and Rat) and Matrices (Plasma and Urine) Using Liquid Chromatography High Resolution Mass Spectrometry (LC-HRMS) Analysis. J Am Soc Mass Spectrom 2021; 32:2033-2049. [PMID: 33826317 DOI: 10.1021/jasms.0c00435] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Bile acids (BAs) are biomolecules synthesized in the liver from cholesterol and are constituents of bile. The in-vivo BA pool includes more than 50 known diverse BAs which are unconjugated, amino acid conjugated, sulfated, and glucuronidated metabolites. Hemostasis of bile acids is known to be highly regulated and an interplay between liver metabolism, gut microbiome function, intestinal absorption, and enterohepatic recirculation. Interruption of BA homeostasis has been attributed to several metabolic diseases and drug induced liver injury (DILI), and their use as potential biomarkers is increasingly becoming important. Speciated quantitative and comprehensive profiling of BAs in various biomatrices from humans and preclinical animal species are important to understand their significance and biological function. Consequently, a versatile one single bioanalytical method for BAs is required to accommodate quantitation in a broad range of biomatrices from human and preclinical animal species. Here we report a versatile, comprehensive, and high throughput liquid chromatography-high resolution mass spectrometry (LC-HRMS) targeted metabolomics method for quantitative analysis of 50 different BAs in multiple matrices including human serum, plasma, and urine and plasma and urine of preclinical animal species (rat, rabbit, dog, and monkey). The method has been sufficiently qualified for accuracy, precision, robustness, and ruggedness and addresses the issue of nonspecific binding of bile acids to plastic for urine samples. Application of this method includes comparison for BA analysis between matched plasma and serum samples, human and animal species differences in BA pools, data analysis, and visualization of complex BA data using BA indices or ratios to understand BA biology, metabolism, and transport.
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Affiliation(s)
- Dewakar Sangaraju
- Drug Metabolism and Pharmacokinetics, Genentech Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Yao Shi
- Bioanalytical Department, Covance Laboratories, Inc., 3301 Kinsman Blvd, Madison, Wisconsin 53704, United States
| | - Michael Van Parys
- Bioanalytical Department, Covance Laboratories, Inc., 3301 Kinsman Blvd, Madison, Wisconsin 53704, United States
| | - Adam Ray
- Bioanalytical Department, Covance Laboratories, Inc., 3301 Kinsman Blvd, Madison, Wisconsin 53704, United States
| | - Abigail Walker
- Bioanalytical Department, Covance Laboratories, Inc., 3301 Kinsman Blvd, Madison, Wisconsin 53704, United States
| | - Rachel Caminiti
- Bioanalytical Department, Covance Laboratories, Inc., 3301 Kinsman Blvd, Madison, Wisconsin 53704, United States
| | - Dennis Milanowski
- Bioanalytical Department, Covance Laboratories, Inc., 3301 Kinsman Blvd, Madison, Wisconsin 53704, United States
| | - Allan Jaochico
- Drug Metabolism and Pharmacokinetics, Genentech Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Brian Dean
- Drug Metabolism and Pharmacokinetics, Genentech Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Xiaorong Liang
- Drug Metabolism and Pharmacokinetics, Genentech Inc., 1 DNA Way, South San Francisco, California 94080, United States
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26
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Leask M, Lovegrove M, Walker A, Duncan E, Dearden P. Evolution and genomic organization of the insect sHSP gene cluster and coordinate regulation in phenotypic plasticity. BMC Ecol Evol 2021; 21:154. [PMID: 34348652 PMCID: PMC8336396 DOI: 10.1186/s12862-021-01885-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Conserved syntenic gene complexes are rare in Arthropods and likely only retained due to functional constraint. Numerous sHSPs have been identified in the genomes of insects, some of which are located clustered in close proximity. Previous phylogenetic analyses of these clustered sHSP have been limited to a small number of holometabolous insect species and have not determined the pattern of evolution of the clustered sHSP genes (sHSP-C) in insect or Arthropod lineages. Results Using eight genomes from representative insect orders and three non-insect arthropod genomes we have identified that a syntenic cluster of sHSPs (sHSP-C) is a hallmark of most Arthropod genomes. Using 11 genomes from Hymenopteran species our phylogenetic analyses have refined the evolution of the sHSP-C in Hymenoptera and found that the sHSP-C is order-specific with evidence of birth-and-death evolution in the hymenopteran lineage. Finally we have shown that the honeybee sHSP-C is co-ordinately expressed and is marked by genomic features, including H3K27me3 histone marks consistent with coordinate regulation, during honeybee ovary activation. Conclusions The syntenic sHSP-C is present in most insect genomes, and its conserved coordinate expression and regulation implies that it is an integral genomic component of environmental response in arthropods. Supplementary Information The online version contains supplementary material available at 10.1186/s12862-021-01885-8.
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Affiliation(s)
- Megan Leask
- Department of Biochemistry, University of Otago, Dunedin, New Zealand.
| | - Mackenzie Lovegrove
- Department of Biochemistry, University of Otago, Dunedin, New Zealand.,Genomics Aotearoa and Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Abigail Walker
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Elizabeth Duncan
- School of Biology, Faculty of Biological Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Peter Dearden
- Department of Biochemistry, University of Otago, Dunedin, New Zealand.,Genomics Aotearoa and Department of Biochemistry, University of Otago, Dunedin, New Zealand
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Mirajkar A, Logan G, Rivera M, Macintosh T, Walker A, Lebowitz D, Ganti L. 2 Racial Disparities in Patients Hospitalized for COVID-19: An Observational Cohort Study. Ann Emerg Med 2021. [PMCID: PMC8335415 DOI: 10.1016/j.annemergmed.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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28
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Brighi C, Waddington D, Walker A, Holloway L, Aly F, Koh E, Keall P. OC-0398 Stability of multiparametric MR imaging biomarker-derived dose prescriptions for glioblastoma. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06885-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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29
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Hopkins C, McKenzie J, Anari S, Carrie S, Ramakrishnan Y, Kara N, Philpott C, Hobson J, Qureishi A, Stew B, Bhalla R, Gane S, Walker A, Harries P, Hathorn I, Lund V. British Rhinological Society Consensus Guidance on the use of biological therapies for chronic rhinosinusitis with nasal polyps. Clin Otolaryngol 2021; 46:1037-1043. [DOI: 10.1111/coa.13779] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/14/2021] [Accepted: 03/28/2021] [Indexed: 12/15/2022]
Affiliation(s)
| | - Jo‐Lyn McKenzie
- Guy’s and Hospitals Royal Brisbane and Women's Hospital Herston QLD Australia
| | - Shahram Anari
- University Hospitals Birmingham NHS Trust Birmingham UK
| | - Sean Carrie
- Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University Newcastle upon Tyne UK
| | | | - Naveed Kara
- County Durham & Darlington NHS Foundation Trust Darlington UK
| | - Carl Philpott
- Norwich Medical School University of East Anglia Norwich UK
| | | | | | - Ben Stew
- University Hospital Wales Cardiff UK
| | - Raj Bhalla
- Manchester University NHS Foundation Trust Manchester UK
| | - Simon Gane
- The Royal National Throat Nose and Ear Hospital London UK
| | | | | | | | - Valerie Lund
- Royal National Throat, Nose and Ear Hospital UCLH Foundation Trust London UK
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30
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Smith ME, Swords C, Rocke JPJ, Walker A, Bryan JE, Milinis K, Mathew RG, Jones GH, McLaren O, Hutson K, Slovick A, Hopkins C, Harries PG, Heward E, Shakeel M, Gomati A, Bance M, Lancaster J, Gaskell P, Smyth C, Dorris C, Kelly A, McCrory D, Bhatt YM, Jama GM, Morgan M, Perkins V, Spraggs P, Khosla S, Takwoingi Y, Gopala‐Krishnan S, Strachan D, Omakobia E, Puvanendran M, Myuran T, Rennie C, Devabalan Y, Cardozo A, Tse A, McRae D, Burgan OT, Reddy E, Wright B, Kara N, Ivy A, Williams R, Walkden A, Quraishi M, Stobbs N, Chatzimichalis M, Elston E, Khemani S, Liu A, Kirkland P, Vasanthan R, Miah M, Lee K, Mclarnon C, Williams MR, Okonkwo O, Mughal Z, Karagama Y, Xie C, De M, Amlani A, Jassar P, Cao H, Patil S, Philpott C, Meghji S, Das S, Cole S, Vijendren A, Ally M, Kothari P, Schechter E, Ranganathan B, Advani R, Toma S, Haymes A, Shakir A, Yap D, Costello R, Evans L, Chisholm E, Ojha S, Spielmann P, Steven R, Supriya M, Mathew E, Masood A, Dewhurst S, Ward V, Haigh T, Patiar S, Nemeth Z, Terry R, Vithlani R, Bowyer D, Yang D, Monksfield P, Muzaffar J, Siddiq A, Whittaker JD, Ramakrishnan Y, Vakharia N, Cain A, Cooper F, Izzat S, Nair D, Tan S, Daudia A, Gilchrist J, Tan N, Kim M, Singh V, Hallett E, Ray J, Yu B, DeCarpentier J, Chandrasekar B, Bhimrao S, Eastwood M, Sunkaraneni VS, Patel J, Moore A, Shetty P, Mawby T, Shelton F, Jindal M, Yao A, Geyer M, Lowe E, Jones H, Ghasemi AA, Trinidade A, Hardy A, Little S, Munroe‐Gray T, Bennett A, Li L, Khalid‐Raja M, McNally G, Thomas G, Elmorsy M, Williams C, Zammit M, Seymour K, Warner E, Potter C, Easto R, Shaida A, Forde CT, Karamchandani D, Gill C, Syed I, Walker D, Stewart K, Simmons M, Abou‐Foul AK, Bathala S, Emerson H, Almeyda J, Leadon M, Fahmy F, Kaleva AI, Moorthy R, Bates J, Wasson J, Selwyn A, Daultrey C, Patel S, Siau D, Sawant R, Moore P, Ali F. Admission avoidance in acute epistaxis: A prospective national audit during the initial peak of the COVID‐19 pandemic. Clin Otolaryngol 2021; 46:577-586. [DOI: 10.1111/coa.13716] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/30/2020] [Accepted: 12/20/2020] [Indexed: 01/16/2023]
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31
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Amin N, Walker A, Alobid I, Anari S, Bast F, Bhalla RK, Cathcart R, Harries PG, Hathorn I, Philpott CM, Ramakrishnan Y, Stew B, Surda P, Ting F, Hopkins C. Defining appropriateness criteria for endoscopic sinus surgery in the management of adult dental implant patients with incidental maxillary sinus findings on conebeam computed tomography. Clin Otolaryngol 2020; 45:862-869. [DOI: 10.1111/coa.13609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/25/2020] [Accepted: 07/10/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Nikul Amin
- Guy's and St Thomas' NHS Foundation Trust London UK
| | | | - Isam Alobid
- Hospital ClínicUniversitat de BarcelonaIDIBAPSCIBERESCentro Médico Teknon Barcelona Spain
| | - Shahram Anari
- University Hospitals Birmingham NHS Trust Birmingham UK
| | - Florian Bast
- Guy's and St Thomas' NHS Foundation Trust London UK
| | - Rajiv K. Bhalla
- Manchester Academic Health Sciences CentreUniversity of Manchester Manchester UK
| | | | | | | | - Carl M. Philpott
- James Paget University Hospitals NHS Foundation Trust Gorleston‐on‐Sea UK
| | | | | | - Pavol Surda
- Guy's and St Thomas' NHS Foundation Trust London UK
| | - Fiona Ting
- Sydney Hills ENT Clinic Sydney Australia
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Affiliation(s)
- Abigail Walker
- Department of Otolaryngology, University Hospital Lewisham, London, UK
| | | | | | - Claire Hopkins
- Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust
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Mistry R, Walker A, Walker N, Ofo E. Royal Society of Medicine Surgical Innovation Day Adrian Tanner Prize Winner 2019: Multidisciplinary care and surgical innovation for the benefit of the patient with head and neck cancer of unknown primary. JRSM Open 2020; 11:2054270420921066. [PMID: 32685179 PMCID: PMC7346693 DOI: 10.1177/2054270420921066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Head and neck carcinoma of unknown primary accounts for approximately 1–5% of all head and neck cancers and presents a genuine diagnostic and therapeutic dilemma. Despite advanced investigations, the primary tumour location remains unknown in up to 40% of these cases. Transoral robotic surgery presents a viable diagnostic and therapeutic option in these patients. This surgical innovation alongside advances in the understanding of head and neck cancer biology means that a multidisciplinary approach in the management of these complex patients is of utmost importance to ensure optimal therapeutic outcomes.
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Affiliation(s)
- Rakesh Mistry
- Department of ENT Surgery, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Abigail Walker
- Department of ENT Surgery, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Nathan Walker
- Department of ENT Surgery, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Enyinnaya Ofo
- Department of ENT Surgery, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
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Kim S, Walker A, Okerlund D, Hsieh J. Intelligent Motion Correction Significantly Impacts The Volumes Of Calcium Blooming Artifacts For Coronary Computed Tomography Angiography (CCTA). J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mistry R, Walker A, Kim D, Ofo E. Transoral robotic surgery for the benefit of patients with head and neck cancer of unknown primary: our experience at St George's University Hospital, London. Ann R Coll Surg Engl 2020; 102:442-450. [PMID: 32347742 PMCID: PMC7388938 DOI: 10.1308/rcsann.2020.0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Head and neck carcinoma of unknown primary represents 1-5% of all head and neck cancers and presents a diagnostic and therapeutic dilemma. In approximately 40% of cases, a primary tumour location remains unknown despite investigation. With advancements in our understanding of the role of high-risk human papilloma virus in head and neck cancer, transoral robotic surgery presents an option for diagnosis and therapy. MATERIALS AND METHODS This is a retrospective case series from a single centre. Case notes were reviewed for 28 patients who had transoral robotic surgery for head and neck carcinoma of unknown primary between May 2015 and July 2019. RESULTS Transoral robotic surgery identified an oropharyngeal primary tumour in 19 of 28 (67.8%) patients. All oropharyngeal primaries were p16 positive. The base of tongue identification rate was 63.2%. Median length of inpatient stay postoperatively was 1.0 day. Normal oral intake resumed within 48 hours in 96% (27/28) of patients. Three patients (10.3%) suffered minor postoperative bleeds that were all managed conservatively. DISCUSSION The base of tongue primary identification rate (63.2%) in this series is consistent with that previously reported (43-63%; 95% confidence interval). Primary tumour identification rate if a patient is p16 positive is 86.3% (19/22), with 100% of these being oropharyngeal. We suggest future investigation into p16 status as a means of stratifying patients with head and neck carcinoma of unknown primary for transoral robotic surgery. CONCLUSION Transoral robotic base of tongue mucosectomy (or lingual tonsillectomy) is a promising technique that offers a high yield of positive identification for the primary tumour. It is well tolerated with minimal associated morbidity. Our findings are comparable with those in the current literature.
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Affiliation(s)
- R Mistry
- St George’s University Hospitals NHS Foundation Trust, Tooting, London, UK
| | - A Walker
- St George’s University Hospitals NHS Foundation Trust, Tooting, London, UK
| | - D Kim
- St George’s University Hospitals NHS Foundation Trust, Tooting, London, UK
| | - E Ofo
- St George’s University Hospitals NHS Foundation Trust, Tooting, London, UK
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Roy T, Banang-Mbeumi S, Boateng S, Chamcheu R, Walker A, Chamcheu J. 615 Inverse docking assisted identification of flavonols as c-Kit, CDK2 and mTOR inhibitors for melanoma and non-melanoma skin cancer management. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.625] [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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Rovira A, Dawson D, Walker A, Tornari C, Dinham A, Foden N, Surda P, Archer S, Lonsdale D, Ball J, Ofo E, Karagama Y, Odutoye T, Little S, Simo R, Arora A. Tracheostomy care and decannulation during the COVID-19 pandemic. A multidisciplinary clinical practice guideline. Eur Arch Otorhinolaryngol 2020; 278:313-321. [PMID: 32556788 PMCID: PMC7299456 DOI: 10.1007/s00405-020-06126-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/09/2020] [Indexed: 12/11/2022]
Abstract
Purpose Traditional critical care dogma regarding the benefits of early tracheostomy during invasive ventilation has had to be revisited due to the risk of COVID-19 to patients and healthcare staff. Standard practises that have evolved to minimise the risks associated with tracheostomy must be comprehensively reviewed in light of the numerous potential episodes for aerosol generating procedures. We meet the urgent need for safe practise standards by presenting the experience of two major London teaching hospitals, and synthesise our findings into an evidence-based guideline for multidisciplinary care of the tracheostomy patient. Methods This is a narrative review presenting the extensive experience of over 120 patients with tracheostomy, with a pragmatic analysis of currently available evidence for safe tracheostomy care in COVID-19 patients. Results Tracheostomy care involves many potentially aerosol generating procedures which may pose a risk of viral transmission to staff and patients. We make a series of recommendations to ameliorate this risk through infection control strategies, equipment modification, and individualised decannulation protocols. In addition, we discuss the multidisciplinary collaboration that is absolutely fundamental to safe and effective practise. Conclusion COVID-19 requires a radical rethink of many tenets of tracheostomy care, and controversy continues to exist regarding the optimal techniques to minimise risk to patients and healthcare workers. Safe practise requires a coordinated multidisciplinary team approach to infection control, weaning and decannulation, with integrated processes for continuous prospective data collection and audit.
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Affiliation(s)
- Aleix Rovira
- Department of Otorhinolaryngology Head and Neck Surgery, St George's Hospital NHS Foundation Trust, London, UK.
| | - Deborah Dawson
- Department of Critical Care, St George's Hospital NHS Foundation Trust, London, UK
| | - Abigail Walker
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Lewisham, London, UK
| | - Chrysostomos Tornari
- Department of Otorhinolaryngology Head and Neck Surgery, St George's Hospital NHS Foundation Trust, London, UK
| | - Alison Dinham
- Department of Physiotherapy, Guy's and St Thomas Hospital NHS Foundation Trust, London, UK
| | - Neil Foden
- Department of Otorhinolaryngology Head and Neck Surgery, St George's Hospital NHS Foundation Trust, London, UK
| | - Pavol Surda
- Department of Otorhinolayngology Head and Neck Surgery, Guy's and St Thomas Hospital NHS Foundation Trust, London, UK
| | - Sally Archer
- Speech and Language Therapy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Dagan Lonsdale
- Critical Care Unit, St George's Hospital NHS Foundation Trust, London, UK
- St George's University of London, London, UK
| | - Jonathan Ball
- Critical Care Unit, St George's Hospital NHS Foundation Trust, London, UK
| | - Enyi Ofo
- Department of Otorhinolaryngology Head and Neck Surgery, St George's Hospital NHS Foundation Trust, London, UK
| | - Yakubu Karagama
- Department of Otorhinolayngology Head and Neck Surgery, Guy's and St Thomas Hospital NHS Foundation Trust, London, UK
| | - Tunde Odutoye
- Department of Otorhinolaryngology Head and Neck Surgery, St George's Hospital NHS Foundation Trust, London, UK
| | - Sarah Little
- Department of Otorhinolaryngology Head and Neck Surgery, St George's Hospital NHS Foundation Trust, London, UK
| | - Ricard Simo
- Department of Otorhinolayngology Head and Neck Surgery, Guy's and St Thomas Hospital NHS Foundation Trust, London, UK
| | - Asit Arora
- Department of Otorhinolayngology Head and Neck Surgery, Guy's and St Thomas Hospital NHS Foundation Trust, London, UK
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Walker A, Hopkins C, Surda P. Use of Google Trends to investigate loss-of-smell-related searches during the COVID-19 outbreak. Int Forum Allergy Rhinol 2020; 10:839-847. [PMID: 32279437 PMCID: PMC7262261 DOI: 10.1002/alr.22580] [Citation(s) in RCA: 149] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Initial reports describing coronavirus 2019 (COVID-19) were dominated by the presence of cough, breathlessness, and fever; anecdotal reports suggested anosmia may also be a manifestation. We used Google Trends (GT) to investigate whether there was a surge in individuals searching for information related to smell loss during the COVID-19 epidemic in Italy, Spain, the United Kingdom, the United States, Germany, France, Iran, and The Netherlands. METHODS GT was used to explore internet activity related to loss of smell in the 8 aforementioned countries. Spearman rank analysis was performed to correlate loss-of-smell-relative search volumes (RSVs), with the increases of daily confirmed cases of COVID-19 and deaths attributed to disease. As a control event, we also performed analysis of smell-related searches during the last UK influenza epidemic of 2009. RESULTS In all 8 countries, we observed strong correlations between daily RSVs related to loss of smell, increases of daily COVID-19+ cases and deaths ranging from 0.633 to 0.952. All correlations were statistically significant (p < 0.05). CONCLUSION There is a strong correlation between the frequency of searches for smell-related information and the onset of COVID-19 infection in Italy, Spain, UK, USA, Germany, France, Iran, and The Netherlands. We hypothesize this may relate to a previously underrecognized symptom.
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Affiliation(s)
- Abigail Walker
- Department of Otorhinolaryngology, Guy's and St Thomas' University Hospital, London, UK
| | - Claire Hopkins
- Department of Otorhinolaryngology, Guy's and St Thomas' University Hospital, London, UK
| | - Pavol Surda
- Department of Otorhinolaryngology, Guy's and St Thomas' University Hospital, London, UK
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Jacob T, Walker A, Mantelakis A, Gibbins N, Keane O. A framework for open tracheostomy in COVID-19 patients. Clin Otolaryngol 2020; 45:649-651. [PMID: 32285555 PMCID: PMC7262328 DOI: 10.1111/coa.13549] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/04/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Tony Jacob
- Department of Otolaryngology, University Hospital Lewisham, London, UK
| | - Abigail Walker
- Department of Otolaryngology, University Hospital Lewisham, London, UK
| | | | - Nicholas Gibbins
- Department of Otolaryngology, University Hospital Lewisham, London, UK
| | - Oliver Keane
- Department of Anaesthesia, University Hospital Lewisham, London, UK
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Surda P, Putala M, Siarnik P, Walker A, De Rome K, Amin N, Sangha MS, Fokkens W. Sleep in elite swimmers: prevalence of sleepiness, obstructive sleep apnoea and poor sleep quality. BMJ Open Sport Exerc Med 2020; 5:e000673. [PMID: 32095263 PMCID: PMC7010988 DOI: 10.1136/bmjsem-2019-000673] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2019] [Indexed: 11/07/2022] Open
Abstract
Objectives Limited data suggest that swimmers might be affected by poor quality of sleep significantly. The aim was to explore the prevalence of sleep disturbances in swimmers and possible link between rhinitis and sleep disturbance. Methods Study 1 was an observational case–control, questionnaire-based study involving 157 elite and non-elite swimmers, 36 non-swimming athletes and 50 controls. In study 2, we measured sleep quality and duration using actigraphy in 20 elite swimmers. We also looked for presence of sleep-disordered breathing using overnight pulse oximetry monitor. Results In study 1, we observed a significant difference in prevalence of excessive daytime sleepiness between groups of elite swimmers and controls. Pittsburgh Sleep Quality Index (PSQI) scores do not suggest that quality of sleep in group of swimmers is impaired. In study 2, we found that prevalence of obstructive sleep apnoea (OSA) in elite swimmers defined as oxygen desaturation index ≥5 was 30%. Analysis of actigraphy data revealed that on nights prior to training days, ‘going to’ bed time was significantly earlier and total sleep time was significantly reduced. Conclusion Swimmers and non-swimming athletes suffer significantly more with excessive daytime sleepiness than healthy controls. In elite swimmers, this is likely linked to high prevalence of OSA. PSQI scores do not suggest that quality of sleep in group of swimmers is impaired, but actigraphy shows great variations between sleep pattern preceding training and rest day. This seems to be associated with early-morning sessions which can be a disruptive element of weekly sleep patterns.
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Affiliation(s)
- Pavol Surda
- ENT Department, Guy's and St Thomas' University Hospital, London, UK
| | - Matus Putala
- Department of Physical Education and Sports, Comenius University, Bratislava, Slovakia
| | - Pavel Siarnik
- Department of Neurology, Comenius University, Bratislava, Slovakia
| | - Abigail Walker
- ENT Department, Guy's and St Thomas' University Hospital, London, UK
| | - Katherine De Rome
- ENT Department, Guy's and St Thomas' University Hospital, London, UK
| | - Nikul Amin
- ENT Department, Guy's and St Thomas' University Hospital, London, UK
| | | | - Wytske Fokkens
- Academisch Medisch Centrum, Amsterdam, North Holland, The Netherlands
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Vergidis P, Moore CB, Novak-Frazer L, Rautemaa-Richardson R, Walker A, Denning DW, Richardson MD. High-volume culture and quantitative real-time PCR for the detection of Aspergillus in sputum. Clin Microbiol Infect 2019; 26:935-940. [PMID: 31811917 DOI: 10.1016/j.cmi.2019.11.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 11/05/2019] [Accepted: 11/09/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Sputum culture is an insensitive method for the diagnosis of pulmonary aspergillosis. Growth of the organism allows identification of the causative species and susceptibility testing, both of which can inform treatment choices. The current practice is to culture an aliquot of diluted sputum. We assessed the value of culturing large volumes of unprocessed sputum, a method that we have termed high-volume culture (HVC). METHODS Specimens were processed by conventional culture (using an aliquot of homogenized, diluted sputum on Sabouraud agar at 37°C and 45°C for up to 5 days) and HVC (using undiluted sputum on Sabouraud agar at 30°C for up to 14 days). A separate specimen was tested by quantitative real-time PCR. Antifungal susceptibility testing was performed by the EUCAST standard. RESULTS We obtained sputum specimens from 229 individuals with the following conditions: chronic pulmonary aspergillosis (66.8%, 153/229), allergic bronchopulmonary aspergillosis (25.3%, 58/229) and Aspergillus bronchitis (7.9%, 18/229). Individuals with invasive pulmonary aspergillosis were not included. The positivity rate of conventional culture was 15.7% (36/229, 95% CI 11.6%-21.0%) and that of HVC was 54.2% (124/229, 95% CI 47.7%-60.5%) (p < 0.001). The higher positivity rate of HVC was demonstrated regardless of administration of antifungal treatment. Quantitive real-time PCR had an overall positivity rate of 49.2% (65/132, 95% CI 40.9%-57.7%), comparable to that of HVC. CONCLUSION Detection of Aspergillus spp. in sputum is greatly enhanced by HVC. HVC allows for detection of azole-resistant isolates that would have been missed by conventional culture. This method can be performed in any microbiology laboratory without the need for additional equipment.
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Affiliation(s)
- P Vergidis
- National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - C B Moore
- Mycology Reference Centre Manchester, ECMM Excellence Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - L Novak-Frazer
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Mycology Reference Centre Manchester, ECMM Excellence Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - R Rautemaa-Richardson
- National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Mycology Reference Centre Manchester, ECMM Excellence Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - A Walker
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - D W Denning
- National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - M D Richardson
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Mycology Reference Centre Manchester, ECMM Excellence Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
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Hutchison M, Gittins J, Walker A, Moore A, Burton C, Sparks N. Washing table eggs: a review of the scientific and engineering issues. WORLD POULTRY SCI J 2019. [DOI: 10.1079/wps20030015] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M.L. Hutchison
- ADAS Microbiology Department, Woodthorne, Wergs Road, Wolverhampton. WV6 8QT, United Kingdom
| | - J. Gittins
- ADAS Poultry Team, Woodthorne, Wergs Road, Wolverhampton, WV6 8QT, United Kingdom
| | - A. Walker
- ADAS Gleadthorpe, Meden Vale, Mansfield, Notts. NG20 9PD, United Kingdom
| | - A. Moore
- ADAS Microbiology Department, Woodthorne, Wergs Road, Wolverhampton. WV6 8QT, United Kingdom
| | - C. Burton
- Silsoe Research Institute, Wrest Park, Silsoe MK45 4HS, United Kingdom
| | - N. Sparks
- Avian Science Research Centre, SAC, Ayr, KA6 5HW, United Kingdom
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Surda P, Tornari C, Putala M, Walker A. Exercise and Rhinitis in Athletes. EMJ 2019. [DOI: 10.33590/emj/10310443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Peak sporting performance requires optimal levels of health and fitness. Rhinitis, with its proven detrimental effects on sleep and mood, and its association with asthma, can clearly compromise athletic ability. Nasal health is therefore of key importance to the athlete. While not a limiting factor in a single exercise effort, the effects of nasal dysfunction can have repercussions in the post-exercise recovery period. Furthermore, it is linked with the development of asthma and may increase susceptibility to upper respiratory tract symptoms. This review aims to investigate the physiology of the nose during exercise, examine the relationship between exercise and nasal dysfunction, and consider the impact that dysfunction may have on an athlete. Lastly, the authors describe the diagnosis and treatment of rhinitis in athletes.
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Affiliation(s)
- Pavol Surda
- Department of Otorhinolaryngology, Guy’s and St Thomas’ University Hospital, London, UK
| | - Chrysostomos Tornari
- Department of Otorhinolaryngology, Guy’s and St Thomas’ University Hospital, London, UK
| | - Matus Putala
- Department of Physical Education and Sports, Comenius University, Bratislava, Slovakia
| | - Abigail Walker
- Department of Otorhinolaryngology, Guy’s and St Thomas’ University Hospital, London, UK
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Barlet B, Hauson A, Connors E, Colonna-Moseley A, Reszegi K, Sarkissians S, Walker A. C-31 A Meta-analysis Examining Fluency Measures in Depressed Elderly. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
Late-life depression (LLD) has been associated with cognitive impairments in domains such as memory, processing speed, and executive functions (e.g., initiation). However, it is unclear whether or not LLD is associated with language fluency difficulties that are often seen in some forms of dementia. Broadly, letter fluency is often observed to be associated with frontal deficits while category fluency is thought to be linked to temporal lobe dysfunction. Both tests are commonly used to assess language in older adults. The current meta-analysis examined potential differences between letter and category fluency in LLD and the robustness of previous findings in this population.
Data Selection
Investigators searched eight databases including PubMed and PsycINFO using terms such as “neuropsychol*,” “late-life,” and “depression.” Studies were excluded if participants were diagnosed with severe mental illness, neurological or other medical conditions that impact neurocognition.
Data Synthesis
Independent coders extracted data from 27 studies (k = 10 letter fluency, k = 17 semantic fluency). The effect size for semantic fluency was g = 0.64 (p < 0.001) with significant heterogeneity I² = 73.53% (Q = 60.45, df = 16, p < 0.001). The effect size for letter fluency was g = 0.49 (p < 0.001) also with significant heterogeneity I² = 52.08% (Q = 18.78, df = 9, p < 0.027).
Conclusions
Depressed individuals exhibited poorer performance on both category and letter fluency when compared to controls. This may indicate that depressed elderly individuals have difficulty with initiating verbal responses regardless of whether these responses rely on semantic networks or executive control.
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Pollard A, Hauson A, Stelmach N, Sarkissians S, Walker A, Cabral C, Wollman S, Hall M. A-25 Paced Auditory Serial Addition Test in Individuals with Cocaine Versus Methamphetamine Dependence. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
Research suggests that cocaine and methamphetamine differ in their impact on executive functions (EF). The Paced Auditory Serial Addition Test (PASAT) is used to assess working memory; a component of EF. The purpose of this meta-analysis was to examine the difference between the effect of these two drugs on PASAT scores.
Data Selection
Three researchers independently searched nine databases (e.g., PsycINFO, Pubmed, ProceedingsFirst), extracted required data, and calculated effect sizes. Inclusion criteria identified studies that had (a) compared cocaine or methamphetamine dependent groups to healthy controls and (b) matched groups on either age, education, or IQ (at least 2 out of 3). Studies were excluded if participants were reported to have Axis I diagnoses (other than cocaine or methamphetamine dependence) or comorbidities known to impact neuropsychological functioning. Six articles were coded and analyzed for the current study.
Data Synthesis
Cocaine studies showed a medium statistically significant effect size (g = 0.370, p = 0.020), while methamphetamine did not (g = 0.198, p = 0.172). There was no heterogeneity in effect sizes for both drugs. Subgroup analysis found no significant difference between the two drugs on the PASAT (Q-between = 0.646, p = 0.421).
Conclusions
In contrast to methamphetamine, cocaine is associated with poorer performance on PASAT. This is in line with previous studies that found that cocaine had more significant impact on EF than methamphetamine. Given the preliminary nature of this meta-analysis and the small number of studies on the topic, future primary studies should directly contrast how these two drugs impact EF.
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Walker A, Hauson A, Sarkissians S, Pollard A, Flora-Tostado C, Stelmach N, Holt A, Wollman S, Hall M. A-17 Category Test performance in individuals with alcohol versus methamphetamine dependence. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
The Category Test (CT) has consistently been found to be sensitive at detecting the effects of alcohol on the brain. However, this test has not been as widely used in examining the effects of methamphetamine. The current meta-analysis compared effect sizes of studies that have examined performance on the CT in alcohol versus methamphetamine dependent participants.
Data selection
Three researchers independently searched nine databases (e.g., PsycINFO, Pubmed, ProceedingsFirst), extracted required data, and calculated effect sizes. Inclusion criteria identified studies that had (a) compared alcohol or methamphetamine dependent groups to healthy controls and (b) matched groups on either age, education, or IQ (at least 2 out of 3). Studies were excluded if participants were reported to have Axis I diagnoses (other than alcohol or methamphetamine dependence) or comorbidities known to impact neuropsychological functioning. Sixteen articles were coded and analyzed for the current study.
Data synthesis
Alcohol studies showed a large effect size (g = 0.745, p < 0.001) while methamphetamine studies evidenced a moderate effect size (g = 0.406, p = 0.001); both without statistically significant heterogeneity (I2 = 0). Subgroup analysis revealed a statistically significant difference between the effect sizes from alcohol versus methamphetamine studies (Q-between = 5.647, p = 0.017).
Conclusions
The CT is sensitive to the effects of both alcohol and methamphetamine and should be considered when examining dependent patients who might exhibit problem solving, concept formation, and set loss difficulties in everyday living.
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Buenaventura T, Bitsi S, Laughlin WE, Burgoyne T, Lyu Z, Oqua AI, Norman H, McGlone ER, Klymchenko AS, Corrêa IR, Walker A, Inoue A, Hanyaloglu A, Grimes J, Koszegi Z, Calebiro D, Rutter GA, Bloom SR, Jones B, Tomas A. Agonist-induced membrane nanodomain clustering drives GLP-1 receptor responses in pancreatic beta cells. PLoS Biol 2019; 17:e3000097. [PMID: 31430273 PMCID: PMC6716783 DOI: 10.1371/journal.pbio.3000097] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 08/30/2019] [Accepted: 08/05/2019] [Indexed: 12/26/2022] Open
Abstract
The glucagon-like peptide-1 receptor (GLP-1R), a key pharmacological target in type 2 diabetes (T2D) and obesity, undergoes rapid endocytosis after stimulation by endogenous and therapeutic agonists. We have previously highlighted the relevance of this process in fine-tuning GLP-1R responses in pancreatic beta cells to control insulin secretion. In the present study, we demonstrate an important role for the translocation of active GLP-1Rs into liquid-ordered plasma membrane nanodomains, which act as hotspots for optimal coordination of intracellular signaling and clathrin-mediated endocytosis. This process is dynamically regulated by agonist binding through palmitoylation of the GLP-1R at its carboxyl-terminal tail. Biased GLP-1R agonists and small molecule allosteric modulation both influence GLP-1R palmitoylation, clustering, nanodomain signaling, and internalization. Downstream effects on insulin secretion from pancreatic beta cells indicate that these processes are relevant to GLP-1R physiological actions and might be therapeutically targetable. Nanodomain segregation and clustering of the glucagon-like peptide-1 receptor, a key target for type 2 diabetes therapy, is regulated by agonist binding, leading to compartmentalization of downstream signaling and clathrin-dependent internalization and impacting pancreatic beta cell responses.
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Affiliation(s)
- Teresa Buenaventura
- Section of Cell Biology and Functional Genomics, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, United Kingdom
| | - Stavroula Bitsi
- Section of Cell Biology and Functional Genomics, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, United Kingdom
| | - William E. Laughlin
- Section of Cell Biology and Functional Genomics, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, United Kingdom
| | - Thomas Burgoyne
- Department of Cell Biology, Institute of Ophthalmology, University College London, London, United Kingdom
| | - Zekun Lyu
- Section of Cell Biology and Functional Genomics, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, United Kingdom
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, United Kingdom
| | - Affiong I. Oqua
- Section of Cell Biology and Functional Genomics, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, United Kingdom
| | - Hannah Norman
- Section of Cell Biology and Functional Genomics, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, United Kingdom
| | - Emma R. McGlone
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, United Kingdom
| | - Andrey S. Klymchenko
- Laboratoire de Bioimagerie et Pathologies, UMR CNRS 7021, University of Strasbourg, Illkirch-Strasbourg, France
| | - Ivan R. Corrêa
- New England Biolabs, Ipswich, Massachusetts, United States of America
| | - Abigail Walker
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | - Aylin Hanyaloglu
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Jak Grimes
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- Centre of Membrane Proteins and Receptors (COMPARE), Universities of Birmingham and Nottingham, Birmingham and Nottingham, United Kingdom
| | - Zsombor Koszegi
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- Centre of Membrane Proteins and Receptors (COMPARE), Universities of Birmingham and Nottingham, Birmingham and Nottingham, United Kingdom
| | - Davide Calebiro
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- Centre of Membrane Proteins and Receptors (COMPARE), Universities of Birmingham and Nottingham, Birmingham and Nottingham, United Kingdom
| | - Guy A. Rutter
- Section of Cell Biology and Functional Genomics, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, United Kingdom
| | - Stephen R. Bloom
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, United Kingdom
| | - Ben Jones
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, United Kingdom
- * E-mail: (AT); (BJ)
| | - Alejandra Tomas
- Section of Cell Biology and Functional Genomics, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, United Kingdom
- * E-mail: (AT); (BJ)
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Abstract
OBJECTIVES This article reviews the principles of unsupervised learning, a novel technique which has increasingly been reported as a tool for the investigation of chronic rhinosinusitis (CRS). It represents a paradigm shift from the traditional approach to investigating CRS based upon the clinically recognized phenotypes of "with polyps" and "without polyps" and instead relies upon the application of complex mathematical models to derive subgroups which can then be further examined. This review article reports on the principles which underlie this investigative technique and some of the published examples in CRS. METHODS This review summarizes the different types of unsupervised learning techniques which have been described and briefly expounds upon their useful applications. A literature review of studies which have unsupervised learning is then presented to provide a practical guide to its uses and some of the new directions of investigations suggested by their findings. RESULTS The commonest unsupervised learning technique applied to rhinology research is cluster analysis, which can be further subdivided into hierarchical and non-hierarchical approaches. The mathematical principles which underpin these approaches are explained within this article. Studies which have used these techniques can be broadly divided into those which have used clinical data only and that which includes biomarkers. Studies which include biomarkers adhere closely to the established canon of CRS disease phenotypes, while those that use clinical data may diverge from the typical "polyp versus non-polyp" phenotypes and reflect subgroups of patients who share common symptom modifiers. SUMMARY Artificial intelligence is increasingly influential in health care research and machine learning techniques have been reported in the investigation of CRS, promising several interesting new avenues for research. However, when critically appraising studies which use this technique, the reader needs to be au fait with the limitations and appropriate uses of its application.
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Affiliation(s)
- Abigail Walker
- Department of ENT Surgery, St George's Hospital, London, UK
| | - Pavol Surda
- Department of ENT Surgery, Guy's Hospital, London, UK
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Walker A, Philpott C, Hopkins C. What is the most appropriate treatment for chronic rhinosinusitis? Postgrad Med J 2019; 95:493-496. [DOI: 10.1136/postgradmedj-2019-136519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/22/2019] [Indexed: 12/13/2022]
Abstract
Chronic rhinosinusitis (CRS) is a common, treatable disease that affects approximately 11% of British adults. It places an enormous burden on patients, with significant detriment to their quality of life, and the health service as it consumes vast numbers of both primary and secondary care resources. However, there is considerable variability in treatment strategies and prescribing practices. This review summarises the key recommendations from landmark guidelines in the treatment of CRS and critically appraises the evidence for treatment.
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Meda M, Gentry V, Walker A. Are perineal swabs required as part of initial staff screening in healthcare-associated Streptococcus pyogenes outbreaks? J Hosp Infect 2019; 102:241-242. [DOI: 10.1016/j.jhin.2018.11.021] [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] [Received: 11/29/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
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