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Johnson PL, Dualeh SHA, Ward A, Jean RA, Aubry S, Chapman A, Curtiss W, Joseph J, Scott JW, Hemmila MR. Association of timing and agent for VTE prophylaxis in patients with severe traumatic brain injury on VTE, mortality, neurosurgical intervention, and discharge disposition. J Trauma Acute Care Surg 2024:01586154-990000000-00738. [PMID: 38745357 DOI: 10.1097/ta.0000000000004383] [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: 05/16/2024]
Abstract
BACKGROUND Trauma patients are at increased risk for venous thromboembolism events (VTE). The decision of when to initiate VTE chemoprophylaxis (VTEP) and with what agent remains controversial in patients with severe traumatic brain injury (TBI). METHODS This comparative effectiveness study evaluated the impact of timing and agent for VTEP on outcomes for patients with severe TBI (AIS Head = 3,4, or 5). Data was collected at 35 Level 1 and 2 trauma centers from January 1, 2017 to June 1, 2022. Patients were placed into analysis cohorts: No VTEP, low-molecular weight heparin (LMWH) ≤ 48 hours, LMWH>48 hours, Heparin≤48 hours, Heparin>48 hours. Propensity score matching accounting for patient factors and injury characteristics was used with logistic regression modeling to evaluate in-hospital mortality, VTE events, and discharge disposition. Neurosurgical intervention after initiation of VTEP was used to evaluate extension of intracranial hemorrhage. RESULTS Of 12,879 patients, 32% had no VTEP, 36% LMWH, and 32% Heparin. Overall mortality was 8.3% and lowest among patients receiving LMWH≤48 hours (4.1%). VTE rates were lower with use of LMWH (1.6 vs 4.5%, OR 2.98, 95% CI 1.40-6.34, p = 0.005) without increasing mortality or neurosurgical interventions. VTE rates were lower with early prophylaxis (2.0 vs 3.5%, OR 1.76, 95% CI 1.15-2.71, p = 0.01) without increasing mortality (p = 1.0). Early VTEP was associated with more non-fatal intracranial operations (p < 0.001). However, patients undergoing neurosurgical intervention after VTEP initiation had no difference in rates of mortality, withdrawal of care, or unfavorable discharge disposition (p = 0.7, p = 0.1, p = 0.5). CONCLUSIONS In patients with severe TBI, LMWH usage was associated with lower VTE incidence without increasing mortality or neurosurgical interventions. Initiation of VTEP≤48 hours decreased VTE incidence and increased non-fatal neurosurgical interventions without affecting mortality. LMWH is the preferred VTEP agent for severe TBI, and initiation ≤48 hours should be considered in relation to these risks and benefits. LEVEL OF EVIDENCE Therapeutic/Care Management, Level III.
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Affiliation(s)
| | | | - Ayobami Ward
- Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, MI
| | | | | | - Alistair Chapman
- Department of Surgery, Corewell Health Butterworth Hospital, Grand Rapids, MI
| | - William Curtiss
- Department of Surgery, Trinity Health Ann Arbor Hospital, Ypsilanti, MI
| | - Jacob Joseph
- Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, MI
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Schmitd LB, Hafner H, Ward A, Asghari Adib E, Biscola NP, Kohen R, Patel M, Williamson RE, Desai E, Bennett J, Saxman G, Athaiya M, Wilborn D, Shumpert J, Zhao XF, Kawaguchi R, Geschwind DH, Hoke A, Shrager P, Collins CA, Havton LA, Kalinski AL, Giger RJ. Sarm1 is not necessary for activation of neuron-intrinsic growth programs yet required for the Schwann cell repair response and peripheral nerve regeneration. bioRxiv 2024:2024.03.04.583374. [PMID: 38496662 PMCID: PMC10942360 DOI: 10.1101/2024.03.04.583374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Upon peripheral nervous system (PNS) injury, severed axons undergo rapid SARM1-dependent Wallerian degeneration (WD). In mammals, the role of SARM1 in PNS regeneration, however, is unknown. Here we demonstrate that Sarm1 is not required for axotomy induced activation of neuron-intrinsic growth programs and axonal growth into a nerve crush site. However, in the distal nerve, Sarm1 is necessary for the timely induction of the Schwann cell (SC) repair response, nerve inflammation, myelin clearance, and regeneration of sensory and motor axons. In Sarm1-/- mice, regenerated fibers exhibit reduced axon caliber, defective nerve conduction, and recovery of motor function is delayed. The growth hostile environment of Sarm1-/- distal nerve tissue was demonstrated by grafting of Sarm1-/- nerve into WT recipients. SC lineage tracing in injured WT and Sarm1-/- mice revealed morphological differences. In the Sarm1-/- distal nerve, the appearance of p75NTR+, c-Jun+ SCs is significantly delayed. Ex vivo, p75NTR and c-Jun upregulation in Sarm1-/- nerves can be rescued by pharmacological inhibition of ErbB kinase. Together, our studies show that Sarm1 is not necessary for the activation of neuron intrinsic growth programs but in the distal nerve is required for the orchestration of cellular programs that underlie rapid axon extension.
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Affiliation(s)
- Ligia B. Schmitd
- Department of Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor MI, USA
| | - Hannah Hafner
- Department of Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor MI, USA
| | - Ayobami Ward
- Department of Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor MI, USA
- Department of Neurosurgery, University of Michigan Medical School, Ann Arbor MI, USA
| | - Elham Asghari Adib
- Department of Molecular, Cellular and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
| | - Natalia P. Biscola
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rafi Kohen
- Department of Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor MI, USA
| | - Manav Patel
- Department of Biology, Ball State University, Muncie IN, USA
| | | | - Emily Desai
- Department of Biology, Ball State University, Muncie IN, USA
| | | | - Grace Saxman
- Department of Biology, Ball State University, Muncie IN, USA
| | - Mitre Athaiya
- Department of Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor MI, USA
| | - David Wilborn
- Department of Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor MI, USA
| | - Jaisha Shumpert
- Department of Biology, Ball State University, Muncie IN, USA
| | - Xiao-Feng Zhao
- Department of Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor MI, USA
| | - Riki Kawaguchi
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Daniel H. Geschwind
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Institute of Precision Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Ahmet Hoke
- Department of Neurology, The Johns Hopkins University, Baltimore, MD, USA
| | - Peter Shrager
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
| | - Catherine A. Collins
- Department of Molecular, Cellular and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
- Department of Neurosciences, Case Western Reserve University, Cleveland, OH, USA
| | - Leif A. Havton
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J Peters VA Medical Center, Bronx, NY, USA
| | - Ashley L. Kalinski
- Department of Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor MI, USA
- Department of Biology, Ball State University, Muncie IN, USA
| | - Roman J. Giger
- Department of Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor MI, USA
- Department of Neurology, University of Michigan Medical School, Ann Arbor MI, USA
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Redwood T, Ward A, Ali T, Poole C, O'Dell C, Rebaudo D. In praise of postgraduate career clinics: Translating health professionals' willingness to engagement. Nurs Open 2024; 11:e2113. [PMID: 38366785 PMCID: PMC10873677 DOI: 10.1002/nop2.2113] [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: 10/31/2022] [Revised: 01/12/2024] [Accepted: 01/22/2024] [Indexed: 02/18/2024] Open
Abstract
AIM To capture and retain healthcare staff in postgraduate courses relevant to individual career aspirations, service requirements and continuous practice development (CPD) within an English UK university. DESIGN Two virtual career clinics for postgraduate practitioners to engage in CPD offers within the university. An online post-enrolment online survey to explore their experiences of engagement with the university. METHODS Mixed: qualitative and quantitative methods. Engaging 10 participants attended the career clinics, and 42 participants with an online survey. RESULTS The career clinics were well received by participants who mapped CPD requirements and individual career aspirations. The surveys exposed challenges with marketing and enrolment; however, these were mitigated with support. Four recommendations are presented within this paper applicable to the international postgraduate education of all health practitioners.
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Affiliation(s)
| | - A. Ward
- University of NorthamptonNorthamptonUK
| | - T. Ali
- University of NorthamptonNorthamptonUK
| | - C. Poole
- University of NorthamptonNorthamptonUK
| | - C. O'Dell
- University of NorthamptonNorthamptonUK
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4
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Walker NF, Schutz C, Ward A, Barr D, Opondo C, Shey M, Elkington PT, Wilkinson KA, Wilkinson RJ, Meintjes G. Elevated plasma matrix metalloproteinases associate with Mycobacterium tuberculosis blood stream infection and mortality in HIV-associated tuberculosis. medRxiv 2023:2023.12.12.23299845. [PMID: 38168355 PMCID: PMC10760259 DOI: 10.1101/2023.12.12.23299845] [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] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Mortality from HIV-associated tuberculosis (HIV-TB) is high, particularly among hospitalised patients. In 433 people living with HIV admitted to hospital with symptoms of TB, we investigated plasma matrix metalloproteinases (MMP) and matrix-derived biomarkers in relation to TB diagnosis, mortality and Mycobacterium tuberculosis (Mtb) blood stream infection (BSI). Compared to other diagnoses, MMP-8 was elevated in confirmed TB and in Mtb-BSI, positively correlating with extracellular matrix breakdown products. Baseline MMP-3, -7, -8, -10 and procollagen III N-terminal propeptide (PIIINP) associated with Mtb-BSI and 12-week mortality. These findings implicate MMP dysregulation in pathophysiology of advanced HIV-TB and support MMP inhibition as a host-directed therapeutic strategy for HIV-TB.
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Affiliation(s)
- N F Walker
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- TB Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, WC1E 7HT, United Kingdom
| | - C Schutz
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa
| | - A Ward
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa
| | - D Barr
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Wellcome Liverpool Glasgow Centre for Global Health Research, University of Liverpool, Liverpool, L69 3BX, United Kingdom
- Department of Infectious Diseases, Queen Elizabeth University Hospital, Glasgow, G51 4TF
| | - C Opondo
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, WC1E 7HT, United Kingdom
| | - M Shey
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa
| | - P T Elkington
- NIHR Biomedical Research Centre, School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, United Kingdom
| | - K A Wilkinson
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa
- The Francis Crick Institute, London, NW1 1AT, United Kingdom
| | - R J Wilkinson
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa
- The Francis Crick Institute, London, NW1 1AT, United Kingdom
- Department of Infectious Diseases, Imperial College London, W12 0NN, United Kingdom
| | - G Meintjes
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa
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Perlow HK, Nalin A, Ritter A, Addington M, Ward A, Liu M, Nappi C, Blakaj DM, Beyer S, Thomas EM, Grecula JC, Raval R, Kotecha R, Boulter D, Dawson E, Zoller W, Palmer JD. Advancing beyond the Hippocampus to Preserve Cognition for Patients with Brain Metastases: Dosimetric Results from a Phase 2 Trial of Memory-Avoidance Whole Brain Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e145-e146. [PMID: 37784722 DOI: 10.1016/j.ijrobp.2023.06.960] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Recent advances to preserve neurocognitive function in patients treated for brain metastases include stereotactic radiosurgery (SRS), hippocampal avoidance whole brain radiation therapy (HA-WBRT), and memantine administration. However, 23% of patients receiving HA-WBRT and memantine on NRG-CC001 still experienced executive function deterioration at 4 months, with 12% experiencing total recall and delayed recognition deterioration at 6 months. The hippocampus, corpus callosum, fornix, and amygdala are key neurocognitive substructures with a low propensity for brain metastases. Herein, we report our preliminary experience using an advanced "memory-avoidance" WBRT (MA-WBRT) approach sparing these substructures for patients with multiple (>15) brain metastases. MATERIALS/METHODS Ten consecutive patients treated with MA-WBRT on a phase 2 clinical trial (OSU-21074) were reviewed. In each patient, the hippocampi, amygdalae, corpus callosa, and fornix were contoured. Patients were not eligible for MA-WBRT if they had metastases in these substructures. A memory- avoidance region created using a 5mm volumetric expansion around these substructures. Hotspots were avoided in the hypothalamus and pituitary gland. Dose constraints for these avoidance structures were modeled after NRG CC-001 and include a D100% ≤ 9 Gy and a D0.03 cc ≤ 16 (acceptable to 20 Gy). Coverage of brain metastases was prioritized over memory avoidance dose constraints. Linac-based volumetric modulated arc therapy (VMAT) plans were generated for a prescription dose of 30 Gy in 10 fractions. RESULTS On average, the memory avoidance structure volume was 37.1 ccs (Range: 25.2-44.6 ccs), occupying 2.5% of the entire whole brain target volume. All treatment plans met the D100% dose constraint, and 8/10 plans met the D0.03cc constraint, with priority given to tumor coverage for the remaining 2 cases. VMAT spared the memory avoidance structures with a median dose range of 10.8-14.2 Gy and a maximum dose (D0.03cc) range of 15.6-22.7 Gy. The mean dose to the memory avoidance structures was 12.7 Gy (Range: 11.5-13.8 Gy). Target coverage (D98% > 25 Gy) and homogeneity (D2% ≤ 37.5 Gy) were achieved for all plans. CONCLUSION Modern VMAT techniques allow for sparing of the hippocampus, amygdala, corpus callosum, and fornix with good target coverage and homogeneity. Prospective quality of life and cognitive data including are being collected and include the Functional Assessment of Cancer Therapy - Brain (Fact-Br), Hopkins Verbal Learning Test (HLVT-R), Trail Making Test A/B (TMT-A/B) and Controlled Oral Word Association Test (COWAT). After enrollment is completed, these data will be evaluated to assess the efficacy of MA-WBRT to mitigate declines in quality of life and cognition after whole brain radiation.
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Affiliation(s)
- H K Perlow
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - A Nalin
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - A Ritter
- The Ohio State University, Columbus, OH
| | - M Addington
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - A Ward
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - M Liu
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - C Nappi
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - D M Blakaj
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - S Beyer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - E M Thomas
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - J C Grecula
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - R Raval
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - R Kotecha
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL
| | - D Boulter
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - E Dawson
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - W Zoller
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - J D Palmer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
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6
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Parsons LA, Lo F, Ward A, Shindell D, Raman SR. Higher Temperatures in Socially Vulnerable US Communities Increasingly Limit Safe Use of Electric Fans for Cooling. Geohealth 2023; 7:e2023GH000809. [PMID: 37577109 PMCID: PMC10413955 DOI: 10.1029/2023gh000809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/09/2023] [Accepted: 07/09/2023] [Indexed: 08/15/2023]
Abstract
As the globe warms, people will increasingly need affordable, safe methods to stay cool and minimize the worst health impacts of heat exposure. One of the cheapest cooling methods is electric fans. Recent research has recommended ambient air temperature thresholds for safe fan use in adults. Here we use hourly weather reanalysis data (1950-2021) to examine the temporal and spatial evolution of ambient climate conditions in the continental United States (CONUS) considered safe for fan use, focusing on high social vulnerability index (SVI) regions. We find that although most hours in the day are safe for fan use, there are regions that experience hundreds to thousands of hours per year that are too hot for safe fan use. Over the last several decades, the number of hours considered unsafe for fan use has increased across most of the CONUS (on average by ∼70%), with hotspots across the US West and South, suggesting that many individuals will increasingly need alternative cooling strategies. People living in high-SVI locations are 1.5-2 times more likely to experience hotter climate conditions than the overall US population. High-SVI locations also experience higher rates of warming that are approaching and exceeding important safety thresholds that relate to climate adaptation. These results highlight the need to direct additional resources to these communities for heat adaptive strategies.
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Affiliation(s)
- L. A. Parsons
- Nicholas School of the EnvironmentDuke UniversityDurhamNCUSA
- Global ScienceThe Nature ConservancyDurhamNCUSA
| | - F. Lo
- Environmental Defense FundNew York CityNYUSA
| | - A. Ward
- Nicholas Institute for Energy, Environment, and SustainabilityDuke UniversityDurhamNCUSA
| | - D. Shindell
- Nicholas School of the EnvironmentDuke UniversityDurhamNCUSA
| | - S. R. Raman
- Population Health SciencesDuke UniversityDurhamNCUSA
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Ward A, Copertino D, Stevenson E, McNeil E, Chukwukere U, Gandhi R, McMahon D, Bosch R, Mellors J, Jones B, Macatangay B, Cyktor J, Eron J. OP 4.6 – 00185 No associations between magnitudes of HIV-specific CTL responses on stable art and subsequent decay of intact proviruses or cell-associated HIV mRNA. J Virus Erad 2022. [DOI: 10.1016/j.jve.2022.100206] [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: 12/24/2022] Open
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8
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Ward A, Ives P, Koumousidis A. Complications of oxidised regenerated cellulose at Caesarean section: A report of two cases. Facts Views Vis Obgyn 2022; 14:347-352. [PMID: 36724429 PMCID: PMC10364339 DOI: 10.52054/fvvo.14.4.050] [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: 02/03/2023] Open
Abstract
Two patients underwent surgical deliveries within four months of one another at a single maternity unit. Both patients had complications of infection-like symptoms such as offensive vaginal discharge and pyrexia, months following their caesarean sections resulting in further surgery. The incidents were thought to be secondary to woven oxidised regenerated cellulose (ORC) use. ORC must be used according to its relevant product literature which can vary between brands. Surgeons must keep abreast of changes to the haemostatic material provided to them and therefore the properties of each type, especially when faced with bleeding not suitable for suturing or electrocautery.
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9
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Strong M, Kathawate V, Goethe P, Tudrick L, Linzey J, Ward A, Zaki M, Joshi R, Jackson W, Szerlip N. DISP-04. PATIENTS WITH PROGRESSION OF SPINE METASTASES WHO PRESENT TO CLINIC HAVE BETTER OUTCOMES COMPARED TO THOSE WHO PRESENT TO THE EMERGENCY DEPARTMENT. Neuro Oncol 2022. [PMCID: PMC9660454 DOI: 10.1093/neuonc/noac209.486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
As cancer therapies have improved, survival has increased. Spine metastases are becoming more common in the course of oncologic disease. Complications arising from these metastases have a significant impact on patient quality of life and the optimal method to follow these patients and avoid deficits has not yet been adequately studied. The purpose of this study was to identify characteristics of a subgroup of oncologic patients with metastatic spinal disease. Retrospective analysis of oncological patients ( > 18 years) who underwent stereotactic body radiation therapy (SBRT) to the spine at the University of Michigan, from 2010 to 2020 was performed. A total of 395 radiographic isocenters in 298 patients were identified. Of these, 112 isocenters in 83 patients and 283 isocenters in 215 patients were treated after presenting to the ED or clinic, respectively. As expected, patients presenting to the ED had more deficits compared to the clinic (severe pain (30% vs 6%); difficulty ambulating (48% vs 8%); weakness (25% vs 6%); or myelopathy (11% vs 1%). Social economic factors including marital status, insurance type, and having a primary care physician were similar between groups. Of the 112 ED isocenters, 58 required surgery plus SBRT (52%); while 54 required SBRT only (48%). Additionally, of the 283 clinic isocenters, 53 required surgery plus SBRT (19%); while 230 only required SBRT (81%). The overall survival was higher for clinic compared to ED (12.6mos vs 8.5mos), respectively. Interestingly, even when surgical intervention was taken into consideration, those presenting to the ED still had poorer outcomes compared to clinic (6.7mos vs 13.3mos), respectively. Metastatic spinal disease patients who present to the ED have poorer survival than those who present to the clinic. A better understanding of the factors that drive this phenomenon is warranted in order to improve the management and outcomes of this population.
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Affiliation(s)
| | | | | | | | | | | | - Mark Zaki
- University of Michigan , Ann Arbor , USA
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10
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Yakushev A, Lens L, Düllmann CE, Khuyagbaatar J, Jäger E, Krier J, Runke J, Albers HM, Asai M, Block M, Despotopulos J, Di Nitto A, Eberhardt K, Forsberg U, Golubev P, Götz M, Götz S, Haba H, Harkness-Brennan L, Herzberg RD, Heßberger FP, Hinde D, Hübner A, Judson D, Kindler B, Komori Y, Konki J, Kratz J, Kurz N, Laatiaoui M, Lahiri S, Lommel B, Maiti M, Mistry AK, Mokry C, Moody KJ, Nagame Y, Omtvedt JP, Papadakis P, Pershina V, Rudolph D, Samiento L, Sato T, Schädel M, Scharrer P, Schausten B, Shaughnessy DA, Steiner J, Thörle-Pospiech P, Toyoshima A, Trautmann N, Tsukada K, Uusitalo J, Voss KO, Ward A, Wegrzecki M, Wiehl N, Williams E, Yakusheva V. On the adsorption and reactivity of element 114, flerovium. Front Chem 2022; 10:976635. [PMID: 36092655 PMCID: PMC9453156 DOI: 10.3389/fchem.2022.976635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/19/2022] [Indexed: 12/01/2022] Open
Abstract
Flerovium (Fl, element 114) is the heaviest element chemically studied so far. To date, its interaction with gold was investigated in two gas-solid chromatography experiments, which reported two different types of interaction, however, each based on the level of a few registered atoms only. Whereas noble-gas-like properties were suggested from the first experiment, the second one pointed at a volatile-metal-like character. Here, we present further experimental data on adsorption studies of Fl on silicon oxide and gold surfaces, accounting for the inhomogeneous nature of the surface, as it was used in the experiment and analyzed as part of the reported studies. We confirm that Fl is highly volatile and the least reactive member of group 14. Our experimental observations suggest that Fl exhibits lower reactivity towards Au than the volatile metal Hg, but higher reactivity than the noble gas Rn.
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Affiliation(s)
- A. Yakushev
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
- *Correspondence: A. Yakushev,
| | - L. Lens
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Ch. E. Düllmann
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - J. Khuyagbaatar
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
| | - E. Jäger
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - J. Krier
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - J. Runke
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - H. M. Albers
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - M. Asai
- Japan Atomic Energy Agency, Tokai, Japan
| | - M. Block
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - J. Despotopulos
- Lawrence Livermore National Laboratory, Livermore, CA, United States
| | - A. Di Nitto
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - K. Eberhardt
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | | | | | - M. Götz
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - S. Götz
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | | | | | | | - F. P. Heßberger
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
| | - D. Hinde
- Australian National University, Canberra, ACT, Australia
| | - A. Hübner
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - D. Judson
- University of Liverpool, Liverpool, United Kingdom
| | - B. Kindler
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | | | - J. Konki
- University of Jyväskylä, Jyväskylä, Finland
| | - J.V. Kratz
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - N. Kurz
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - M. Laatiaoui
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - S. Lahiri
- Saha Institute of Nuclear Physics, Kolkata, India
| | - B. Lommel
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - M. Maiti
- Indian Institute of Technology Roorkee, Roorkee, India
| | - A. K. Mistry
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
| | - Ch. Mokry
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - K. J. Moody
- Lawrence Livermore National Laboratory, Livermore, CA, United States
| | - Y. Nagame
- Japan Atomic Energy Agency, Tokai, Japan
| | | | - P. Papadakis
- University of Liverpool, Liverpool, United Kingdom
| | - V. Pershina
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | | | | | - T.K. Sato
- Japan Atomic Energy Agency, Tokai, Japan
| | - M. Schädel
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - P. Scharrer
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - B. Schausten
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - D. A. Shaughnessy
- Lawrence Livermore National Laboratory, Livermore, CA, United States
| | - J. Steiner
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - P. Thörle-Pospiech
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | | | - N. Trautmann
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - K. Tsukada
- Japan Atomic Energy Agency, Tokai, Japan
| | | | - K.-O. Voss
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - A. Ward
- University of Liverpool, Liverpool, United Kingdom
| | - M. Wegrzecki
- Łukasiewicz Research Network—Institute of Electron Technology, Warsaw, Poland
| | - N. Wiehl
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - E. Williams
- Australian National University, Canberra, ACT, Australia
| | - V. Yakusheva
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
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11
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Strong MJ, Linzey JR, Zaki MM, Joshi RS, Ward A, Yee TJ, Khalsa SSS, Saadeh YS, Park P. Navigated retrodiaphragmatic/retroperitoneal approach for the treatment of symptomatic kyphoscoliosis: an operative video. Neurosurgical Focus: Video 2022; 7:V6. [PMID: 36284727 PMCID: PMC9557346 DOI: 10.3171/2022.3.focvid2215] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/30/2022] [Indexed: 11/06/2022]
Abstract
Retropleural, retrodiaphragmatic, and retroperitoneal approaches are utilized to access difficult thoracolumbar junction (T10–L2) pathology. The authors present a 58-year-old man with chronic low-back pain who failed years of conservative therapy. Preoperative radiographs demonstrated significant levoconvex scoliosis with coronal and sagittal imbalance. He underwent a retrodiaphragmatic/retroperitoneal approach for T12–L1, L1–2, L2–3, and L3–4 interbody release and fusion in conjunction with second-stage facet osteotomies, L4–5 TLIF, and T10–iliac posterior instrumented fusion. This video focuses on the retrodiaphragmatic approach assisted by 3D navigation. The video can be found here: https://stream.cadmore.media/r10.3171/2022.3.FOCVID2215
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Affiliation(s)
- Michael J. Strong
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Joseph R. Linzey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Mark M. Zaki
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | | | - Ayobami Ward
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Timothy J. Yee
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | | | - Yamaan S. Saadeh
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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12
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Pilbury M, Lockley C, McGloughlin E, Ward A, Hogarth L, Hebberd B, Powrie B. ePS2.03 A service evaluation of ‘CF THRIVE’: an online, student-led group for children with cystic fibrosis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00291-0] [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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13
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Yakushev A, Lens L, Düllmann CE, Block M, Brand H, Calverley T, Dasgupta M, Di Nitto A, Götz M, Götz S, Haba H, Harkness-Brennan L, Herzberg RD, Heßberger FP, Hinde D, Hübner A, Jäger E, Judson D, Khuyagbaatar J, Kindler B, Komori Y, Konki J, Kratz J, Krier J, Kurz N, Laatiaoui M, Lommel B, Lorenz C, Maiti M, Mistry A, Mokry C, Nagame Y, Papadakis P, Såmark-Roth A, Rudolph D, Runke J, Sarmiento L, Sato T, Schädel M, Scharrer P, Schausten B, Steiner J, Thörle-Pospiech P, Toyoshima A, Trautmann N, Uusitalo J, Ward A, Wegrzecki M, Yakusheva V. First Study on Nihonium (Nh, Element 113) Chemistry at TASCA. Front Chem 2021; 9:753738. [PMID: 34917588 PMCID: PMC8669335 DOI: 10.3389/fchem.2021.753738] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/27/2021] [Indexed: 11/13/2022] Open
Abstract
Nihonium (Nh, element 113) and flerovium (Fl, element 114) are the first superheavy elements in which the 7p shell is occupied. High volatility and inertness were predicted for Fl due to the strong relativistic stabilization of the closed 7p 1/2 sub-shell, which originates from a large spin-orbit splitting between the 7p 1/2 and 7p 3/2 orbitals. One unpaired electron in the outermost 7p 1/2 sub-shell in Nh is expected to give rise to a higher chemical reactivity. Theoretical predictions of Nh reactivity are discussed, along with results of the first experimental attempts to study Nh chemistry in the gas phase. The experimental observations verify a higher chemical reactivity of Nh atoms compared to its neighbor Fl and call for the development of advanced setups. First tests of a newly developed detection device miniCOMPACT with highly reactive Fr isotopes assure that effective chemical studies of Nh are within reach.
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Affiliation(s)
- A. Yakushev
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
| | - L. Lens
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Ch. E. Düllmann
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - M. Block
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - H. Brand
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - T. Calverley
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | - M. Dasgupta
- Department of Nuclear Physics, Australian National University, Canberra, ACT, Australia
| | - A. Di Nitto
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - M. Götz
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - S. Götz
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | | | | | - R-D. Herzberg
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | - F. P. Heßberger
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
| | - D. Hinde
- Department of Nuclear Physics, Australian National University, Canberra, ACT, Australia
| | - A. Hübner
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - E. Jäger
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - D. Judson
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | - J. Khuyagbaatar
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
| | - B. Kindler
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | | | - J. Konki
- Department of Physics, University of Jyväskylä, Jyväskylä, Finland
| | - J.V. Kratz
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - J. Krier
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - N. Kurz
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - M. Laatiaoui
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
| | - B. Lommel
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | | | - M. Maiti
- Indian Institute of Technology Roorkee, Roorkee, India
| | - A.K. Mistry
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
| | - Ch. Mokry
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Y. Nagame
- Japan Atomic Energy Agency, Tokai, Japan
| | - P. Papadakis
- Department of Physics, University of Jyväskylä, Jyväskylä, Finland
| | | | - D. Rudolph
- Department of Physics, Lund University, Lund, Sweden
| | - J. Runke
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | | | - T.K. Sato
- Japan Atomic Energy Agency, Tokai, Japan
| | - M. Schädel
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - P. Scharrer
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - B. Schausten
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - J. Steiner
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - P. Thörle-Pospiech
- Helmholtz-Institut Mainz, Mainz, Germany
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | | | - N. Trautmann
- Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - J. Uusitalo
- Department of Physics, University of Jyväskylä, Jyväskylä, Finland
| | - A. Ward
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | - M. Wegrzecki
- Łukasiewicz-Instytut Mikroelektroniki I Fotoniki, Warsaw, Poland
| | - V. Yakusheva
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Helmholtz-Institut Mainz, Mainz, Germany
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14
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Hosain A, Mladkova N, Zoller W, Zoller I, Ward A, DiConstanzo D, Blakaj D. Effects of Radiation Treatment on Pituitary Gland and Hypothalamus Function. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Ward A, Ahmed R, Adedeji J, McGregor-Riley J. 1065 Exposing the Incidence of Ileus in Pelvic and Acetabular Fractures: A Retrospective Case Analysis. Br J Surg 2021. [DOI: 10.1093/bjs/znab258.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Paralytic ileus is a temporary inhibition of gastrointestinal mobility in the absence of mechanical obstruction. Ileus has previously been observed in up to 40% of patients undergoing bowel surgery, leading to increased morbidity and length of stay. Pelvic and acetabular fractures are often caused by high energy trauma and are associated with a risk of visceral injury. This is the first study to report the incidence of and risk factors for ileus following admission with pelvic and/or acetabular fractures.
Method
All patients over the age of 16 presenting to a major trauma centre throughout 2019 were included. Data included patient demographics, injury pattern, fracture management and presence of ileus. Previous studies identified patients as having ileus if they failed to tolerate an oral diet and open their bowels for more than three days (GI-2). Analysis assessed risk factors for ileus as well as its effect on length of stay.
Results
An incidence of ileus of 40.35% was observed in the 57 included patients. Ileus was three times more common in patients with a diagnosis of diabetes mellitus (p = 0.56) and 2.5 times more common in the presence of an open pelvic/acetabular fracture (p = 0.73). Length of stay was significantly longer in patients under 65 years identified as having ileus (p = 0.046). Gender, age, opiate use, fracture management and surgical approach were not identified as risk factors.
Conclusions
The authors have identified the essentiality of early risk factor identification and hope to encourage further research to create a prognostic tool.
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Affiliation(s)
- A Ward
- Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - R Ahmed
- The University of Sheffield, Sheffield, United Kingdom
| | - J Adedeji
- Southend University Hospital, Essex, United Kingdom
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16
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Phoon KM, Ward A, O'Dowd D, Pitcher F, Amos L, Butler J, Brewer P, Davies M, Chadwick C, Davies H, Blundell C. 965 Complication Rates in Operatively Managed Ankle Fracture/Dislocations - The Effect of Pre-Reduction Imaging and Compliance with BOAST 12 Guidance. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
The BOAST-12 guidelines for the management of ankle fractures aims to optimise functional recovery and reduce complications. They advise against having radiographs prior to urgent reduction of clinically deformed ankles as it could cause an unacceptable delay to subsequent management. Our study aimed to assess the effect of time to acceptable reduction on the risk of complications and time to definitive reduction.
Method
This was a retrospective observational study of patients with ankle fracture-dislocations between 2013 to 2017 at the Northern General Hospital’s Emergency Department (ED). Information collected from 2 patient groups (with and without pre-reduction radiographs), included patient demographics, time to accepted reduction, number of manipulations, operations, and subsequent complications.
Results
242 patients were identified. Time from arrival in ED to acceptable reduction was significantly longer in patients with pre-reduction radiographs versus patients without (184.5 vs 82 minutes, p < 0.00), but did not increase the overall risk of complications (p = 0.62). Pre-reduction radiographs were associated with insignificantly higher rates of post-traumatic osteoarthritis (p = 0.17) and slightly longer wait time for definitive intervention (1 vs 2 days, p = 0.72). However, this had no relationship with the number of manipulations (p = 0.53).
Conclusions
The use of pre-reduction radiographs significantly increased time to acceptable reduction of ankle fracture-dislocations. However, this was not associated with increased risk of complications or time to definitive management.
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Affiliation(s)
- K M Phoon
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - A Ward
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - D O'Dowd
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - F Pitcher
- The University of Sheffield Medical School, Sheffield, United Kingdom
| | - L Amos
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - J Butler
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - P Brewer
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - M Davies
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - C Chadwick
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - H Davies
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - C Blundell
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
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17
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Ortega Franco A, Adamson-Raieste A, Rahman R, Pihlak R, Peters N, Scott JA, Aruketty S, Thomson C, Dransfield S, Henshaw A, Ward A, Cutts T, Carter L, Thistlethwaite F, Cook N, Graham D, Stevenson J, Krebs M. 44P Value of comprehensive genomic profiling in pre-screening patients for NTRK fusion in STARTRK2 trial: Single centre experience. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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18
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Ganjoo K, Madison R, Rosenzweig M, Oxnard G, Venstrom J, Ward A, Schrock A. 1532P Fusion and rearrangement (RE) detection using DNA and RNA-based comprehensive genomic profiling (CGP) of sarcomas. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.862] [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] Open
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19
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Almond E, Fullarton R, Kidane G, Withers D, Ward A, Graham S. PO-1605 Sensitivity of DoseCHECK and Mobius3D for patient-specific QA of Ethos Therapy on-line adaptive RT. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08056-7] [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: 11/24/2022]
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20
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Fung A, Ward A, Patel K, Krkovic M. 1005 Antibiotic-Impregnated Calcium Sulfate Beads Are Not Effective in the Primary Prevention of Infection in Open Femur and Tibia Fractures. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Infection is a major complication of open fractures. Antibiotic-impregnated calcium sulfate (AICS) beads are widely used as an adjuvant to systemic antibiotics. Whilst their efficacy in the secondary prevention of infection is established, we present the first retrospective study evaluating AICS beads in the primary prevention of infection in open fractures.
Method
214 open femur and tibia fractures in 207 patients were reviewed over a seven-year period. 148 fractures received only systemic antibiotic prophylaxis. 66 fractures also received AICS beads. The occurrence of acute infection (wound infection and acute osteomyelitis) was recorded, as well as that of long-term complications (chronic osteomyelitis, non-union and death).
Results
Fractures that received AICS with systemic antibiotics had an overall acute infection rate of 42% (28/66), compared to 43% (63/148) in fractures that received only systemic antibiotics (p > 0.05). There was no significant difference in infection rate even when fractures were stratified by Gustilo-Anderson grade. There was also no significant difference in the rate of long-term complications.
Conclusions
Our results indicate that the adjuvant use of AICS beads is not effective for the primary prevention of acute infection or long-term complications in open leg fractures. Further research is needed to elucidate the factors influencing the outcomes of AICS use.
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Affiliation(s)
- A Fung
- University of Cambridge, Cambridge, United Kingdom
| | - A Ward
- University of Cambridge, Cambridge, United Kingdom
| | - K Patel
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - M Krkovic
- Addenbrooke's Hospital, Cambridge, United Kingdom
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21
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Baban B, Braun M, Khodadadi H, Ward A, Alverson K, Malik A, Nguyen K, Nazarian S, Hess DC, Forseen S, Post AF, Vale FL, Vender JR, Hoda MN, Akbari O, Vaibhav K, Dhandapani KM. AMPK induces regulatory innate lymphoid cells after traumatic brain injury. JCI Insight 2021; 6:126766. [PMID: 33427206 PMCID: PMC7821592 DOI: 10.1172/jci.insight.126766] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 12/11/2018] [Accepted: 11/18/2020] [Indexed: 12/26/2022] Open
Abstract
The CNS is regarded as an immunoprivileged organ, evading routine immune surveillance; however, the coordinated development of immune responses profoundly influences outcomes after brain injury. Innate lymphoid cells (ILCs) are cytokine-producing cells that are critical for the initiation, modulation, and resolution of inflammation, but the functional relevance and mechanistic regulation of ILCs are unexplored after acute brain injury. We demonstrate increased proliferation of all ILC subtypes within the meninges for up to 1 year after experimental traumatic brain injury (TBI) while ILCs were present within resected dura and elevated within cerebrospinal fluid (CSF) of moderate-to-severe TBI patients. In line with energetic derangements after TBI, inhibition of the metabolic regulator, AMPK, increased meningeal ILC expansion, whereas AMPK activation suppressed proinflammatory ILC1/ILC3 and increased the frequency of IL-10-expressing ILC2 after TBI. Moreover, intracisternal administration of IL-33 activated AMPK, expanded ILC2, and suppressed ILC1 and ILC3 within the meninges of WT and Rag1-/- mice, but not Rag1-/- IL2rg-/- mice. Taken together, we identify AMPK as a brake on the expansion of proinflammatory, CNS-resident ILCs after brain injury. These findings establish a mechanistic framework whereby immunometabolic modulation of ILCs may direct the specificity, timing, and magnitude of cerebral immunity.
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Affiliation(s)
- Babak Baban
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, Georgia, USA.,Department of Surgery.,Department of Neurology
| | | | - Hesam Khodadadi
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, Georgia, USA.,Department of Neurology
| | | | | | - Aneeq Malik
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, Georgia, USA
| | | | - Skon Nazarian
- Department of Radiology and Imaging, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | | | - Scott Forseen
- Department of Radiology and Imaging, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | | | | | | | - Md Nasrul Hoda
- Department of Neurobiology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Omid Akbari
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kumar Vaibhav
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, Georgia, USA.,Department of Neurosurgery, and
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22
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Santiago C, Huttner I, Chand R, Humphreys D, Young P, Ward A, Fatkin D. TTNtv Carriers do not Have Increased Susceptibility to Chemotherapy-Induced Cardiomyopathy. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Drullinsky D, Ward A, Graciano C, Harap R, Pham D. MINIMALLY INVASIVE HEARTMATE 3 VENTRICULAR ASSIST DEVICE IMPLANTATION. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.194] [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: 10/23/2022] Open
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Welford J, Rafferty R, Hunt K, Duncan L, Richardson O, Ward A, Rushton C, Short D, Greystoke A. CN14 The utility of a brief clinical frailty scale (CFS) in predicting prognosis and discharge destination in oncology inpatients. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Berry P, Burrows K, Hall R, Gater A, Bradley H, Ward A, Tolley C, Delong P, Hsia EC. AB1332-HPR ASSESSING THE PATIENT EXPERIENCE OF LUPUS NEPHRITIS: DEVELOPMENT OF A CONCEPTUAL MODEL AND REVIEW OF EXISTING PATIENT-REPORTED OUTCOME (PRO) MEASURES. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5634] [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: 11/04/2022]
Abstract
Background:Lupus nephritis (LN) is an autoimmune disease characterized by inflammation of the kidneys as a result of systemic lupus erythematosus (SLE). Approximately 50% of SLE patients will develop LN, which is considered to be one of the most severe manifestations of SLE and the leading cause of morbidity and mortality in SLE. While there is ample existing evidence on disease experience and PROs used in extra-renal SLE, little research has been done in LN. Qualitative interviews with patients can help identify concepts that are both important and relevant to the patient. In order to effectively evaluate treatment benefit, it is critical that PRO measures used to assess such concepts and define clinical trial endpoints are fit for purpose and have strong evidence of content validity in the specific context of use.Objectives:The objective of this study was to understand the patient experience of LN and to identify and characterize the signs and symptoms of LN and their impact on health-related quality of life (HRQoL) through the development of a disease-specific conceptual model. This model was then used to evaluate the content validity of existing PRO measures available for use in LN.Methods:A structured literature search was conducted in Medline, Embase and PsycINFO to identify qualitative research articles documenting the patient experience of LN. PRO measures developed or commonly used to assess patient experiences of LN were also identified. Semi-structured concept elicitation interviews were conducted with 15 adult patients in the US with a clinician-confirmed diagnosis of LN (defined in accordance with established clinical guidelines). Supplementary qualitative data were also collected from a review of publicly available online blogs/forums. Findings were used to inform the development of a conceptual model detailing the impact of LN signs, symptoms and HRQoL and evaluate the validity of existing measures used within LN.Results:Searches revealed a paucity of qualitative research conducted with LN patients, supporting the need for prospective research in LN. Consistent with existing literature in SLE, the core signs and symptoms identified from the qualitative literature review, interviews and blog/forum review included joint pain, fatigue, joint stiffness, swelling (particularly in the extremities) and skin rashes. LN patients also reported urinary frequency, urgency, foamy urine and blood in their urine. Disease impact on physical functioning, activities of daily living, emotions, social life, work/finances and sleep were reported. PRO measures commonly used to evaluate patient experiences in LN included the SF-36, LupusQOL, LupusPRO, SLE Symptom Checklist, KDQoL and KSQ. Conceptual mapping of instruments against the newly developed conceptual model (Figure 1) highlighted that no single measure provides a comprehensive assessment of all symptoms/impact important to LN patients. Furthermore, items are largely focused on impact of symptoms with few items on symptom severity.Figure 1.Conceptual model of lupus nephritis symptoms and associated impactsConclusion:The presentation of signs and symptoms in LN patients appears similar to those reported in extra-renal SLE populations, with the addition of swelling and urinary symptoms. Qualitative research with LN patients guided the development of a comprehensive LN conceptual model outlining the disease experience from the patients’ perspective. These insights can be useful to inform PRO measurement strategies for clinical trials in LN.Acknowledgments:With thanks to Dr. Betty Diamond and Dr. David Wofsy for their collaboration and helpful insightsDisclosure of Interests:Pamela Berry Employee of: Janssen, Kate Burrows Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract, Rebecca Hall Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract., Adam Gater Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract, Helena Bradley Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract, Amy Ward Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract, Chloe Tolley Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract, Patricia Delong Employee of: Janssen, Elizabeth C Hsia Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC
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Vaibhav K, Braun M, Alverson K, Khodadadi H, Kutiyanawalla A, Ward A, Banerjee C, Sparks T, Malik A, Rashid MH, Khan MB, Waters MF, Hess DC, Arbab AS, Vender JR, Hoda N, Baban B, Dhandapani KM. Neutrophil extracellular traps exacerbate neurological deficits after traumatic brain injury. Sci Adv 2020; 6:eaax8847. [PMID: 32523980 PMCID: PMC7259928 DOI: 10.1126/sciadv.aax8847] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 03/25/2020] [Indexed: 05/22/2023]
Abstract
Traumatic brain injury (TBI) is a major cause of mortality and morbidity. Preventative measures reduce injury incidence and/or severity, yet one-third of hospitalized patients with TBI die from secondary pathological processes that develop during supervised care. Neutrophils, which orchestrate innate immune responses, worsen TBI outcomes via undefined mechanisms. We hypothesized that formation of neutrophil extracellular traps (NETs), a purported mechanism of microbial trapping, exacerbates acute neurological injury after TBI. NET formation coincided with cerebral hypoperfusion and tissue hypoxia after experimental TBI, while elevated circulating NETs correlated with reduced serum deoxyribonuclease-1 (DNase-I) activity in patients with TBI. Functionally, Toll-like receptor 4 (TLR4) and the downstream kinase peptidylarginine deiminase 4 (PAD4) mediated NET formation and cerebrovascular dysfunction after TBI. Last, recombinant human DNase-I degraded NETs and improved neurological function. Thus, therapeutically targeting NETs may provide a mechanistically innovative approach to improve TBI outcomes without the associated risks of global neutrophil depletion.
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Affiliation(s)
- Kumar Vaibhav
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Molly Braun
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Katelyn Alverson
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Hesam Khodadadi
- Department of Oral Biology, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Ammar Kutiyanawalla
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Ayobami Ward
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Christopher Banerjee
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Tyler Sparks
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Aneeq Malik
- Department of Oral Biology, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Mohammad H. Rashid
- Department of Biochemistry and Molecular Biology, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Michael F. Waters
- Department of Neurology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - David C. Hess
- Department of Neurology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Ali S. Arbab
- Department of Biochemistry and Molecular Biology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - John R. Vender
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Nasrul Hoda
- Department of Neurology, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Department of Neurology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
- Department of Neurobiology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Babak Baban
- Department of Oral Biology, Dental College of Georgia, Augusta University, Augusta, GA, USA
- Department of Neurology, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Krishnan M. Dhandapani
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Greystoke A, Ward A, Welford J, Rushton C, Short D, Todd A, Rafferty R, Hunt K, Duncan L, Tanner L, Gardiner J. Implementation of the Rockwood Clinical Frailty Score (CFS) into the Newcastle upon Tyne NHS Trust lung cancer practice. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30220-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Santiago C, Chand R, Humphreys D, Young P, Ward A, Huttner I, Fatkin D. 002 Titin Truncation Provides a Sensitised Template for Cardio-Depressant Effects of Alcohol. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.009] [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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Frandrup J, Hall J, Reed D, Young J, Ward A, Sun X. Predicting Early Stages of Beef Respiratory Disease Using Thermal Imaging Technology. Meat and Muscle Biology 2019. [DOI: 10.22175/mmb.10721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
ObjectivesThe objective of this research was to utilize thermal imaging technology to estimate body temperature, so that an early stage of BRD can be detected.Materials and MethodsNinety-two steers were restrained in a squeeze chute that is housed in an indoor handling facility on 6 separate occasions. At least one image was taken of each side of the head using a thermal infrared camera (FLIR E8 WiFi, FLIR, Wilsonville, OR). The distance at which the images were taken was approximately 1 m from the steer. The rectal temperature was used as the control method to compare thermal imaging data. After thermal image acquisition, images were analyzed using the FLIR ResearchIR Max software (v. 4.40.8.28, FLIR, Wilsonville, OR), with the regions of interest being the eye and nasal cavity.ResultsThe analysis focused on minimum (MIN), maximum (MAX), mean, standard deviation (SD), and range of temperatures in the regions of interest. The REG procedure in SAS (v. 9.4, SAS Institute, Inc., Cary, NC) was used to perform stepwise regression to predict rectal temperature from the outdoor temperature (OTEMP) and all imaging features. When OTEMP was greater than –17.8°C, the regression model contained OTEMP, left nasal MAX, left nasal SD, and left eye MAX temperature and right eye temperature range, with an R2 of 0.24. When OTEMP was above freezing (0°C), the regression model contained left nasal temperature range, right eye temperature range, and average nasal mean temperature, with an R2 increase to 0.50. When using all data, the regression model fit left nasal MAX, right nasal MIN, average nasal mean, and left eye MAX temperatures and right eye temperature range, with an R2 of 0.08. These results show that thermal imaging technology has higher prediction accuracy in warmer temperature ranges than extreme cold conditions.ConclusionMore validation research on this thermal imaging technology needs to be conducted at warmer temperatures since all the current data was collected on cold winter days and a large portion of U.S. cattle are reared in more temperate and warmer areas than North Dakota such as Nebraska, Kansas, Texas, Oklahoma, and Florida. Overall, these results show promise for using thermal imaging technology to help detect BRD in an earlier stage by detecting fever before other clinical signs of BRD are present.
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Affiliation(s)
- J. Frandrup
- North Dakota State University Animal Science
| | - J. Hall
- North Dakota State University Animal Science
| | - D. Reed
- North Dakota State University Animal Science
| | - J. Young
- North Dakota State University Animal Science
| | - A. Ward
- North Dakota State University Animal Science
| | - X. Sun
- North Dakota State University Agricultural & Biosystems Engineering
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Nath SD, Ward A, Knutson E, Sun X, Keller W, Bauer M, Swanson K, Carlin K. Effect of Feeding a Low Vitamin a Diet to Beef Steers on Calpain 1 Activation during Meat Aging. Meat and Muscle Biology 2019. [DOI: 10.22175/mmb.10702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
ObjectivesThe objective of the study was to determine if a vitamin A deficient diet during beef finishing influences calpain 1 activation during meat aging.Materials and MethodsSixty-four steers of approximately 7 mo of age were subjected to a 14-d acclimation period followed by a 95-d growing period on a low vitamin A diet (1017 IU vitamin A/kg DM) designed to deplete liver vitamin A stores. Steers were assigned to a randomized complete blocked design with a 2 × 2 arrangement of treatments (breed: commercial Angus, n = 32, and purebred Simmental, n = 32; and a Low Vitamin A diet or a control diet). The low Vitamin A (LVA) treatment was a finishing diet with no supplemental vitamin A (723 IU vitamin A/kg DM). The control (CON) treatment was the LVA diet plus supplementation with 2200 IU vitamin A/kg DM for a total of 2923 IU vitamin A/kg DM. Serum retinol concentrations were monitored at the beginning and end of treatment. Upon completion of finishing, steers were slaughtered in two groups at a commercial plant. After fabrication, boneless strip loins (IMPS 180) were collected and transported to NDSU. Samples (approximately 40 g) were collected from the anterior portion of the strip loin on d-2 and d-7 of aging and immediately frozen. Protein was extracted from meat samples in fractionation buffers to yield sarcoplasmic and myofibrillar portions, separated by SDS-PAGE, and transferred to PVDF membranes. Immunoblot analysis was done using anti-desmin (d-2 and d-7) and anti-calpain 1 (d-2) antibodies, and results were visualized and documented. A pooled control was run on all membranes and set to a value of one for normalizing results. All experimental data were analyzed using the Proc Mixed procedure of SAS with breed of steers, dietary treatments, their interaction and slaughter date used as a fixed effect.ResultsCalpain 1 autolysis in the sarcoplasmic protein fraction of the d-2 aged loin samples were not affected by treatment or breed. The myofibrillar protein fraction from Angus loins had greater (P = 0.02) accumulation of the 76 kDa calpain 1 autolysis product than that from the Simmental loins; the myofibrillar fraction of the loins from the LVA treatment tended (P = 0.07) to have more 76 kDa calpain 1 autolysis product than that from the CON. There were not any differences (P > 0.19) in the 80 kDa calpain 1 band or the 78 kDa calpain 1 intermediate autolysis product in the myofibrillar fraction. There was a treatment by breed interaction (P = 0.01) for desmin in the d-7 aged loins where Angus loins from the CON treatment had less accumulation of the 46 kDa band than Angus loins on the LVA treatment and Simmental loins from either treatment.ConclusionVitamin A restriction increased protein proteolysis in Angus but not in Simmental steers. The increased calpain 1 autolysis in Angus vs. Simmental, regardless of Vitamin A treatment, indicates a genetic difference that may be the driver for the increased protein degradation in steers a restricted vitamin A diet.
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Affiliation(s)
- S. D. Nath
- North Dakota State University Animal Sciences
| | - A. Ward
- North Dakota State University Animal Sciences
| | - E. Knutson
- North Dakota State University Animal Sciences
| | - X. Sun
- North Dakota State University Agricultural and Biosystems Engineering
| | - W. Keller
- North Dakota State University Animal Sciences
| | - M. Bauer
- North Dakota State University Animal Sciences
| | - K. Swanson
- North Dakota State University Animal Sciences
| | - K. Carlin
- North Dakota State University Animal Sciences
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Warburton KL, Ward A, Turner D, Goulden V. Home phototherapy: experience of setting up a new service in the U.K.'s National Health Service. Br J Dermatol 2019; 182:251-253. [PMID: 31498877 DOI: 10.1111/bjd.18511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- K L Warburton
- Leeds Centre for Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, U.K
| | - A Ward
- Leeds Centre for Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, U.K
| | - D Turner
- Leeds Centre for Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, U.K
| | - V Goulden
- Leeds Centre for Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, U.K
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Liu W, Fakir H, Randhawa G, Kassam Z, Chung H, Chung P, Ward A, Zukotynski K, Emmett L, Bauman G. DRIVE: Defining Radiorecurrent Intraprostatic Target Volumes. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1834] [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: 10/26/2022]
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Smith C, Hoover D, Surry K, D'Souza D, Cool D, Gomez-Lemus J, Moussa M, Bauman G, Ward A. Does MRI Prostatic Lesion Targeting Using High Dose Rate Brachytherapy Lead to Elevated Dose to the Corresponding Histologic Lesions. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1771] [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: 10/26/2022]
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Moset V, Wahid R, Ward A, Møller HB. Modelling methane emission mitigation by anaerobic digestion: effect of storage conditions and co-digestion. Environ Technol 2019; 40:2633-2642. [PMID: 29498588 DOI: 10.1080/09593330.2018.1447999] [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] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 02/28/2018] [Indexed: 06/08/2023]
Abstract
In this work the methane conversion factor (MCF) of untreated and anaerobically digested cattle manure (CM) as a function of storage temperature, time and co-digestion was measured in an in vitro experiment and modelled based on IPCC (2006) methodology (Tier 2). For this, one sample of untreated CM, one sample of mono-digested CM and three samples of CM co-digested with grass were incubated at seven different temperatures (from 5°C to 50°C) over 346 days. The main results showed that ultimate methane yield (B0) of CM is higher than the B0 reported by the IPCC (2006). Two temperature ranges should be considered for MCF evolution, below 15°C very low MCF was measured in this work for untreated CM, mono and co-digested samples. At higher temperatures, MCF obtained in this work and that provided by the IPCC could be comparable depending on storage time. Anaerobic mono-digestion decreased MCF compared to untreated CM at all temperatures and times, except in the temperature range between 20°C and 25°C if storage time is low, due to a lag phase observed in CM. This lag phase would probably not happen in real storage conditions depending on the proportion of old manure remaining in the storage tank. Co-digestion with grass-decreased MCF compared to mono-digestion, but increased CH4 production in terms of fresh matter due to the higher B0 of the mixture. Storage time, temperature and co-digestion should be considered in the quantification of CH4 emission from digested material.
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Affiliation(s)
- Veronica Moset
- a Department of Engineering, Aarhus University , Aarhus , Denmark
| | - R Wahid
- a Department of Engineering, Aarhus University , Aarhus , Denmark
| | - A Ward
- a Department of Engineering, Aarhus University , Aarhus , Denmark
| | - H B Møller
- a Department of Engineering, Aarhus University , Aarhus , Denmark
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Kagan V, Mehta C, Michel E, Ward A, Jivan A, Ricciardi M, Anderson A, Pham D, Rich J. Approaches to Repairing Outflow Graft Stenosis in Left Ventricular Assist Devices. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Bi Y, Liu J, Furmanski B, Zhao H, Yu J, Osgood C, Ward A, Keegan P, Booth BP, Rahman A, Wang Y. Model-informed drug development approach supporting approval of the 4-week (Q4W) dosing schedule for nivolumab (Opdivo) across multiple indications: a regulatory perspective. Ann Oncol 2019; 30:644-651. [PMID: 30715147 DOI: 10.1093/annonc/mdz037] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND A nivolumab dosage regimen of 480 mg intravenously (i.v.) every 4 weeks (Q4W) was approved by FDA for the majority of the approved indications for nivolumab. METHODS The proposed new dosage regimen was supported by pharmacokinetic modeling and simulation, dose/exposure-response relationships for efficacy and safety in the indicated patient populations, and the clinical safety data with the 480 mg Q4W dosage regimen. Pharmacokinetic exposures achieved with 480 mg Q4W were predicted for 4166 patients in 21 clinical studies with various types of solid and hematological tumors. Exposure-response analyses were conducted to predict 480 mg Q4W safety and efficacy across all FDA-approved indications for nivolumab. RESULTS For the overall population, the geometric mean exposure achieved with 480 mg i.v. Q4W was 5.2% higher for steady state Cavg and 15.6% lower for Ctrough than those with 3 mg/kg i.v. Q2W, the approved dosage regimen. The simulated concentration-time course achieved with 480 mg Q4W regimen was below the median concentration achieved with 10 mg/kg i.v. Q2W that was also studied in clinical trials. The predicted probability of adverse events was similar between 480 mg Q4W and that observed with the 3 mg/kg Q2W regimen. Efficacy results were found to be similar between Q2W and Q3W dosage regimens in patients with renal cell carcinoma. The predicted efficacy for each indication suggested that the efficacy with 480 mg Q4W is unlikely to be compromised compared with that observed with 3 mg/kg Q2W. CONCLUSIONS The model-informed analyses of predicted exposure, efficacy and safety based on data from extensive clinical experience with nivolumab suggest that the benefit-risk profile of 480 mg Q4W regimen is comparable to the approved 3 mg/kg Q2W regimen, thus providing the regulatory basis for the approval of 480 mg Q4W regimen in the absence of clinical efficacy data with this new dosage regimen.
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Affiliation(s)
- Y Bi
- Divisions of Pharmacometrics, Office of Clinical Pharmacology, FDA, USA
| | - J Liu
- Divisions of Pharmacometrics, Office of Clinical Pharmacology, FDA, USA.
| | - B Furmanski
- Clinical Pharmacology V, Office of Clinical Pharmacology, FDA, USA
| | - H Zhao
- Clinical Pharmacology V, Office of Clinical Pharmacology, FDA, USA
| | - J Yu
- Divisions of Pharmacometrics, Office of Clinical Pharmacology, FDA, USA
| | - C Osgood
- Oncology Products II, Office of Hematology and Oncology Products, FDA, USA
| | - A Ward
- Oncology Products II, Office of Hematology and Oncology Products, FDA, USA
| | - P Keegan
- Oncology Products II, Office of Hematology and Oncology Products, FDA, USA
| | - B P Booth
- Clinical Pharmacology V, Office of Clinical Pharmacology, FDA, USA
| | - A Rahman
- Clinical Pharmacology V, Office of Clinical Pharmacology, FDA, USA
| | - Y Wang
- Divisions of Pharmacometrics, Office of Clinical Pharmacology, FDA, USA.
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Frandrup J, Hall J, Jr DR, Young J, Ward A, Sun X. Predicting Early Stages of Beef Respiratory Disease Using Thermal Imaging Technology. Meat and Muscle Biology 2019. [DOI: 10.22175/mmb2019.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Nath SD, Ward A, Knutson E, Sun X, Keller W, Bauer M, Swanson K, Carlin K. Effect of Feeding a Low Vitamin a Diet to Beef Steers on Calpain 1 Activation during Meat Aging. Meat and Muscle Biology 2019. [DOI: 10.22175/mmb2019.0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Anderson V, Doe S, Ward A. Management recommendations of the lung cancer MDT: are they being followed? Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30199-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Maharjan D, Rodas-González A, Tanner A, Kennedy V, Kirsch J, Gaspers J, Negrin-Pereira N, Fontoura A, Bauer M, Swanson K, Reynolds L, Stokka G, Ward A, Dahlen C, Neville B, Wittenberg K, McGeough E, Vonnahme K, Schaefer A, López-Campos Ó, Aalhus J, Ominski K. PSIX-14 Impact of needle-free injection device on injection-site tissue damage in beef sub-primals. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Maharjan
- University of Manitoba, Winnipeg, MB, Canada
| | | | - A Tanner
- North Dakota State University,Fargo, ND, United States
| | - V Kennedy
- North Dakota State University,Fargo, ND, United States
| | - J Kirsch
- North Dakota State University,Fargo, ND, United States
| | - J Gaspers
- North Dakota State University,Fargo, ND, United States
| | | | - A Fontoura
- Cornell University,Ithaca, NY, United States
| | - M Bauer
- North Dakota State University,Fargo, ND, United States
| | - K Swanson
- North Dakota State University,Fargo, ND, United States
| | - L Reynolds
- North Dakota State University,Fargo, ND, United States
| | - G Stokka
- North Dakota State University,Fargo, ND, United States
| | - A Ward
- North Dakota State University,Fargo, ND, United States
| | - C Dahlen
- North Dakota State University,Fargo, ND, United States
| | - B Neville
- Carrington REC,Carrington, ND, United States
| | | | - E McGeough
- University of Manitoba, Winnipeg, MB, Canada
| | - K Vonnahme
- North Dakota State University,Fargo, ND, United States
| | - A Schaefer
- University of Alberta,Lacombe, AB, Canada
| | - Ó López-Campos
- Agriculture and Agri-Food Canada, Lacombe Research and Development Centre, 6000 C & E Trail,Lacombe, Alberta, Canada T4L 1W1
| | - J Aalhus
- Agriculture and Agri-Food Canada, Lacombe Research and Development Centre, 6000 C & E Trail,Lacombe, Alberta, Canada T4L 1W1
| | - K Ominski
- University of Manitoba, Winnipeg, MB, Canada
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41
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Crouse M, Greseth N, McLean K, Crosswhite M, Negrin-Pereira N, Ward A, Reynolds L, Dahlen C, Neville B, Borowicz P, Caton J. PSI-11 Maternal nutrition and stage of early pregnancy in beef heifers: Influence on glutamine transporter SLC38A7 in utero-placental tissues from d 16 to 50 of gestation. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Crouse
- North Dakota State University,Fargo, ND, United States
| | - N Greseth
- University of Wisconsin Madison,Madison, WI, United States
| | - K McLean
- University of Kentucky,Lexington, KY, United States
| | - M Crosswhite
- Oklahoma State University,Stillwater, OK, United States
| | | | - A Ward
- North Dakota State University,Fargo, ND, United States
| | - L Reynolds
- North Dakota State University,Fargo, ND, United States
| | - C Dahlen
- North Dakota State University,Fargo, ND, United States
| | - B Neville
- Carrington REC,Carrington, ND, United States
| | - P Borowicz
- North Dakota State University,Fargo, ND, United States
| | - J Caton
- North Dakota State University,Fargo, ND, United States
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42
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Maharjan D, Rodas-González A, Tanner A, Kennedy V, Kirsch J, Gaspers J, Negrin-Pereira N, Fontoura A, Bauer M, Swanson K, Reynolds L, Stokka G, Ward A, Dahlen C, Neville B, Wittenberg K, McGeough E, Vonnahme K, Schaefer A, López-Campos Ó, Aalhus J, Gardiner P, Ominski K. PSI-35 Corn supplementation of beef cows and its impact on growth performance and carcass outcomes of their progeny. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D Maharjan
- University of Manitoba, Winnipeg, MB, Canada
| | | | - A Tanner
- North Dakota State University,Fargo, ND, United States
| | - V Kennedy
- North Dakota State University,Fargo, ND, United States
| | - J Kirsch
- North Dakota State University,Fargo, ND, United States
| | - J Gaspers
- North Dakota State University,Fargo, ND, United States
| | | | - A Fontoura
- Cornell University,Ithica, NY, United States
| | - M Bauer
- North Dakota State University,Fargo, ND, United States
| | - K Swanson
- North Dakota State University,Fargo, ND, United States
| | - L Reynolds
- North Dakota State University,Fargo, ND, United States
| | - G Stokka
- North Dakota State University,Fargo, ND, United States
| | - A Ward
- North Dakota State University,Fargo, ND, United States
| | - C Dahlen
- North Dakota State University,Fargo, ND, United States
| | - B Neville
- Carrington REC, Foster County, ND, United States
| | | | - E McGeough
- University of Manitoba, Winnipeg, MB, Canada
| | - K Vonnahme
- North Dakota State University,Fargo, ND, United States
| | - A Schaefer
- University of Alberta,Lacombe, AB, Canada
| | - Ó López-Campos
- Agriculture and Agri-Food Canada, Lacombe Research and Development Centre,Lacombe, AB, Canada
| | - J Aalhus
- Agriculture and Agri-Food Canada, Lacombe Research and Development Centre,Lacombe, AB, Canada
| | - P Gardiner
- University of Manitoba, Winnipeg, MB, Canada
| | - K Ominski
- University of Manitoba, Winnipeg, MB, Canada
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43
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Nelson M, Ward A, Swanson K, Vonnahme K, Berg E. PSII-2 Effects of Replacing Supplemental Sucrose with Beef on Maternal Health and Fetal Growth and Development Using a Sow Biomedical Model. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Nelson
- North Dakota State University,Fargo, ND, United States
| | - A Ward
- North Dakota State University,Fargo, ND, United States
| | - K Swanson
- North Dakota State University,Fargo, ND, United States
| | - K Vonnahme
- North Dakota State University,Fargo, ND, United States
| | - E Berg
- North Dakota State University,Fargo, ND, United States
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44
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Crouse M, Caton J, Cushman R, Greseth N, McLean K, Reynolds L, Dahlen C, Borowicz P, Ward A. 139 Wettemann Graduate Scholar in Physiology: Maternal nutrition alters concentrations of nutrients in fetal fluids and expression of genes impacting production efficiencies in bovine fetal liver, muscle, and cerebrum during the first 50. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Crouse
- North Dakota State University,Fargo, ND, United States
| | - J Caton
- North Dakota State University,Fargo, ND, United States
| | - R Cushman
- USDA/ARS/US MARC, Clay Center, NE, United States
| | - N Greseth
- University of Wisconsin Madison,Madison, WI, United States
| | - K McLean
- University of Kentucky,Louisville, KY, United States
| | - L Reynolds
- North Dakota State University,Fargo, ND, United States
| | - C Dahlen
- North Dakota State University,Fargo, ND, United States
| | - P Borowicz
- North Dakota State University,Fargo, ND, United States
| | - A Ward
- North Dakota State University,Fargo, ND, United States
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45
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Vishnoi V, Liebenberg P, Reid F, Ward A, Draganic B. A primary germ cell tumour in the gastrointestinal tract: a caecal lesion of yolk-sac morphology in a young patient. J Surg Case Rep 2018; 2018:rjy291. [PMID: 30397438 PMCID: PMC6210665 DOI: 10.1093/jscr/rjy291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/23/2018] [Accepted: 10/10/2018] [Indexed: 11/13/2022] Open
Abstract
A 24-year-old man with a history of Crohns disease, whilst undergoing surveillance colonoscopy was found to have an ulcerated caecal lesion. The histopathology from the mucosal biopsy was suggestive of a yolk sac tumour. After thorough re-examination, the patient had no radiological evidence of malignancy in his testes or retroperitoneum. His alpha-fetoprotein levels returned as 2145, whilst his carcinoembryonic antigen was negligible. The patient was therefore consented for and underwent a laparoscopic right hemi-colectomy with an ileocolic anastomosis, without any complications. The formal histopathology confirmed the results from the biopsy, of a yolk sac non seminous germ cell tumour with positive lymph nodes and lymphovascular invasion. The patient was referred on to medical oncology for neoadjuvant chemotherapy. As the literature in his instance is scarce, the patient's overall prognosis remains unclear. To the best of our knowledge this is the first reported primary germ cell tumour of the gastrointestinal tract.
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Affiliation(s)
- V Vishnoi
- Department of Surgery, John Hunter Hospital, New Lambton Road, New Lambton Heights, Australia
| | - P Liebenberg
- Department of Surgery, John Hunter Hospital, New Lambton Road, New Lambton Heights, Australia
| | - F Reid
- Department of Surgery, John Hunter Hospital, New Lambton Road, New Lambton Heights, Australia
| | - A Ward
- Department of Pathology, John Hunter Hospital, New Lambton Heights, Australia
| | - B Draganic
- Department of Surgery, John Hunter Hospital, New Lambton Road, New Lambton Heights, Australia
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46
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Todnem N, Ward A, Nahhas M, Vender JR, Alleyne CH, Rahimi SY. A Retrospective Cohort Analysis of Hemorrhagic Arteriovenous Malformations Treated with Combined Endovascular Embolization and Gamma Knife Stereotactic Radiosurgery. World Neurosurg 2018; 122:e713-e722. [PMID: 30394359 DOI: 10.1016/j.wneu.2018.10.125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 08/01/2018] [Revised: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The management of brain arteriovenous malformations (AVMs) remains a controversial topic. Given the relatively low incidence, high heterogeneity, and high morbidity and mortality of these lesions, consensus on treatment strategies is an issue of concern to organized neurosurgery. The present retrospective analysis examined and quantified the outcomes of patients with an initial presentation of intracranial hemorrhage from a Spetzler-Martin grade III or IV AVM, later ruled out as surgical candidates. METHODS A total of 16 patients (5 females; 11 males) had presented with symptomatic hemorrhage confirmed by non-contrast-enhanced computed tomography and were deemed to not be surgical candidates owing to AVM location and/or architecture. The patients underwent combined endovascular embolization and gamma knife stereotactic radiosurgery (SRS). The modified Rankin scale was used to measure the clinical outcomes, comparing the scores at presentation, gamma knife treatment, and the last known follow-up examination. A radiographic evaluation was used to determine the level of AVM nidus involution after the procedure. RESULTS The present study identified 16 patients with ruptured high-grade AVMs of high surgical risk. All the patients had undergone immediate embolization with delayed SRS for treatment of the hemorrhage and nidus of the AVM. A statistically significant proportion of patients showed marked improvement in the modified Rankin scale scores. No subsequent repeat hemorrhage or any associated complications after embolization occurred in any patient. CONCLUSION These findings warrant consideration of endovascular embolization with adjuvant SRS as a powerful treatment option for cases with high surgical morbidity due to AVM characteristics.
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Affiliation(s)
- Nathan Todnem
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Ayobami Ward
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Michael Nahhas
- Department of Neurology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - John R Vender
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | | | - Scott Y Rahimi
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA.
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47
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Palma D, Louie A, Malthaner R, Fortin D, Rodrigues G, Yaremko B, Laba J, Kwan K, Gaede S, Lee T, Ward A, Warner A, Inculet R. OA06.06 MISSILE-NSCLC: A Phase II Trial Measuring the Integration of Stereotactic Radiotherapy Plus Surgery in Early-Stage Non-Small Cell Lung Cancer. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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Todnem N, Ward A, Segar S, Rojiani AM, Rahimi SY. Clinically Silent Adrenocorticotropic Hormone-Positive Crooke Cell Adenoma: Case Report and Review of Literature. World Neurosurg 2018; 119:197-200. [PMID: 30077745 DOI: 10.1016/j.wneu.2018.07.233] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Pituitary adenomas are one of the most common tumors of adulthood; however, subtypes such as Crooke cell adenoma are relatively rare. CASE DESCRIPTION We present the case of a 55-year-old woman who presented with new-onset intermittent headache and dizziness. Clinical and laboratory investigations were not suggestive of corticotroph tumor. However, subsequent computed tomography and magnetic resonance imaging scans revealed the presence of a suprasellar pituitary adenoma displacing the optic chiasma superiorly, with hemorrhage and sellar expansion. The lesion was removed by transsphenoidal surgery and the biopsy confirmed the lesion to be a nonfunctioning pituitary macroadenoma. Further investigation revealed that the specimen demonstrated Crooke hyaline changes, with strong immunoreactivity for adrenocorticotropic hormone. However, initial workup and postoperative testing lacked evidence of Cushing disease. There was no sign of recurrence after 1-year follow-up. CONCLUSIONS Clinically silent Crooke cell adenomas are rare occurrences, and as such we report this case with investigation of past cases.
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Affiliation(s)
- Nathan Todnem
- Department of Neurosurgery, The Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Ayobami Ward
- Department of Neurosurgery, The Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Sharmila Segar
- Department of Neurosurgery, The Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Amyn M Rojiani
- Department of Pathology, The Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Scott Y Rahimi
- Department of Neurosurgery, The Medical College of Georgia at Augusta University, Augusta, Georgia, USA.
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49
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Lemons B, Khaing H, Ward A, Thakur P. A rapid method for the sequential separation of polonium, plutonium, americium and uranium in drinking water. Appl Radiat Isot 2018; 136:10-17. [PMID: 29448060 DOI: 10.1016/j.apradiso.2018.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/10/2017] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
Abstract
A new sequential separation method for the determination of polonium and actinides (Pu, Am and U) in drinking water samples has been developed that can be used for emergency response or routine water analyses. For the first time, the application of TEVA chromatography column in the sequential separation of polonium and plutonium has been studied. This method utilizes a rapid Fe+3 co-precipitation step to remove matrix interferences, followed by plutonium oxidation state adjustment to Pu4+ and an incubation period of ~ 1 h at 50-60 °C to allow Po2+ to oxidize to Po4+. The polonium and plutonium were then separated on a TEVA column, while separation of americium from uranium was performed on a TRU column. After separation, polonium was micro-precipitated with copper sulfide (CuS), while actinides were micro co-precipitated using neodymium fluoride (NdF3) for counting by the alpha spectrometry. The method is simple, robust and can be performed quickly with excellent removal of interferences, high chemical recovery and very good alpha peak resolution. The efficiency and reliability of the procedures were tested by using spiked samples. The effect of several transition metals (Cu2+, Pb2+, Fe3+, Fe2+, and Ni2+) on the performance of this method were also assessed to evaluate the potential matrix effects. Studies indicate that presence of up to 25 mg of these cations in the samples had no adverse effect on the recovery or the resolution of polonium alpha peaks.
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Affiliation(s)
- B Lemons
- Carlsbad Environmental Monitoring & Research Center, 1400 University Drive, Carlsbad, NM 88220, United States
| | - H Khaing
- Carlsbad Environmental Monitoring & Research Center, 1400 University Drive, Carlsbad, NM 88220, United States
| | - A Ward
- US Department of Energy, Carlsbad Field Office, 4021 National Parks Highway, Carlsbad, NM 88220, United States
| | - P Thakur
- Carlsbad Environmental Monitoring & Research Center, 1400 University Drive, Carlsbad, NM 88220, United States.
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50
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Braun M, Khan ZT, Khan MB, Kumar M, Ward A, Achyut BR, Arbab AS, Hess DC, Hoda MN, Baban B, Dhandapani KM, Vaibhav K. Selective activation of cannabinoid receptor-2 reduces neuroinflammation after traumatic brain injury via alternative macrophage polarization. Brain Behav Immun 2018; 68:224-237. [PMID: 29079445 PMCID: PMC5767553 DOI: 10.1016/j.bbi.2017.10.021] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 10/14/2017] [Accepted: 10/23/2017] [Indexed: 02/07/2023] Open
Abstract
Inflammation is an important mediator of secondary neurological injury after traumatic brain injury (TBI). Endocannabinoids, endogenously produced arachidonate based lipids, have recently emerged as powerful anti-inflammatory compounds, yet the molecular and cellular mechanisms underlying these effects are poorly defined. Endocannabinoids are physiological ligands for two known cannabinoid receptors, CB1R and CB2R. In the present study, we hypothesized that selective activation of CB2R attenuates neuroinflammation and reduces neurovascular injury after TBI. Using a murine controlled cortical impact (CCI) model of TBI, we observed a dramatic upregulation of CB2R within infiltrating myeloid cells beginning at 72 h. Administration of the selective CB2R agonist, GP1a (1-5 mg/kg), attenuated pro-inflammatory M1 macrophage polarization, increased anti-inflammatory M2 polarization, reduced edema development, enhanced cerebral blood flow, and improved neurobehavioral outcomes after TBI. In contrast, the CB2R antagonist, AM630, worsened outcomes. Taken together, our findings support the development of selective CB2R agonists as a therapeutic strategy to improve TBI outcomes while avoiding the psychoactive effects of CB1R activation.
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Affiliation(s)
- Molly Braun
- Department of Neurosurgery, Medical College of Georgia, Augusta University
| | - Zenab T. Khan
- Department of Neurosurgery, Medical College of Georgia, Augusta University,Center for Nursing Research, Augusta University
| | - Mohammad B. Khan
- Department of Neurology, Medical College of Georgia, Augusta University
| | - Manish Kumar
- European Molecular Biology Laboratory (EMBL), Monterontondo, Italy
| | - Ayobami Ward
- Department of Neurosurgery, Medical College of Georgia, Augusta University
| | | | | | - David C. Hess
- Department of Neurology, Medical College of Georgia, Augusta University
| | - Md. Nasrul Hoda
- Department of Neurology, Medical College of Georgia, Augusta University,Department of Medical Laboratory, Imaging, and Radiological Sciences, College of Allied Health Sciences, Augusta University
| | - Babak Baban
- Department of Neurology, Medical College of Georgia, Augusta University,Department of Oral Biology, Dental College of Georgia, Augusta University,Department of Surgery, Medical College of Georgia, Augusta University
| | | | - Kumar Vaibhav
- Department of Neurosurgery, Medical College of Georgia, Augusta University, United States; Department of Medical Laboratory, Imaging, and Radiological Sciences, College of Allied Health Sciences, Augusta University, United States.
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