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Charlton E, Atkins KJ, Evered L, Silbert B, Scott DA. The long-term incidence of chronic post-surgical pain after coronary artery bypass surgery - A prospective observational study. Eur J Pain 2024; 28:599-607. [PMID: 37969009 DOI: 10.1002/ejp.2203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/17/2023] [Accepted: 11/03/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Chronic post-surgical pain (CPSP) represents a significant issue for many patients following surgery; however, the long-term incidence and impact have not been well described following cardiac surgery. Our aim was to characterize CPSP at least 5 years following coronary artery bypass grafting (CABG) surgery. METHODS This prospective observational study investigated a cohort of patients from a larger trial investigating cognitive outcomes following CABG surgery, with 89 of 148 eligible patients (60.1%) assessed for CPSP at a mean (standard deviation [SD]) of 6.8 [1.2] years. Questionnaires interrogated pain presence, intensity, location, neuropathic characteristics, Geriatric Depression Scale scores (GDS) and instrumental activities of daily living (IADL). RESULTS CPSP was described in 21/89 (23.6%), with 10 rating it as moderate to severe. Six of the CPSP patients (29%) met criteria for neuropathic pain (6.7% overall). The highest rate of CPSP was associated with the leg surgical site (chest 12/89 [13.5%], arm 8/68 [11.8%] and leg (saphenous vein graft-SVG) 11/37 [29.7%]; χ2 = 6.523, p = 0.038). IADL scores were significantly lower for patients with CPSP (mean [SD]: 36.7 [1.6] vs. no CPSP 40.6 [0.6]; p = 0.006). Patients had GDS scores consistent with moderate depression (GDS >8) in 3/21 (14.3%) with CPSP, versus 3/68 (4.4%) non-CPSP patients (χ2 = 3.20, p = 0.073). CONCLUSIONS This study identified a CPSP incidence of 23.6% at a mean of 6.8 years after CABG surgery, with the highest pain proportion at SVG harvest sites. CPSP was associated with neuropathic pain symptoms and had a significant impact on IADLs. This emphasizes the need for long-term follow-up of CABG patients. SIGNIFICANCE This study highlights the impact of CPSP 7 years following cardiac surgery and highlights the effect of surgical site, neuropathic pain and the importance of including pain assessment and management in the long-term follow-up of cardiac surgical patients. Strategies to address and prevent chronic pain following cardiac surgery should be further explored.
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Affiliation(s)
- E Charlton
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - K J Atkins
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - L Evered
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - B Silbert
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - D A Scott
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
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2
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Scott DA, Phan TD. Can lessons be learned from reviewing peri-operative cardiac arrests? Anaesthesia 2024; 79:3-6. [PMID: 37975192 DOI: 10.1111/anae.16180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 11/19/2023]
Affiliation(s)
- D A Scott
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - T D Phan
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
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3
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Shrimpton AJ, Brown JM, Gregson FKA, Cook TM, Scott DA, McGain F, Humphries RS, Dhillon RS, Reid JP, Hamilton F, Bzdek BR, Pickering AE. Quantitative evaluation of aerosol generation during manual facemask ventilation. Anaesthesia 2022; 77:22-27. [PMID: 34700360 PMCID: PMC8653000 DOI: 10.1111/anae.15599] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 01/13/2023]
Abstract
Manual facemask ventilation, a core component of elective and emergency airway management, is classified as an aerosol-generating procedure. This designation is based on one epidemiological study suggesting an association between facemask ventilation and transmission during the SARS-CoV-1 outbreak in 2003. There is no direct evidence to indicate whether facemask ventilation is a high-risk procedure for aerosol generation. We conducted aerosol monitoring during routine facemask ventilation and facemask ventilation with an intentionally generated leak in anaesthetised patients. Recordings were made in ultraclean operating theatres and compared against the aerosol generated by tidal breathing and cough manoeuvres. Respiratory aerosol from tidal breathing in 11 patients was reliably detected above the very low background particle concentrations with median [IQR (range)] particle counts of 191 (77-486 [4-1313]) and 2 (1-5 [0-13]) particles.l-1 , respectively, p = 0.002. The median (IQR [range]) aerosol concentration detected during facemask ventilation without a leak (3 (0-9 [0-43]) particles.l-1 ) and with an intentional leak (11 (7-26 [1-62]) particles.l-1 ) was 64-fold (p = 0.001) and 17-fold (p = 0.002) lower than that of tidal breathing, respectively. Median (IQR [range]) peak particle concentration during facemask ventilation both without a leak (60 (0-60 [0-120]) particles.l-1 ) and with a leak (120 (60-180 [60-480]) particles.l-1 ) were 20-fold (p = 0.002) and 10-fold (0.001) lower than a cough (1260 (800-3242 [100-3682]) particles.l-1 ), respectively. This study demonstrates that facemask ventilation, even when performed with an intentional leak, does not generate high levels of bioaerosol. On the basis of this evidence, we argue facemask ventilation should not be considered an aerosol-generating procedure.
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Affiliation(s)
- A. J. Shrimpton
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
| | - J. M. Brown
- Department of Anaesthesia and Intensive Care MedicineNorth Bristol NHS TrustBristolUK
| | | | - T. M. Cook
- Department of Anaesthesia and Intensive Care MedicineRoyal United Hospital NHS TrustBathUK
| | - D. A. Scott
- Department of Critical CareUniversity of Melbourne; St. Vincent's Hospital MelbourneAustralia
| | - F. McGain
- Western HealthFootscrayVictoriaAustralia
| | - R. S. Humphries
- Climate Science CentreCSIRO Oceans and AtmosphereAspendaleVictoriaAustralia
| | - R. S. Dhillon
- Department of NeurosurgerySt Vincent's Hospital MelbourneFitzroyVictoriaAustralia
| | - J. P. Reid
- School of ChemistryUniversity of BristolBristolUK
| | - F. Hamilton
- Department of Population Health SciencesUniversity of BristolBristolUK
| | - B. R. Bzdek
- School of ChemistryUniversity of BristolBristolUK
| | - A. E. Pickering
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
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Dhillon RS, Humphries RS, Scott DA. On the differences between studies of aerosolisation during tracheal intubation and extubation. Anaesthesia 2021; 76 Suppl 3:20-22. [PMID: 33406272 DOI: 10.1111/anae.15371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2020] [Indexed: 02/04/2023]
Affiliation(s)
- R S Dhillon
- St Vincent's Hospital Melbourne, Fitzroy, Australia
| | | | - D A Scott
- St Vincent's Hospital Melbourne, Fitzroy, Australia
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5
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Scott DA, Humphries RS, Dhillon RS. Confirming estimates of aerosol clearance time. Anaesthesia 2020; 76 Suppl 3:22-23. [PMID: 33368167 DOI: 10.1111/anae.15347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 11/28/2022]
Affiliation(s)
- D A Scott
- St Vincent's Hospital Melbourne, Victoria, Australia
| | - R S Humphries
- Climate Science Centre, CSIRO Oceans and Atmosphere, Victoria, Australia
| | - R S Dhillon
- St Vincent's Hospital Melbourne, Victoria, Australia
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6
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Dhillon RS, Rowin WA, Humphries RS, Kevin K, Ward JD, Phan TD, Nguyen LV, Wynne DD, Scott DA. Aerosolisation during tracheal intubation and extubation in an operating theatre setting. Anaesthesia 2020; 76:182-188. [PMID: 33047327 PMCID: PMC7675280 DOI: 10.1111/anae.15301] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 01/25/2023]
Abstract
Aerosol‐generating procedures such as tracheal intubation and extubation pose a potential risk to healthcare workers because of the possibility of airborne transmission of infection. Detailed characterisation of aerosol quantities, particle size and generating activities has been undertaken in a number of simulations but not in actual clinical practice. The aim of this study was to determine whether the processes of facemask ventilation, tracheal intubation and extubation generate aerosols in clinical practice, and to characterise any aerosols produced. In this observational study, patients scheduled to undergo elective endonasal pituitary surgery without symptoms of COVID‐19 were recruited. Airway management including tracheal intubation and extubation was performed in a standard positive pressure operating room with aerosols detected using laser‐based particle image velocimetry to detect larger particles, and spectrometry with continuous air sampling to detect smaller particles. A total of 482,960 data points were assessed for complete procedures in three patients. Facemask ventilation, tracheal tube insertion and cuff inflation generated small particles 30–300 times above background noise that remained suspended in airflows and spread from the patient’s facial region throughout the confines of the operating theatre. Safe clinical practice of these procedures should reflect these particle profiles. This adds to data that inform decisions regarding the appropriate precautions to take in a real‐world setting.
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Affiliation(s)
- R S Dhillon
- Department of Neurosurgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - W A Rowin
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - R S Humphries
- Climate Science Centre, CSIRO Oceans and Atmosphere, Aspendale, Victoria, Australia
| | - K Kevin
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - J D Ward
- Climate Science Centre, CSIRO Oceans and Atmosphere, Aspendale, Victoria, Australia
| | - T D Phan
- University of Melbourne and Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - L V Nguyen
- Department of Neurosurgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - D D Wynne
- Department of Neurosurgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - D A Scott
- University of Melbourne and Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
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7
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Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, Oh ES, Crosby G, Berger M, Eckenhoff RG. Recommendations for the Nomenclature of Cognitive Change Associated with Anaesthesia and Surgery-20181. J Alzheimers Dis 2019; 66:1-10. [PMID: 30347621 DOI: 10.3233/jad-189004] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cognitive change affecting patients after anaesthesia and surgery has been recognised for more than 100 yr. Research into cognitive change after anaesthesia and surgery accelerated in the 1980s when multiple studies utilised detailed neuropsychological testing for assessment of cognitive change after cardiac surgery. This body of work consistently documented decline in cognitive function in elderly patients after anaesthesia and surgery, and cognitive changes have been identified up to 7.5 yr afterwards. Importantly, other studies have identified that the incidence of cognitive change is similar after non-cardiac surgery. Other than the inclusion of non-surgical control groups to calculate postoperative cognitive dysfunction, research into these cognitive changes in the perioperative period has been undertaken in isolation from cognitive studies in the general population. The aim of this work is to develop similar terminology to that used in cognitive classifications of the general population for use in investigations of cognitive changes after anaesthesia and surgery. A multispecialty working group followed a modified Delphi procedure with no prespecified number of rounds comprised of three face-to-face meetings followed by online editing of draft versions.Two major classification guidelines [Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5) and National Institute for Aging and the Alzheimer Association (NIA-AA)] are used outside of anaesthesia and surgery, and may be useful for inclusion of biomarkers in research. For clinical purposes, it is recommended to use the DSM-5 nomenclature. The working group recommends that 'perioperative neurocognitive disorders' be used as an overarching term for cognitive impairment identified in the preoperative or postoperative period. This includes cognitive decline diagnosed before operation (described as neurocognitive disorder); any form of acute event (postoperative delirium) and cognitive decline diagnosed up to 30 days after the procedure (delayed neurocognitive recovery) and up to 12 months (postoperative neurocognitive disorder).
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Affiliation(s)
- L Evered
- St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia.,University of Melbourne, Fitzroy, VIC, Australia
| | - B Silbert
- St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia.,University of Melbourne, Fitzroy, VIC, Australia
| | - D S Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - D A Scott
- St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia.,University of Melbourne, Fitzroy, VIC, Australia
| | - S T DeKosky
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - L S Rasmussen
- Department of Anaesthesia, Center of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - E S Oh
- Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - G Crosby
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - M Berger
- Neurologic Outcomes Research Group, Anesthesiology Department, Duke University Medical Center, Durham, NC, USA
| | - R G Eckenhoff
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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8
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Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, Oh ES, Crosby G, Berger M, Eckenhoff RG. Recommendations for the Nomenclature of Cognitive Change Associated With Anaesthesia and Surgery-2018. Anesth Analg 2019; 127:1189-1195. [PMID: 30325748 DOI: 10.1213/ane.0000000000003634] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cognitive change affecting patients after anaesthesia and surgery has been recognised for more than 100 yr. Research into cognitive change after anaesthesia and surgery accelerated in the 1980s when multiple studies utilised detailed neuropsychological testing for assessment of cognitive change after cardiac surgery. This body of work consistently documented decline in cognitive function in elderly patients after anaesthesia and surgery, and cognitive changes have been identified up to 7.5 yr afterwards. Importantly, other studies have identified that the incidence of cognitive change is similar after non-cardiac surgery. Other than the inclusion of non-surgical control groups to calculate postoperative cognitive dysfunction, research into these cognitive changes in the perioperative period has been undertaken in isolation from cognitive studies in the general population. The aim of this work is to develop similar terminology to that used in cognitive classifications of the general population for use in investigations of cognitive changes after anaesthesia and surgery. A multispecialty working group followed a modified Delphi procedure with no prespecified number of rounds comprised of three face-to-face meetings followed by online editing of draft versions.Two major classification guidelines [Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5) and National Institute for Aging and the Alzheimer Association (NIA-AA)] are used outside of anaesthesia and surgery, and may be useful for inclusion of biomarkers in research. For clinical purposes, it is recommended to use the DSM-5 nomenclature. The working group recommends that 'perioperative neurocognitive disorders' be used as an overarching term for cognitive impairment identified in the preoperative or postoperative period. This includes cognitive decline diagnosed before operation (described as neurocognitive disorder); any form of acute event (postoperative delirium) and cognitive decline diagnosed up to 30 days after the procedure (delayed neurocognitive recovery) and up to 12 months (postoperative neurocognitive disorder).
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Affiliation(s)
- L Evered
- St Vincent's Hospital, Melbourne, Fitzroy, Victoria, Australia.,University of Melbourne, Fitzroy, Victoria, Australia
| | - B Silbert
- St Vincent's Hospital, Melbourne, Fitzroy, Victoria, Australia.,University of Melbourne, Fitzroy, Victoria, Australia
| | - D S Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - D A Scott
- St Vincent's Hospital, Melbourne, Fitzroy, Victoria, Australia.,University of Melbourne, Fitzroy, Victoria, Australia
| | - S T DeKosky
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - L S Rasmussen
- Department of Anaesthesia, Center of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - E S Oh
- Division of Geriatric Medicine and Gerontology, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - G Crosby
- Harvard Medical School, Brigham & Women's Hospital, Boston, MA, USA
| | - M Berger
- Neurologic Outcomes Research Group, Anesthesiology Department, Duke University Medical Center, Durham, NC, USA
| | - R G Eckenhoff
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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9
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Affiliation(s)
- D. A. Scott
- Department of Anaesthesia and Acute Pain MedicineSt. Vincent's Hospital Melbourne Vic. Australia
- University of Melbourne Vic Australia
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10
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Konishi Y, Evered LA, Scott DA, Silbert BS. Postoperative cognitive dysfunction after sevoflurane or propofol general anaesthesia in combination with spinal anaesthesia for hip arthroplasty. Anaesth Intensive Care 2019; 46:596-600. [PMID: 30447669 DOI: 10.1177/0310057x1804600610] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It is unknown if the type of general anaesthetic used for maintenance of anaesthesia affects the incidence of postoperative cognitive dysfunction (POCD). The aim of this study was to compare the incidence of POCD in patients administered either sevoflurane or propofol for maintenance of anaesthesia during total hip replacement surgery. Following administration of a spinal anaesthetic, patients received either sevoflurane (n=121) or propofol (n=171) at the discretion of the anaesthetist for maintenance of general anaesthesia to maintain the processed electroencephalogram (bispectral index, BIS) under 60. POCD was assessed postoperatively at day 7, three months, and 12 months using a neurocognitive test battery. There was no statistically significant difference between the incidence of POCD at any timepoint with sevoflurane compared to propofol. The mean BIS was significantly lower in the sevoflurane group than in the propofol group (mean BIS 44.3 [standard deviation, SD 7.5] in the sevoflurane group versus 53.7 [SD 8.1] in the propofol group, <i>P</i>=0.0001). However, there was no statistically significant association between intraoperative BIS level and the incidence of POCD at any timepoint. Our results suggest that the incidence of POCD is not strongly influenced by the type of anaesthesia used in elderly patients.
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Affiliation(s)
- Y Konishi
- Fellow, Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Victoria; Teikyo University School of Medicine, Tokyo, Japan
| | - L A Evered
- Associate Professor, Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital; Perioperative and Pain Medicine Unit, Melbourne Medical School, University of Melbourne; Melbourne, Victoria
| | - D A Scott
- Professor, Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital; Perioperative and Pain Medicine Unit, Melbourne Medical School, University of Melbourne, Melbourne, Victoria
| | - B S Silbert
- Associate Professor, Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital; Perioperative and Pain Medicine Unit, Melbourne Medical School, University of Melbourne, Melbourne, Victoria
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Abstract
Free flap microvascular surgery involves the transfer of a mobilised tissue flap with complete vascular reanastomosis at the new site. Ischaemia frequently threatens flap survival and may require a return to the operating theatre for anastomotic revision. Arterial spasm and hypoperfusion are recognised as factors in flap ischaemia. Phosphodiesterase inhibitors such as milrinone may improve flap blood flow and possibly flap survival by arterial dilation and increasing cardiac output. To investigate the role of milrinone in this type of surgery, a double-blinded randomised controlled trial was conducted with 88 patients receiving either a milrinone bolus and infusion throughout surgery or placebo (normal saline). We found that milrinone did not improve graft survival, return to theatre rate, or surgically graded arterial spasm, but did require more vasopressor support. We conclude that intraoperative milrinone did not improve flap outcomes in microvascular surgery.
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Affiliation(s)
- S. J. Jones
- Departments of Anaesthesia and Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Anaesthesia
| | - D. A. Scott
- Departments of Anaesthesia and Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Anaesthesia
| | - R. Watson
- Departments of Anaesthesia and Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Anaesthesia
| | - W. A. Morrison
- Departments of Anaesthesia and Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
- Bernard O'Brien Institute of Microsurgery and Director, St Vincent's Hospital Department of Plastic Surgery
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12
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Affiliation(s)
- D. A. Scott
- Department of Anaesthesia and Acute Pain Medicine; St. Vincent's Hospital Melbourne; University of Melbourne; Vic. Australia
| | - L. A. Evered
- Department of Anaesthesia and Acute Pain Medicine; St. Vincent's Hospital Melbourne; University of Melbourne; Vic. Australia
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13
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Abstract
A persistent neurological deficit, such as paraplegia or paraparesis, secondary to spinal cord injury remains one of the most feared complications of surgery on the descending thoracic or abdominal aorta. This is despite sophisticated advances in imaging and the use of less invasive endovascular procedures. Extensive fenestrated endovascular aortic graft prostheses still carry a risk of spinal cord injury of up to 10%; thus, this risk should be identified and strategies implemented to protect the spinal cord and maintain perfusion. The patients at highest risk are those undergoing extensive thoracic aortic stenting including thoracic, abdominal, and pelvic vessels. Although many techniques are available, lumbar cerebrospinal fluid drainage remains the most frequent intervention, along with maintenance of perfusion pressure and possibly staged procedures to allow collateral vessel stabilization. Many questions remain regarding other technical aspects, spinal cord monitoring and cooling, pharmacological protection, and the optimal duration of interventions into the postoperative period.
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Affiliation(s)
- D A Scott
- University of Melbourne, Parkville, VIC 3052, Australia Department of Anaesthesia and Acute Pain Medicine
| | - M J Denton
- University of Melbourne, Parkville, VIC 3052, Australia Vascular Surgical Unit, St Vincent's Hospital Melbourne, PO Box 2900, Fitzroy, VIC 3065, Australia
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14
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Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, Oh ES, Crosby G, Berger M, Eckenhoff RG. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Br J Anaesth 2018; 121:1005-1012. [PMID: 30336844 DOI: 10.1016/j.bja.2017.11.087] [Citation(s) in RCA: 376] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 09/12/2017] [Accepted: 10/02/2017] [Indexed: 12/11/2022] Open
Abstract
Cognitive change affecting patients after anaesthesia and surgery has been recognised for more than 100 yr. Research into cognitive change after anaesthesia and surgery accelerated in the 1980s when multiple studies utilised detailed neuropsychological testing for assessment of cognitive change after cardiac surgery. This body of work consistently documented decline in cognitive function in elderly patients after anaesthesia and surgery, and cognitive changes have been identified up to 7.5 yr afterwards. Importantly, other studies have identified that the incidence of cognitive change is similar after non-cardiac surgery. Other than the inclusion of non-surgical control groups to calculate postoperative cognitive dysfunction, research into these cognitive changes in the perioperative period has been undertaken in isolation from cognitive studies in the general population. The aim of this work is to develop similar terminology to that used in cognitive classifications of the general population for use in investigations of cognitive changes after anaesthesia and surgery. A multispecialty working group followed a modified Delphi procedure with no prespecified number of rounds comprised of three face-to-face meetings followed by online editing of draft versions. Two major classification guidelines [Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5) and National Institute for Aging and the Alzheimer Association (NIA-AA)] are used outside of anaesthesia and surgery, and may be useful for inclusion of biomarkers in research. For clinical purposes, it is recommended to use the DSM-5 nomenclature. The working group recommends that 'perioperative neurocognitive disorders' be used as an overarching term for cognitive impairment identified in the preoperative or postoperative period. This includes cognitive decline diagnosed before operation (described as neurocognitive disorder); any form of acute event (postoperative delirium) and cognitive decline diagnosed up to 30 days after the procedure (delayed neurocognitive recovery) and up to 12 months (postoperative neurocognitive disorder).
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Affiliation(s)
- L Evered
- St Vincent's Hospital, Melbourne, Fitzroy, Victoria, Australia; University of Melbourne, Fitzroy, Victoria, Australia.
| | - B Silbert
- St Vincent's Hospital, Melbourne, Fitzroy, Victoria, Australia; University of Melbourne, Fitzroy, Victoria, Australia
| | - D S Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - D A Scott
- St Vincent's Hospital, Melbourne, Fitzroy, Victoria, Australia; University of Melbourne, Fitzroy, Victoria, Australia
| | - S T DeKosky
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - L S Rasmussen
- Department of Anaesthesia, Center of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - E S Oh
- Division of Geriatric Medicine and Gerontology, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - G Crosby
- Harvard Medical School, Brigham & Women's Hospital, Boston, MA, USA
| | - M Berger
- Neurologic Outcomes Research Group, Anesthesiology Department, Duke University Medical Center, Durham, NC, USA
| | - R G Eckenhoff
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Cavanna F, Depalo R, Aliotta M, Anders M, Bemmerer D, Best A, Boeltzig A, Broggini C, Bruno CG, Caciolli A, Corvisiero P, Davinson T, di Leva A, Elekes Z, Ferraro F, Formicola A, Fülöp Z, Gervino G, Guglielmetti A, Gustavino C, Gyürky G, Imbriani G, Junker M, Menegazzo R, Mossa V, Pantaleo FR, Prati P, Scott DA, Somorjai E, Straniero O, Strieder F, Szücs T, Takács MP, Trezzi D. Erratum: Three New Low-Energy Resonances in the ^{22}Ne(p,γ)^{23}Na Reaction [Phys. Rev. Lett. 115, 252501 (2015)]. Phys Rev Lett 2018; 120:239901. [PMID: 29932705 DOI: 10.1103/physrevlett.120.239901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Indexed: 06/08/2023]
Abstract
This corrects the article DOI: 10.1103/PhysRevLett.115.252501.
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Ironfield CM, Scott DA. Potential for inadvertent airway delivery of carbon dioxide with humidified high flow oxygen circuit. Anaesth Intensive Care 2017; 45:631. [PMID: 28911294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Affiliation(s)
- D. A. Scott
- Department of Anaesthesia and Acute Pain Medicine; St. Vincent's Hospital Melbourne and The University of Melbourne; Melbourne Australia
| | - R. McDougall
- Department of Anaesthesia and Pain Management; Melbourne Australia
- The University of Melbourne; Melbourne Australia
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Scott DA, Angel P, Xu H, Drake R, Yeh E. Abstract P6-07-30: Identifying novel glycosylation markers in Her2+ breast cancer using MALDI mass spectrometry. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-07-30] [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]
Abstract
Abstract
Breast cancer characterized by human epidermal growth factor receptor 2 (HER2) overexpression represents approximately 25-30% of all breast cancer cases. Many patients acquire resistance to current chemotherapies, leading to a more aggressive disease state with severe clinical outcomes. Lapatinib, a first generation tyrosine kinase inhibitor of HER2 and EGFR (epidermal growth factor receptor), is commonly used to treat HER2+ breast cancer. Resistance to lapatinib is steadily increasing among HER2+ patients, highlighting the need for therapy development. Identifying markers that predict treatment response or potential drug targets could enhance treatment efficacy and patient survival. To investigate this, we have used MALDI mass spectrometry to identify N-linked glycans specific to human breast cancer cell lines with known resistance and sensitivity to lapatinib treatment, JIMT-1 (resistant) HER2+ and BT474 (sensitive) HER2+. After different lapatinib dose and time course experiments, N-linked glycans were isolated and comparatively profiled by high resolution MALDI mass spectrometry. Differences in the levels of fucosylation and sialylation of glycans from sensitive and resistant cell lines, before and after treatment, were evaluated. In addition, mouse xenograft tumor tissues derived from the same cell lines treated with and without lapatinib were processed for on-tissue imaging of N-glycans using a MALDI imaging mass spectrometry approach. Tissues from HER2+ human breast tumors were also imaged with the same MALDI imaging approach. Cumulatively, these preliminary studies have identified novel glycosylation patterns associated with lapatinib treatment sensitivity and resistance.
Citation Format: Scott DA, Angel P, Xu H, Drake R, Yeh E. Identifying novel glycosylation markers in Her2+ breast cancer using MALDI mass spectrometry [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-07-30.
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Affiliation(s)
- DA Scott
- Medical University of South Carolina, Charleston, SC
| | - P Angel
- Medical University of South Carolina, Charleston, SC
| | - H Xu
- Medical University of South Carolina, Charleston, SC
| | - R Drake
- Medical University of South Carolina, Charleston, SC
| | - E Yeh
- Medical University of South Carolina, Charleston, SC
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Goulas T, Garcia-Ferrer I, Hutcherson JA, Potempa BA, Potempa J, Scott DA, Gomis-Rüth FX. Structure of RagB, a major immunodominant outer-membrane surface receptor antigen of Porphyromonas gingivalis. Mol Oral Microbiol 2016; 31:472-485. [PMID: 26441291 PMCID: PMC4823178 DOI: 10.1111/omi.12140] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 12/14/2022]
Abstract
Porphyromonas gingivalis is the main causative agent of periodontitis. It deregulates the inflammatory and innate host immune responses through virulence factors, which include the immunodominant outer-membrane surface receptor antigens A (PgRagA) and B (PgRagB), co-transcribed from the rag pathogenicity island. The former is predicted to be a Ton-dependent porin-type translocator but the targets of this translocation and the molecular function of PgRagB are unknown. Phenomenologically, PgRagB has been linked with epithelial cell invasion and virulence according to murine models. It also acts as a Toll-like receptor agonist and promotes multiple mediators of inflammation. Hence, PgRagB is a candidate for the development of a periodontitis vaccine, which would be facilitated by the knowledge of its atomic structure. Here, we crystallized and solved the structure of 54-kDa PgRagB, which revealed a single domain centered on a curved helical scaffold. It consists of four tetratrico peptide repeats (TPR1-4), each arranged as two helices connected by a linker, plus two extra downstream capping helices. The concave surface bears four large intertwined irregular inserts (A-D), which contribute to an overall compact moiety. Overall, PgRagB shows substantial structural similarity with Bacteroides thetaiotaomicron SusD and Tannerella forsythia NanU, which are, respectively, engaged in binding and uptake of malto-oligosaccharide/starch and sialic acid. This suggests a similar sugar-binding function for PgRagB for uptake by the cognate PgRagA translocator, and, consistently, three potential monosaccharide-binding sites were tentatively assigned on the molecular surface.
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Affiliation(s)
- T Goulas
- Proteolysis Laboratory, Department of Structural Biology ('María de Maeztu' Unit of Excellence), Molecular Biology Institute of Barcelona, CSIC, Barcelona, Spain
| | - I Garcia-Ferrer
- Proteolysis Laboratory, Department of Structural Biology ('María de Maeztu' Unit of Excellence), Molecular Biology Institute of Barcelona, CSIC, Barcelona, Spain
| | - J A Hutcherson
- Department of Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, USA
| | - B A Potempa
- Department of Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, USA
| | - J Potempa
- Department of Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, USA
- Małopolska Center of Biotechnology and Department Laboratory of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland
| | - D A Scott
- Department of Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, USA
- Department of Microbiology and Immunology, University of Louisville School of Dentistry, Louisville, KY, USA
| | - F Xavier Gomis-Rüth
- Proteolysis Laboratory, Department of Structural Biology ('María de Maeztu' Unit of Excellence), Molecular Biology Institute of Barcelona, CSIC, Barcelona, Spain.
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Zak J, Vives V, Szumska D, Vernet A, Schneider JE, Miller P, Slee EA, Joss S, Lacassie Y, Chen E, Escobar LF, Tucker M, Aylsworth AS, Dubbs HA, Collins AT, Andrieux J, Dieux-Coeslier A, Haberlandt E, Kotzot D, Scott DA, Parker MJ, Zakaria Z, Choy YS, Wieczorek D, Innes AM, Jun KR, Zinner S, Prin F, Lygate CA, Pretorius P, Rosenfeld JA, Mohun TJ, Lu X. ASPP2 deficiency causes features of 1q41q42 microdeletion syndrome. Cell Death Differ 2016; 23:1973-1984. [PMID: 27447114 PMCID: PMC5136487 DOI: 10.1038/cdd.2016.76] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 11/09/2022] Open
Abstract
Chromosomal abnormalities are implicated in a substantial number of human developmental syndromes, but for many such disorders little is known about the causative genes. The recently described 1q41q42 microdeletion syndrome is characterized by characteristic dysmorphic features, intellectual disability and brain morphological abnormalities, but the precise genetic basis for these abnormalities remains unknown. Here, our detailed analysis of the genetic abnormalities of 1q41q42 microdeletion cases identified TP53BP2, which encodes apoptosis-stimulating protein of p53 2 (ASPP2), as a candidate gene for brain abnormalities. Consistent with this, Trp53bp2-deficient mice show dilation of lateral ventricles resembling the phenotype of 1q41q42 microdeletion patients. Trp53bp2 deficiency causes 100% neonatal lethality in the C57BL/6 background associated with a high incidence of neural tube defects and a range of developmental abnormalities such as congenital heart defects, coloboma, microphthalmia, urogenital and craniofacial abnormalities. Interestingly, abnormalities show a high degree of overlap with 1q41q42 microdeletion-associated abnormalities. These findings identify TP53BP2 as a strong candidate causative gene for central nervous system (CNS) defects in 1q41q42 microdeletion syndrome, and open new avenues for investigation of the mechanisms underlying CNS abnormalities.
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Affiliation(s)
- J Zak
- Ludwig Institute for Cancer Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX3 7DQ, UK
| | - V Vives
- Ludwig Institute for Cancer Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX3 7DQ, UK
| | - D Szumska
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 7BN, UK
| | - A Vernet
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 7BN, UK
| | - J E Schneider
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 7BN, UK
| | - P Miller
- Ludwig Institute for Cancer Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX3 7DQ, UK
| | - E A Slee
- Ludwig Institute for Cancer Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX3 7DQ, UK
| | - S Joss
- Queen Elizabeth University Hospital Glasgow, Glasgow G51 4TF, UK
| | - Y Lacassie
- Department of Pediatrics, Louisiana State University, New Orleans, LA 70118, USA
- Genetics Services, Children's Hospital New Orleans, New Orleans, LA 70118, USA
| | - E Chen
- Kaiser Permanente, San Francisco Medical Center, San Francisco, CA 94115, USA
| | - L F Escobar
- St Vincent Children's Hospital, Indianapolis, IN 46260, USA
| | - M Tucker
- St Vincent Children's Hospital, Indianapolis, IN 46260, USA
| | - A S Aylsworth
- Departments of Pediatrics and Genetics, University of North Carolina, Chapel Hill, NC 27599, USA
| | - H A Dubbs
- Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - A T Collins
- Seattle Children's Hospital, Seattle, WA 98105, USA
| | - J Andrieux
- Institute of Medical Genetics, Jeanne de Flandre Hospital, CHRU de Lille, Lille 59000, France
| | | | - E Haberlandt
- Clinical Department of Pediatrics, Innsbruck Medical University, Innsbruck A-6020, Austria
| | - D Kotzot
- Division of Human Genetics, Department of Medical Genetics, Molecular and Clinical Pharmacology, Innsbruck Medical University, Innsbruck A-6020, Austria
| | - D A Scott
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - M J Parker
- Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK
| | - Z Zakaria
- Institute for Medical Research, Kuala Lumpur, Jalan Pahang 50588, Malaysia
| | - Y S Choy
- Prince Court Medical Centre, Kuala Lumpur 50450, Malaysia
| | - D Wieczorek
- Institute of Human Genetics, University Clinic Essen, Duisburg-Essen University, Essen 45122, Germany
- Institute of Human Genetics, University Clinic, Heinrich-Heine University, Düsseldorf 40225, Germany
| | - A M Innes
- Department of Medical Genetics and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada T3B 6A8
| | - K R Jun
- Department of Laboratory Medicine, Haeundae Paik Hospital, Inje University, Haeundae-gu, Busan, Korea
| | - S Zinner
- Seattle Children's Hospital, Seattle, WA 98105, USA
| | - F Prin
- The Francis Crick Institute Mill Hill Laboratory, London NW7 1AA, UK
| | - C A Lygate
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 7BN, UK
| | - P Pretorius
- Department of Neuroradiology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK
| | - J A Rosenfeld
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - T J Mohun
- The Francis Crick Institute Mill Hill Laboratory, London NW7 1AA, UK
| | - X Lu
- Ludwig Institute for Cancer Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX3 7DQ, UK
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Bruno CG, Scott DA, Aliotta M, Formicola A, Best A, Boeltzig A, Bemmerer D, Broggini C, Caciolli A, Cavanna F, Ciani GF, Corvisiero P, Davinson T, Depalo R, Di Leva A, Elekes Z, Ferraro F, Fülöp Z, Gervino G, Guglielmetti A, Gustavino C, Gyürky G, Imbriani G, Junker M, Menegazzo R, Mossa V, Pantaleo FR, Piatti D, Prati P, Somorjai E, Straniero O, Strieder F, Szücs T, Takács MP, Trezzi D. Improved Direct Measurement of the 64.5 keV Resonance Strength in the ^{17}O(p,α)^{14}N Reaction at LUNA. Phys Rev Lett 2016; 117:142502. [PMID: 27740778 DOI: 10.1103/physrevlett.117.142502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Indexed: 06/06/2023]
Abstract
The ^{17}O(p,α)^{14}N reaction plays a key role in various astrophysical scenarios, from asymptotic giant branch stars to classical novae. It affects the synthesis of rare isotopes such as ^{17}O and ^{18}F, which can provide constraints on astrophysical models. A new direct determination of the E_{R}=64.5 keV resonance strength performed at the Laboratory for Underground Nuclear Astrophysics (LUNA) accelerator has led to the most accurate value to date ωγ=10.0±1.4_{stat}±0.7_{syst} neV, thanks to a significant background reduction underground and generally improved experimental conditions. The (bare) proton partial width of the corresponding state at E_{x}=5672 keV in ^{18}F is Γ_{p}=35±5_{stat}±3_{syst} neV. This width is about a factor of 2 higher than previously estimated, thus leading to a factor of 2 increase in the ^{17}O(p, α)^{14}N reaction rate at astrophysical temperatures relevant to shell hydrogen burning in red giant and asymptotic giant branch stars. The new rate implies lower ^{17}O/^{16}O ratios, with important implications on the interpretation of astrophysical observables from these stars.
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Affiliation(s)
- C G Bruno
- SUPA, School of Physics and Astronomy, University of Edinburgh, EH9 3FD Edinburgh, United Kingdom
| | - D A Scott
- SUPA, School of Physics and Astronomy, University of Edinburgh, EH9 3FD Edinburgh, United Kingdom
| | - M Aliotta
- SUPA, School of Physics and Astronomy, University of Edinburgh, EH9 3FD Edinburgh, United Kingdom
| | - A Formicola
- INFN, Laboratori Nazionali del Gran Sasso (LNGS), 67100 Assergi, Italy
| | - A Best
- Università di Napoli "Federico II" and INFN, Sezione di Napoli, 80126 Napoli, Italy
| | - A Boeltzig
- Gran Sasso Science Institute, INFN, Viale F. Crispi 7, 67100 L'Aquila, Italy
| | - D Bemmerer
- Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - C Broggini
- INFN, Sezione di Padova, Via F. Marzolo 8, 35131 Padova, Italy
| | - A Caciolli
- Università degli Studi di Padova and INFN, Sezione di Padova, Via F. Marzolo 8, 35131 Padova, Italy
| | - F Cavanna
- Università degli Studi di Genova and INFN, Sezione di Genova, Via Dodecaneso 33, 16146 Genova, Italy
| | - G F Ciani
- Gran Sasso Science Institute, INFN, Viale F. Crispi 7, 67100 L'Aquila, Italy
| | - P Corvisiero
- Università degli Studi di Genova and INFN, Sezione di Genova, Via Dodecaneso 33, 16146 Genova, Italy
| | - T Davinson
- SUPA, School of Physics and Astronomy, University of Edinburgh, EH9 3FD Edinburgh, United Kingdom
| | - R Depalo
- Università degli Studi di Padova and INFN, Sezione di Padova, Via F. Marzolo 8, 35131 Padova, Italy
| | - A Di Leva
- Università di Napoli "Federico II" and INFN, Sezione di Napoli, 80126 Napoli, Italy
| | - Z Elekes
- Institute for Nuclear Research (MTA ATOMKI), P.O. Box 51, HU-4001 Debrecen, Hungary
| | - F Ferraro
- Università degli Studi di Genova and INFN, Sezione di Genova, Via Dodecaneso 33, 16146 Genova, Italy
| | - Zs Fülöp
- Institute for Nuclear Research (MTA ATOMKI), P.O. Box 51, HU-4001 Debrecen, Hungary
| | - G Gervino
- Università degli Studi di Torino and INFN, Sezione di Torino, Via P. Giuria 1, 10125 Torino, Italy
| | - A Guglielmetti
- Università degli Studi di Milano and INFN, Sezione di Milano, Via G. Celoria 16, 20133 Milano, Italy
| | - C Gustavino
- INFN, Sezione di Roma La Sapienza, Piazzale A. Moro 2, 00185 Roma, Italy
| | - Gy Gyürky
- Institute for Nuclear Research (MTA ATOMKI), P.O. Box 51, HU-4001 Debrecen, Hungary
| | - G Imbriani
- Università di Napoli "Federico II" and INFN, Sezione di Napoli, 80126 Napoli, Italy
| | - M Junker
- INFN, Laboratori Nazionali del Gran Sasso (LNGS), 67100 Assergi, Italy
| | - R Menegazzo
- INFN, Sezione di Padova, Via F. Marzolo 8, 35131 Padova, Italy
| | - V Mossa
- Università degli Studi di Bari e INFN, Sezione di Bari, 70125 Bari, Italy
| | - F R Pantaleo
- Università degli Studi di Bari e INFN, Sezione di Bari, 70125 Bari, Italy
| | - D Piatti
- Università degli Studi di Padova and INFN, Sezione di Padova, Via F. Marzolo 8, 35131 Padova, Italy
| | - P Prati
- Università degli Studi di Genova and INFN, Sezione di Genova, Via Dodecaneso 33, 16146 Genova, Italy
| | - E Somorjai
- Institute for Nuclear Research (MTA ATOMKI), P.O. Box 51, HU-4001 Debrecen, Hungary
| | - O Straniero
- Osservatorio Astronomico di Collurania, Teramo, INFN, Sezione di Napoli, 80126 Napoli, Italy
| | - F Strieder
- South Dakota School of Mines, 501 E. Saint Joseph Street, South Dakota 57701, USA
| | - T Szücs
- Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - M P Takács
- Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - D Trezzi
- Università degli Studi di Milano and INFN, Sezione di Milano, Via G. Celoria 16, 20133 Milano, Italy
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Simsek Ozek N, Zeller I, Renaud DE, Gümüş P, Nizam N, Severcan F, Buduneli N, Scott DA. Differentiation of Chronic and Aggressive Periodontitis by FTIR Spectroscopy. J Dent Res 2016; 95:1472-1478. [PMID: 27608648 DOI: 10.1177/0022034516663696] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Without longitudinal clinical data, it is difficult to differentiate some cases of chronic periodontitis (CP) and aggressive periodontitis (AgP). Furthermore, both forms of disease are exacerbated by tobacco use. Therefore, this cross-sectional study was planned, primarily, to determine the ability of Fourier-transform infrared (FTIR) spectroscopy to distinguish CP and AgP patients by analysis of human saliva samples and, secondarily, to assess the potential confounding influence of smoking on discriminating disease-specific spectral signatures. FTIR spectra were collected from patients with a clinical diagnosis of CP (n = 18; 7 smokers) or AgP (n = 23; 9 smokers). Self-reported smoking status, which may be unreliable, was confirmed by salivary cotinine analysis. Spectral band area analysis and hierarchical cluster analyses were performed to clarify if the 2 periodontitis groups as well as smoker and nonsmoker patients could be differentiated from each other. Significant variations in lipid, amino acid, lactic acid, and nucleic acid content were found between nonsmoker CP and AgP groups. Although significantly lower lipid, phospholipid, protein, amino acid, lactic acid, and nucleic acid content was noted in the smoker AgP group compared with the nonsmoker AgP group, in the CP group, phospholipid, protein, amino acid, and lactic acid content was significantly lower for smokers compared with the nonsmokers. Based on these variations, nonsmoker CP and AgP patients were discriminated from each other with high sensitivity and specificity. Successful differentiation was also obtained for the smoker CP and AgP groups. Thiocyanate levels successfully differentiated smokers from nonsmokers, irrespective of periodontal status, with 100% accuracy. Differentiation of AgP and CP forms, concomitant with determination of smoking status, may allow the dental health professional to tailor treatment accordingly.
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Affiliation(s)
- N Simsek Ozek
- Department of Biological Sciences, Middle East Technical University, Ankara, Turkey.,Department of Biology, Atatürk University, Erzurum, Turkey
| | - I Zeller
- Oral Immunology and Infectious Diseases, University of Louisville, Louisville, KY, USA
| | - D E Renaud
- Oral Immunology and Infectious Diseases, University of Louisville, Louisville, KY, USA
| | - P Gümüş
- Department of Periodontology, School of Dentistry, Ege University, Bornova, İzmir, Turkey
| | - N Nizam
- Department of Periodontology, School of Dentistry, Ege University, Bornova, İzmir, Turkey
| | - F Severcan
- Department of Biological Sciences, Middle East Technical University, Ankara, Turkey
| | - N Buduneli
- Department of Periodontology, School of Dentistry, Ege University, Bornova, İzmir, Turkey
| | - D A Scott
- Oral Immunology and Infectious Diseases, University of Louisville, Louisville, KY, USA
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Ratnikov BI, Scott DA, Osterman AL, Smith JW, Ronai ZA. Metabolic rewiring in melanoma. Oncogene 2016; 36:147-157. [PMID: 27270434 PMCID: PMC5140782 DOI: 10.1038/onc.2016.198] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [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: 12/23/2015] [Revised: 04/07/2016] [Accepted: 04/07/2016] [Indexed: 02/07/2023]
Abstract
Oncogene-driven metabolic rewiring is an adaptation to low nutrient and oxygen conditions in the tumor microenvironment that enables cancer cells of diverse origin to hyperproliferate. Aerobic glycolysis and enhanced reliance on glutamine utilization are prime examples of such rewiring. However, tissue of origin as well as specific genetic and epigenetic changes determines gene expression profiles underlying these metabolic alterations in specific cancers. In melanoma, activation of the mitogen-activated protein kinase (MAPK) pathway driven by mutant BRAF or NRAS is a primary cause of malignant transformation. Activity of the MAPK pathway, as well as other factors, such as HIF1α, Myc and MITF, are among those that control the balance between non-oxidative and oxidative branches of central carbon metabolism. Here, we discuss the nature of metabolic alterations that underlie melanoma development and affect its response to therapy.
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Affiliation(s)
- B I Ratnikov
- Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla CA, USA
| | - D A Scott
- Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla CA, USA
| | - A L Osterman
- Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla CA, USA
| | - J W Smith
- Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla CA, USA
| | - Z A Ronai
- Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla CA, USA
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Cavanna F, Depalo R, Aliotta M, Anders M, Bemmerer D, Best A, Boeltzig A, Broggini C, Bruno CG, Caciolli A, Corvisiero P, Davinson T, di Leva A, Elekes Z, Ferraro F, Formicola A, Fülöp Z, Gervino G, Guglielmetti A, Gustavino C, Gyürky G, Imbriani G, Junker M, Menegazzo R, Mossa V, Pantaleo FR, Prati P, Scott DA, Somorjai E, Straniero O, Strieder F, Szücs T, Takács MP, Trezzi D. Three New Low-Energy Resonances in the ^{22}Ne(p,γ)^{23}Na Reaction. Phys Rev Lett 2015; 115:252501. [PMID: 26722918 DOI: 10.1103/physrevlett.115.252501] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Indexed: 06/05/2023]
Abstract
The ^{22}Ne(p,γ)^{23}Na reaction takes part in the neon-sodium cycle of hydrogen burning. This cycle affects the synthesis of the elements between ^{20}Ne and ^{27}Al in asymptotic giant branch stars and novae. The ^{22}Ne(p,γ)^{23}Na reaction rate is very uncertain because of a large number of unobserved resonances lying in the Gamow window. At proton energies below 400 keV, only upper limits exist in the literature for the resonance strengths. Previous reaction rate evaluations differ by large factors. In the present work, the first direct observations of the ^{22}Ne(p,γ)^{23}Na resonances at 156.2, 189.5, and 259.7 keV are reported. Their resonance strengths are derived with 2%-7% uncertainty. In addition, upper limits for three other resonances are greatly reduced. Data are taken using a windowless ^{22}Ne gas target and high-purity germanium detectors at the Laboratory for Underground Nuclear Astrophysics in the Gran Sasso laboratory of the National Institute for Nuclear Physics, Italy, taking advantage of the ultralow background observed deep underground. The new reaction rate is a factor of 20 higher than the recent evaluation at a temperature of 0.1 GK, relevant to nucleosynthesis in asymptotic giant branch stars.
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Affiliation(s)
- F Cavanna
- Università degli Studi di Genova and INFN, Sezione di Genova, Via Dodecaneso 33, 16146 Genova, Italy
| | - R Depalo
- Università degli Studi di Padova and INFN, Sezione di Padova, Via F. Marzolo 8, 35131 Padova, Italy
| | - M Aliotta
- SUPA, School of Physics and Astronomy, University of Edinburgh, EH9 3FD Edinburgh, United Kingdom
| | - M Anders
- Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstr. 400, 01328 Dresden, Germany
- Technische Universität Dresden, Institut für Kern- und Teilchenphysik, Zellescher Weg 19, 01069 Dresden, Germany
| | - D Bemmerer
- Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstr. 400, 01328 Dresden, Germany
| | - A Best
- Laboratori Nazionali del Gran Sasso (LNGS), 67100 Assergi (AQ), Italy
| | - A Boeltzig
- Gran Sasso Science Institute, 67100 LAquila, Italy
| | - C Broggini
- INFN, Sezione di Padova, Via F. Marzolo 8, 35131 Padova, Italy
| | - C G Bruno
- SUPA, School of Physics and Astronomy, University of Edinburgh, EH9 3FD Edinburgh, United Kingdom
| | - A Caciolli
- Università degli Studi di Padova and INFN, Sezione di Padova, Via F. Marzolo 8, 35131 Padova, Italy
| | - P Corvisiero
- Università degli Studi di Genova and INFN, Sezione di Genova, Via Dodecaneso 33, 16146 Genova, Italy
| | - T Davinson
- SUPA, School of Physics and Astronomy, University of Edinburgh, EH9 3JZ Edinburgh, United Kingdom
| | - A di Leva
- Università di Napoli Federico II and INFN, Sezione di Napoli, 80126 Napoli, Italy
| | - Z Elekes
- Institute for Nuclear Research (MTA ATOMKI), PO Box 51, HU-4001 Debrecen, Hungary
| | - F Ferraro
- Università degli Studi di Genova and INFN, Sezione di Genova, Via Dodecaneso 33, 16146 Genova, Italy
| | - A Formicola
- Laboratori Nazionali del Gran Sasso (LNGS), 67100 Assergi (AQ), Italy
| | - Zs Fülöp
- Institute for Nuclear Research (MTA ATOMKI), PO Box 51, HU-4001 Debrecen, Hungary
| | - G Gervino
- Università degli Studi di Torino and INFN, Sezione di Torino, Via P. Giuria 1, 10125 Torino, Italy
| | - A Guglielmetti
- Università degli Studi di Milano and INFN, Sezione di Milano, Via G. Celoria 16, 20133 Milano, Italy
| | - C Gustavino
- INFN, Sezione di Roma La Sapienza, Piazzale A. Moro 2, 00185 Roma, Italy
| | - Gy Gyürky
- Institute for Nuclear Research (MTA ATOMKI), PO Box 51, HU-4001 Debrecen, Hungary
| | - G Imbriani
- Università di Napoli Federico II and INFN, Sezione di Napoli, 80126 Napoli, Italy
| | - M Junker
- Laboratori Nazionali del Gran Sasso (LNGS), 67100 Assergi (AQ), Italy
| | - R Menegazzo
- INFN, Sezione di Padova, Via F. Marzolo 8, 35131 Padova, Italy
| | - V Mossa
- Università degli Studi di Bari and INFN, Sezione di Bari, 70125 Bari, Italy
| | - F R Pantaleo
- Università degli Studi di Bari and INFN, Sezione di Bari, 70125 Bari, Italy
| | - P Prati
- Università degli Studi di Genova and INFN, Sezione di Genova, Via Dodecaneso 33, 16146 Genova, Italy
| | - D A Scott
- SUPA, School of Physics and Astronomy, University of Edinburgh, EH9 3JZ Edinburgh, United Kingdom
| | - E Somorjai
- Institute for Nuclear Research (MTA ATOMKI), PO Box 51, HU-4001 Debrecen, Hungary
| | - O Straniero
- Osservatorio Astronomico di Collurania, Teramo, and INFN, Sezione di Napoli, Napoli, Italy
| | - F Strieder
- Institut für Experimentalphysik III, Ruhr-Universität Bochum, 44780 Bochum, Germany
| | - T Szücs
- Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstr. 400, 01328 Dresden, Germany
| | - M P Takács
- Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstr. 400, 01328 Dresden, Germany
- Technische Universität Dresden, Institut für Kern- und Teilchenphysik, Zellescher Weg 19, 01069 Dresden, Germany
| | - D Trezzi
- Università degli Studi di Milano and INFN, Sezione di Milano, Via G. Celoria 16, 20133 Milano, Italy
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Hutcherson JA, Gogeneni H, Yoder-Himes D, Hendrickson EL, Hackett M, Whiteley M, Lamont RJ, Scott DA. Comparison of inherently essential genes of Porphyromonas gingivalis identified in two transposon-sequencing libraries. Mol Oral Microbiol 2015; 31:354-64. [PMID: 26358096 DOI: 10.1111/omi.12135] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2015] [Indexed: 01/10/2023]
Abstract
Porphyromonas gingivalis is a Gram-negative anaerobe and keystone periodontal pathogen. A mariner transposon insertion mutant library has recently been used to define 463 genes as putatively essential for the in vitro growth of P. gingivalis ATCC 33277 in planktonic culture (Library 1). We have independently generated a transposon insertion mutant library (Library 2) for the same P. gingivalis strain and herein compare genes that are putatively essential for in vitro growth in complex media, as defined by both libraries. In all, 281 genes (61%) identified by Library 1 were common to Library 2. Many of these common genes are involved in fundamentally important metabolic pathways, notably pyrimidine cycling as well as lipopolysaccharide, peptidoglycan, pantothenate and coenzyme A biosynthesis, and nicotinate and nicotinamide metabolism. Also in common are genes encoding heat-shock protein homologues, sigma factors, enzymes with proteolytic activity, and the majority of sec-related protein export genes. In addition to facilitating a better understanding of critical physiological processes, transposon-sequencing technology has the potential to identify novel strategies for the control of P. gingivalis infections. Those genes defined as essential by two independently generated TnSeq mutant libraries are likely to represent particularly attractive therapeutic targets.
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Affiliation(s)
- J A Hutcherson
- Department of Microbiology and Immunology, University of Louisville, Louisville, KY, USA.,Department of Oral Immunology and Infectious Diseases, University of Louisville, Louisville, KY, USA
| | - H Gogeneni
- Department of Oral Immunology and Infectious Diseases, University of Louisville, Louisville, KY, USA
| | - D Yoder-Himes
- Department of Biology, University of Louisville, Louisville, KY, USA
| | - E L Hendrickson
- Center for Microbial Proteomics and Chemical Engineering, University of Washington, Seattle, WA, USA
| | - M Hackett
- Center for Microbial Proteomics and Chemical Engineering, University of Washington, Seattle, WA, USA
| | - M Whiteley
- Department of Molecular Biosciences, University of Texas at Austin, Austin, TX, USA
| | - R J Lamont
- Department of Oral Immunology and Infectious Diseases, University of Louisville, Louisville, KY, USA
| | - D A Scott
- Department of Oral Immunology and Infectious Diseases, University of Louisville, Louisville, KY, USA
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Thom H, Thompson JC, Scott DA, Halfpenny N, Sulham K, Corey GR. Comparative efficacy of antibiotics for the treatment of acute bacterial skin and skin structure infections (ABSSSI): a systematic review and network meta-analysis. Curr Med Res Opin 2015; 31:1539-51. [PMID: 26038985 DOI: 10.1185/03007995.2015.1058248] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective was to conduct a systematic review and network meta-analysis (NMA) of existing treatments for ABSSSI focusing on the novel lipoglycopeptide oritavancin. METHODS EMBASE, MEDLINE, MEDLINE in Process, CENTRAL (Cochrane), and select conferences were searched for randomized controlled trials investigating antimicrobial agents for the treatment of ABSSSI. NMA was used to estimate the odds ratios of the Test-Of-Cure (TOC) and Early Clinical Response (ECR) outcomes for treatments relative to vancomycin in the ITT populations. Sub-group analyses in MRSA and MSSA populations were conducted for TOC; sensitivity analyses investigated the use of the clinically evaluable (CE) populations and the restriction to trials following the recent FDA guidelines for clinical trials. RESULTS The systematic review identified 52 trials. The most commonly investigated treatments were vancomycin and linezolid; most trials reported TOC, but not ECR. The posterior mean and 95% credible intervals for odds ratios of TOC for antimicrobial agents relative to vancomycin were: linezolid (1.55; 0.91-2.57), daptomycin (2.18; 0.90-5.42), and oritavancin 1200 mg (1.06; 0.80-1.43). The odds ratio of ECR for oritavancin 1200 mg was 1.02 (0.23-4.33). In the MRSA sub-group the odds ratios relative to vancomycin for TOC were: linezolid (1.55; 0.96-2.46), daptomycin (0.74; 0.13-3.66), and oritavancin 1200 mg (0.94; 0.44-2.02). In the MSSA sub-group they were linezolid (1.36; 0.15-13.34) and oritavancin 1200 mg (0.82; 0.08-7.83). These results were robust to the sensitivity analyses. CONCLUSIONS This NMA provides a unified framework for the comparison of all available antimicrobial agents used in the treatment of ABSSSI and is the first to assess the ECR end-point. The results suggest equivalence of clinical efficacy between vancomycin, daptomycin, linezolid, and novel antimicrobial agents including oritavancin for the treatment of ABSSSI at TOC. The wide uncertainty margins indicate the heterogeneity of the available evidence and the need for further research.
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Affiliation(s)
- H Thom
- a a School of Social and Community Medicine, University of Bristol , Bristol , UK
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Scott DA, Slater R, Duffy M. Limitations of ultrasound-guided central venous cannulation. Anaesth Intensive Care 2015; 43:273-274. [PMID: 25735699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Hawkins N, Scott DA. Identifying Consistent Inconsistency in Network Meta-Analyses - An Illustration In Type 2 Diabetes. Value Health 2014; 17:A334. [PMID: 27200589 DOI: 10.1016/j.jval.2014.08.638] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Quigley JM, Thompson JC, Halfpenny N, Scott DA, Hawkins NS. Riding the E-Publication Wave. Value Health 2014; 17:A545. [PMID: 27201761 DOI: 10.1016/j.jval.2014.08.1763] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Hawkins N, Padhiar A, Thompson J, Scott DA, Eaton JN, Varol N, Norrbacka K, Boye KS, Nicolay C. Assessing Consistency in a Network Meta-Analysis to Compare Once Weekly Dulaglutide Versus Other Glp-1 Receptor Agonists in Patients with Type 2 Diabetes. Value Health 2014; 17:A335. [PMID: 27200592 DOI: 10.1016/j.jval.2014.08.641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- N Hawkins
- ICON Clinical Research UK Ltd., Oxford, UK
| | - A Padhiar
- ICON Clinical Research UK Ltd., Oxford, UK
| | - J Thompson
- ICON Clinical Research UK Ltd., Oxford, UK
| | - D A Scott
- ICON Clinical Research UK Ltd., Oxford, UK
| | - J N Eaton
- ICON Clinical Research UK Ltd., Oxford, UK
| | - N Varol
- Eli Lilly and Company, Windlesham, UK
| | | | - K S Boye
- Eli Lilly and Company, Indianapolis, IN, USA
| | - C Nicolay
- Eli Lilly and Company, Bad Homburg, Germany
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Anders M, Trezzi D, Menegazzo R, Aliotta M, Bellini A, Bemmerer D, Broggini C, Caciolli A, Corvisiero P, Costantini H, Davinson T, Elekes Z, Erhard M, Formicola A, Fülöp Z, Gervino G, Guglielmetti A, Gustavino C, Gyürky G, Junker M, Lemut A, Marta M, Mazzocchi C, Prati P, Rossi Alvarez C, Scott DA, Somorjai E, Straniero O, Szücs T. First direct measurement of the 2H(α,γ)6Li cross section at big bang energies and the primordial lithium problem. Phys Rev Lett 2014; 113:042501. [PMID: 25105610 DOI: 10.1103/physrevlett.113.042501] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Indexed: 06/03/2023]
Abstract
Recent observations of (6)Li in metal poor stars suggest a large production of this isotope during big bang nucleosynthesis (BBN). In standard BBN calculations, the (2)H(α,γ)(6)Li reaction dominates (6)Li production. This reaction has never been measured inside the BBN energy region because its cross section drops exponentially at low energy and because the electric dipole transition is strongly suppressed for the isoscalar particles (2)H and α at energies below the Coulomb barrier. Indirect measurements using the Coulomb dissociation of (6)Li only give upper limits owing to the dominance of nuclear breakup processes. Here, we report on the results of the first measurement of the (2)H(α,γ)(6)Li cross section at big bang energies. The experiment was performed deep underground at the LUNA 400 kV accelerator in Gran Sasso, Italy. The primordial (6)Li/(7)Li isotopic abundance ratio has been determined to be (1.5 ± 0.3) × 10(-5), from our experimental data and standard BBN theory. The much higher (6)Li/(7)Li values reported for halo stars will likely require a nonstandard physics explanation, as discussed in the literature.
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Affiliation(s)
- M Anders
- Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstrasse 400, 01328 Dresden, Germany and Technische Universität Dresden, Mommsenstrasse 9, 01069 Dresden, Germany
| | - D Trezzi
- Università degli Studi di Milano and INFN, Sezione di Milano, Via G. Celoria 16, 20133 Milano, Italy
| | - R Menegazzo
- INFN, Sezione di Padova, Via F. Marzolo 8, 35131 Padova, Italy
| | - M Aliotta
- SUPA, School of Physics and Astronomy, University of Edinburgh, EH9 3JZ Edinburgh, United Kingdom
| | - A Bellini
- Università degli Studi di Genova and INFN, Sezione di Genova, Via Dodecaneso 33, 16146 Genova, Italy
| | - D Bemmerer
- Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - C Broggini
- INFN, Sezione di Padova, Via F. Marzolo 8, 35131 Padova, Italy
| | - A Caciolli
- INFN, Sezione di Padova, Via F. Marzolo 8, 35131 Padova, Italy
| | - P Corvisiero
- Università degli Studi di Genova and INFN, Sezione di Genova, Via Dodecaneso 33, 16146 Genova, Italy
| | - H Costantini
- Università degli Studi di Genova and INFN, Sezione di Genova, Via Dodecaneso 33, 16146 Genova, Italy
| | - T Davinson
- SUPA, School of Physics and Astronomy, University of Edinburgh, EH9 3JZ Edinburgh, United Kingdom
| | - Z Elekes
- Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - M Erhard
- INFN, Sezione di Padova, Via F. Marzolo 8, 35131 Padova, Italy
| | - A Formicola
- Laboratori Nazionali del Gran Sasso (LNGS), Via G. Acitelli 22, 67100 Assergi, Italy
| | - Zs Fülöp
- Institute of Nuclear Research (MTA ATOMKI), PO Box 51, HU-4001 Debrecen, Hungary
| | - G Gervino
- Università degli Studi di Torino and INFN, Sezione di Torino, Via P. Giuria 1, 10125 Torino, Italy
| | - A Guglielmetti
- Università degli Studi di Milano and INFN, Sezione di Milano, Via G. Celoria 16, 20133 Milano, Italy
| | - C Gustavino
- INFN, Sezione di Roma "La Sapienza", Piazzale A. Moro 2, 00185 Roma, Italy
| | - Gy Gyürky
- Institute of Nuclear Research (MTA ATOMKI), PO Box 51, HU-4001 Debrecen, Hungary
| | - M Junker
- Laboratori Nazionali del Gran Sasso (LNGS), Via G. Acitelli 22, 67100 Assergi, Italy
| | - A Lemut
- Università degli Studi di Genova and INFN, Sezione di Genova, Via Dodecaneso 33, 16146 Genova, Italy
| | - M Marta
- Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - C Mazzocchi
- Università degli Studi di Milano and INFN, Sezione di Milano, Via G. Celoria 16, 20133 Milano, Italy
| | - P Prati
- Università degli Studi di Genova and INFN, Sezione di Genova, Via Dodecaneso 33, 16146 Genova, Italy
| | - C Rossi Alvarez
- INFN, Sezione di Padova, Via F. Marzolo 8, 35131 Padova, Italy
| | - D A Scott
- SUPA, School of Physics and Astronomy, University of Edinburgh, EH9 3JZ Edinburgh, United Kingdom
| | - E Somorjai
- Institute of Nuclear Research (MTA ATOMKI), PO Box 51, HU-4001 Debrecen, Hungary
| | - O Straniero
- Osservatorio Astronomico di Collurania, Via M. Maggini, 64100 Teramo, Italy and INFN, Sezione di Napoli, Via Cintia, 80126 Napoli, Italy
| | - T Szücs
- Institute of Nuclear Research (MTA ATOMKI), PO Box 51, HU-4001 Debrecen, Hungary
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Silbert BS, Evered LA, Scott DA, Rahardja S, Gerraty RP, Choong PF. Review of transcranial Doppler ultrasound to detect microemboli during orthopedic surgery. AJNR Am J Neuroradiol 2013; 35:1858-63. [PMID: 23969341 DOI: 10.3174/ajnr.a3688] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Transcranial Doppler ultrasonography has been used to detect microemboli in the middle cerebral artery during orthopedic surgery. We conducted a comprehensive systematic literature review of transcranial Doppler ultrasonography in orthopedic surgery to evaluate its status in this setting. Fourteen studies were selected for qualitative analysis. The highest number of patients studied was 45; emboli were detected in all studies, occurring in 20%-100% of patients. Most embolic counts were below 10, but some high counts were noted. No study reported all the technical parameters of the transcranial Doppler ultrasonography. All studies assessed neurologic status, and 6 studies evaluated cognitive function postoperatively. No study identified an association between postoperative cognitive function and embolic count. Six studies sought the presence of right-to-left shunts.
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Affiliation(s)
- B S Silbert
- From the Department of Anaesthesia (B.S.S., L.A.E., D.A.S., S.R.), Centre for Anaesthesia and Cognitive Function, St. Vincent's Hospital, Melbourne, Australia Department of Anaesthesia (B.S.S., L.A.E., D.A.S.), Perioperative and Pain Medicine Unit, Melbourne Medical School
| | - L A Evered
- From the Department of Anaesthesia (B.S.S., L.A.E., D.A.S., S.R.), Centre for Anaesthesia and Cognitive Function, St. Vincent's Hospital, Melbourne, Australia Department of Anaesthesia (B.S.S., L.A.E., D.A.S.), Perioperative and Pain Medicine Unit, Melbourne Medical School
| | - D A Scott
- From the Department of Anaesthesia (B.S.S., L.A.E., D.A.S., S.R.), Centre for Anaesthesia and Cognitive Function, St. Vincent's Hospital, Melbourne, Australia Department of Anaesthesia (B.S.S., L.A.E., D.A.S.), Perioperative and Pain Medicine Unit, Melbourne Medical School
| | - S Rahardja
- From the Department of Anaesthesia (B.S.S., L.A.E., D.A.S., S.R.), Centre for Anaesthesia and Cognitive Function, St. Vincent's Hospital, Melbourne, Australia
| | - R P Gerraty
- Epworth Healthcare (R.P.G.), Richmond, Victoria, Australia Department of Medicine (R.P.G.), Epworth HealthCare, Monash University, Melbourne, Australia
| | - P F Choong
- Department of Surgery (P.F.C.), University of Melbourne, Melbourne, Australia
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Abstract
Soluble CD44 isoforms have been reported as markers of specific malignancies and inflammatory diseases. However, recent reports suggest tobacco smoking may lead to an elevation in the circulating concentration of specific CD44 variants. We, therefore, investigated the effect of smoking status on circulating levels of total sCD44. Total soluble CD44 was measured by enzyme-linked immunosorbent assay in the serum of two age- and gender-matched groups consisting of smokers (n = 19) and non-smokers (n = 20). Smoking status was confirmed by analysis of serum cotinine. The concentration of total sCD44 was found to be significantly elevated in smokers compared with non-smokers (p = 0.025). The observation that total sCD44 concentration is raised in smokers may have relevance to the aetiology of smoking-associated diseases. The effect of smoking on sCD44 concentrations should be considered when assessing the role of sCD44 as a marker of inflammatory disease, cancer, or other disease processes.
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Affiliation(s)
- D A Scott
- Dental Clinical Research, Guy's, King's and St Thomas' Schools of Medicine, Dentistry and Biomedical Sciences, King's College London, Guy's Hospital, London, SE1 9RT, UK. e-mail:
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Brosens E, Eussen H, van Bever Y, van der Helm RM, Ijsselstijn H, Zaveri HP, Wijnen R, Scott DA, Tibboel D, de Klein A. VACTERL Association Etiology: The Impact of de novo and Rare Copy Number Variations. Mol Syndromol 2013; 4:20-6. [PMID: 23653573 DOI: 10.1159/000345577] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Copy number variations (CNVs), either DNA gains or losses, have been found at common regions throughout the human genome. Most CNVs neither have a pathogenic significance nor result in disease-related phenotypes but, instead, reflect the normal population variance. However, larger CNVs, which often arise de novo, are frequently associated with human disease. A genetic contribution has long been suspected in VACTERL (Vertebral, Anal, Cardiac, TracheoEsophageal fistula, Renal and Limb anomalies) association. The anomalies observed in this association overlap with several monogenetic conditions associated with mutations in specific genes, e.g. Townes Brocks (SALL1), Feingold syndrome (MYCN) or Fanconi anemia. So far VACTERL association has typically been considered a diagnosis of exclusion. Identifying recurrent or de novo genomic variations in individuals with VACTERL association could make it easier to distinguish VACTERL association from other syndromes and could provide insight into disease mechanisms. Sporadically, de novo CNVs associated with VACTERL are described in literature. In addition to this literature review of genomic variation in published VACTERL association patients, we describe CNVs present in 68 VACTERL association patients collected in our institution. De novo variations (>30 kb) are absent in our VACTERL association cohort. However, we identified recurrent rare CNVs which, although inherited, could point to mechanisms or biological processes contributing to this constellation of developmental defects.
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Affiliation(s)
- E Brosens
- Department of Clinical Genetics, Erasmus Medical Centre, The Netherlands ; Department of Pediatric Surgery, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
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Scott DA, Boye KS, Timlin L, Clark JF, Best JH. A network meta-analysis to compare glycaemic control in patients with type 2 diabetes treated with exenatide once weekly or liraglutide once daily in comparison with insulin glargine, exenatide twice daily or placebo. Diabetes Obes Metab 2013; 15:213-23. [PMID: 22958381 DOI: 10.1111/dom.12007] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 06/16/2012] [Accepted: 09/02/2012] [Indexed: 12/19/2022]
Abstract
AIMS The glucagon-like peptide-1 receptor agonists (GLP-1 RAs) exenatide once weekly (ExQW) and liraglutide once daily (QD) are indicated to improve glycaemic control in patients with type 2 diabetes. Although glycaemic control with ExQW versus liraglutide QD 1.8 mg has been directly compared, no studies have compared ExQW with liraglutide QD 1.2 mg or determined the probable relative efficacies of various injectable therapies for glycaemic control; therefore, a network meta-analysis was performed to address these questions. METHODS A systematic review identified randomized controlled trials of ≥24 weeks that compared ExQW, liraglutide QD (1.2 mg, 1.8 mg), insulin glargine, exenatide twice daily (ExBID), or placebo. Twenty-two studies evaluating 11 049 patients were included in the network meta-analysis. Mean differences in HbA1c relative to placebo or each other and probability rankings were estimated. RESULTS Estimated mean differences in HbA1c versus placebo were -1.15% (95% CrI: -1.31 to -1.00) for ExQW, -1.01% (95% CrI: -1.18 to -0.85) for liraglutide 1.2 mg, and -1.18% (95% CrI: -1.32 to -1.04) for liraglutide 1.8 mg. HbA1c differences for ExQW versus liraglutide 1.2 mg and 1.8 mg were -0.14% (95% CrI: -0.34 to 0.06) and 0.03% (95% CrI: -0.14 to 0.18), respectively. The estimated mean difference in HbA1c between liraglutide 1.2 mg and 1.8 mg was 0.17% (95% CrI: 0.02-0.30). Results were consistent when adjusted for background antihyperglycaemic medications and diabetes duration. CONCLUSIONS This network meta-analysis did not identify meaningful differences in HbA1c lowering between ExQW and both liraglutide doses, suggesting that these GLP-1 RAs have similar glycaemic effects.
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Scott DA, Caciolli A, Di Leva A, Formicola A, Aliotta M, Anders M, Bemmerer D, Broggini C, Campeggio M, Corvisiero P, Elekes Z, Fülöp Z, Gervino G, Guglielmetti A, Gustavino C, Gyürky G, Imbriani G, Junker M, Laubenstein M, Menegazzo R, Marta M, Napolitani E, Prati P, Rigato V, Roca V, Somorjai E, Salvo C, Straniero O, Strieder F, Szücs T, Terrasi F, Trezzi D. First direct measurement of the 17O(p,γ)18F reaction cross section at Gamow energies for classical novae. Phys Rev Lett 2012; 109:202501. [PMID: 23215474 DOI: 10.1103/physrevlett.109.202501] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Indexed: 06/01/2023]
Abstract
Classical novae are important contributors to the abundances of key isotopes, such as the radioactive (18)F, whose observation by satellite missions could provide constraints on nucleosynthesis models in novae. The (17)O(p,γ)(18)F reaction plays a critical role in the synthesis of both oxygen and fluorine isotopes, but its reaction rate is not well determined because of the lack of experimental data at energies relevant to novae explosions. In this study, the reaction cross section has been measured directly for the first time in a wide energy range E(c.m.)~/= 200-370 keV appropriate to hydrogen burning in classical novae. In addition, the E(c.m.)=183 keV resonance strength, ωγ=1.67±0.12 μeV, has been measured with the highest precision to date. The uncertainty on the (17)O(p,γ)(18)F reaction rate has been reduced by a factor of 4, thus leading to firmer constraints on accurate models of novae nucleosynthesis.
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Affiliation(s)
- D A Scott
- SUPA, School of Physics and Astronomy, University of Edinburgh, Edinburgh EH9 3JZ, United Kingdom
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Abstract
Despite the increasing use of a variety of different analgesic strategies, opioids continue as the mainstay for management of moderate to severe acute pain. However, concerns remain about their potential adverse effects on ventilation. The most commonly used term, respiratory depression, only describes part of that risk. Opioid-induced ventilatory impairment (OIVI) is a more complete term encompassing opioid-induced central respiratory depression (decreased respiratory drive), decreased level of consciousness (sedation) and upper airway obstruction, all of which, alone or in combination, may result in decreased alveolar ventilation and increased arterial carbon dioxide levels. Concerns about OIVI are warranted, as deaths related to opioid administration in the acute pain setting continue to be reported. Risks are often said to be higher in patients with obstructive sleep apnoea. However, the tendency to use the term ‘obstructive sleep apnoea’ to encompass the much broader spectrum of sleep- and obesity-related hypoventilation syndromes and the related misuse of terminology in papers relating to obstructive sleep apnoea and sleep-disordered breathing remain significant problems in discussions of opioid-related effects. Opioids given for management of acute pain must be titrated to effect for each patient. However, strategies aiming for better pain scores alone, without highlighting the need for appropriate monitoring of OIVI, can and will lead to an increase in adverse events. Therefore, all patients must be monitored appropriately for OIVI (at the very least using sedation scores as a ‘6th vital sign’) so that it can be detected at an early stage and appropriate interventions triggered.
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Affiliation(s)
- P. E. Macintyre
- Acute Pain Service, Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital and Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia; Sydney Medical School, University of Sydney and Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales; Department of Anaesthesia, St Vincent's Hospital and Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Acute Pain Service, Department of Anaesthesia, Royal Adelaide Hospital
| | - J. A. Loadsman
- Acute Pain Service, Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital and Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia; Sydney Medical School, University of Sydney and Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales; Department of Anaesthesia, St Vincent's Hospital and Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Department of Anaesthetics, Royal Prince Alfred Hospital
| | - D. A. Scott
- Acute Pain Service, Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital and Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia; Sydney Medical School, University of Sydney and Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales; Department of Anaesthesia, St Vincent's Hospital and Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Department of Anaesthesia, St Vincent's Hospital
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Baker PA, Flanagan BT, Greenland KB, Morris R, Owen H, Riley RH, Runciman WB, Scott DA, Segal R, Smithies WJ, Merry AF. Equipment to manage a difficult airway during anaesthesia. Anaesth Intensive Care 2011; 39:16-34. [PMID: 21375086 DOI: 10.1177/0310057x1103900104] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Airway complications are a leading cause of morbidity and mortality in anaesthesia. Effective management of a difficult airway requires the timely availability of suitable airway equipment. The Australian and New Zealand College of Anaesthetists has recently developed guidelines for the minimum set of equipment needed for the effective management of an unexpected difficult airway (TG4 [2010] www.anzca.edu.au/resources/professionaldocuments). TG4 [2010] is based on expert consensus, underpinned by wide consultation and an extensive review of the available evidence, which is summarised in a Background Paper (TG4 BP [2010] www.anzca.edu.au/ resources/professional-documents). TG4 [2010] will be reviewed at the end of one year and thereafter every five years or more frequently if necessary. The current paper is reproduced directly from the Background Paper (TG4 BP [2010]).
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Affiliation(s)
- P A Baker
- Australian and New Zealand College of Anaesthetists, Melbourne, Victoria, Australia
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39
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Schaaf CP, Scott DA, Wiszniewska J, Beaudet AL. Identification of incestuous parental relationships by SNP-based DNA microarrays. Lancet 2011. [PMID: 21315943 DOI: 10.1016/s0140-6736(11)60299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
We hypothesized that tobacco smoke induces alterations to the 3-OH fatty acids present in lipid A in a manner consistent with a microflora of reduced inflammatory potential. Whole saliva samples and full-mouth clinical periodontal recordings were obtained from persons with (22 smokers; 15 non-smokers) and without (14 smokers; 15 non-smokers) chronic periodontitis. Clear differences in the contributions of multiple saturated 3-OH fatty acid species were noted in the group with disease compared with healthy individuals. Increases in the long-chain fatty acids associated with anaerobic bacterial periodontopathogens, particularly 3-OH-C(i17.0) (146.7%, relative to controls), were apparent. Significant reductions in the 3-OH fatty acids associated with the consensus (high potency) enteric LPS structure (3-OH-C(12.0) and 3-OH-C(14.0); 33.3% and 15.8% reduction, respectively) were noted in smokers compared with non-smokers with chronic periodontitis. Thus, smoking is associated with specific structural alterations to the lipid-A-derived 3-OH fatty acid profile in saliva that are consistent with an oral microflora of reduced inflammatory potential. These findings provide much-needed mechanistic insight into the established clinical conundrum of increased infection with periodontal pathogens but reduced clinical inflammation in smokers.
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Affiliation(s)
- N Buduneli
- Department of Periodontology, School of Dentistry, Ege University, İzmir, Turkey
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Devapalasundarum AN, Silbert BS, Evered LA, Scott DA, MacIsaac AI, Maruff PT. Cognitive function in patients undergoing coronary angiography. Heart Asia 2010; 2:75-9. [PMID: 27325949 DOI: 10.1136/ha.2009.001230] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/27/2009] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To measure cognition in patients before and after coronary angiography. DESIGN Prospective observational cohort study. SETTING University teaching hospital. PATIENTS 56 patients presenting for elective coronary angiography. MAIN OUTCOME MEASURES Computerised cognitive test battery administered before coronary angiography, before discharge from hospital and 7 days after discharge. A matched healthy control group was used as a comparator. RESULTS When analysed by group, coronary angiography patients performed worse than matched controls at each time point. When the cognitive change was examined for each individual, of the 48 patients tested at discharge, 19 (39.6%) were classified as having a new cognitive dysfunction, and of 49 patients tested at day 7, six (12.2%) were classified as having a new cognitive dysfunction. CONCLUSIONS The results confirm that cognitive function is decreased in patients who have cardiovascular disease. Furthermore, coronary angiography may exacerbate this impaired cognition in some patients.
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Affiliation(s)
- A N Devapalasundarum
- Centre for Anaesthesia and Cognitive Function, Department of Anaesthesia, St Vincent's Hospital, Melbourne, Australia
| | - B S Silbert
- Centre for Anaesthesia and Cognitive Function, Department of Anaesthesia, St Vincent's Hospital, Melbourne, Australia; Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - L A Evered
- Centre for Anaesthesia and Cognitive Function, Department of Anaesthesia, St Vincent's Hospital, Melbourne, Australia
| | - D A Scott
- Centre for Anaesthesia and Cognitive Function, Department of Anaesthesia, St Vincent's Hospital, Melbourne, Australia; Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - A I MacIsaac
- Department of Cardiology, St Vincent's Hospital, Melbourne, Australia
| | - P T Maruff
- Centre for Neuroscience, University of Melbourne, Melbourne, Australia
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Clegg AJ, Loveman E, Gospodarevskaya E, Harris P, Bird A, Bryant J, Scott DA, Davidson P, Little P, Coppin R. The safety and effectiveness of different methods of earwax removal: a systematic review and economic evaluation. Health Technol Assess 2010; 14:1-192. [DOI: 10.3310/hta14280] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- AJ Clegg
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
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Abstract
BACKGROUND AND OBJECTIVE Periodontitis is currently diagnosed almost entirely on gross clinical manifestations that have been in situ for more than 50 years without significant improvement. The general objective of this study was, therefore, to evaluate whether mid-infrared spectroscopy can be used to identify disease-specific molecular alterations to the overall biochemical profile of tissues and body fluids. MATERIAL AND METHODS A total of 190 gingival crevicular fluid samples were obtained from periodontitis (n = 64), gingivitis (n = 61) and normal sites (n = 65). Corresponding infrared absorption spectra of gingival crevicular fluid samples were acquired and processed, and the relative contributions of key functional groups in the infrared spectra were analysed. The qualitative assessment of clinical relevance of these gingival crevicular fluid spectra was interpreted with the multivariate statistical analysis-linear discriminant analysis. RESULTS Using infrared spectroscopy, we have been able to identify four molecular signatures (representing vibrations in amide I, amide II/tyrosine rings and symmetric and asymmetric PO2- stretching vibrations of phosphodiester groups in DNA) in the gingival crevicular fluid of subjects with periodontitis or gingivitis and healthy control subjects that clearly demarcate healthy and diseased periodontal tissues. Furthermore, the diagnostic accuracy for distinction between periodontally healthy and periodontitis sites revealed by multivariate classification of gingival crevicular fluid spectra was 98.4% for a training set of samples and 93.1% for a validation set. CONCLUSION We have established that mid-infrared spectroscopy can be used to identify periodontitis-specific molecular signatures in gingival crevicular fluid and to confirm clinical diagnoses. Future longitudinal studies will assess whether mid-infrared spectroscopy represents a potential prognostic tool, recognized as key to advancement of periodontics.
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Affiliation(s)
- X M Xiang
- Institute for Biodiagnostics, National Research Council of Canada, Winnipeg, MB, Canada
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Scott DA, Merry AF. Development of an ‘Equipment to Manage a Difficult Airway during Anaesthesia’ Professional Document using a new evidence-based approach. Anaesth Intensive Care 2010; 38:11-2. [DOI: 10.1177/0310057x1003800102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- D. A. Scott
- Department of Anaesthesia, St Vincent's Hospital, Melbourne, Victoria and Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - A. F. Merry
- Department of Anaesthesia, St Vincent's Hospital, Melbourne, Victoria and Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
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Abstract
Recently publicized cases of child abuse and neglect ahve highlighted the complexity of interaction between professionals in the alcohol and drug field and those in the child welfare field. Despite exhortations to practitioners in both fields to see their clients from a "family-centred perspective", a range of psychological, ethical, conceptual, professional and organizational factors mean that this often remains an elusive goal. In this paper the obstacles to adopting a family-centred approach which cuts across different professions and fields of service are identified. These factors interact in complex ways and although workers feel the tensions, it is difficult for them to perceive the set of constraints as a whole from the vantage point of an actor in the process. By identifying and analysing these obstacles workers in both fields may be better able to collaborate in maximizing the opportunities which also exist for family-centred practice.
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Affiliation(s)
- D A Scott
- School of Social Work, University of Melbourne, Australia
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Abstract
BACKGROUND Pain after craniotomy is often under-treated. Opiates carry distinct disadvantages. Non-steroidal anti-inflammatory drugs have an anti-platelet action and carry a bleeding risk. Cyclo-oxygenase 2 inhibitors such as parecoxib are not associated with a bleeding risk and would be welcome analgesics if shown to be effective. METHODS In a prospective double-blind, randomized, placebo-controlled study, we investigated the analgesic effect of a single dose of parecoxib 40 mg given at dural closure in 82 patients undergoing elective craniotomies. Remifentanil was used intraoperatively, and i.v. morphine was titrated to the requirement in the post-anaesthetic unit. On the ward, i.m. morphine 5 mg as required and regular acetaminophen was prescribed. Morphine use and visual analogue pain scores were recorded at 1, 6, 12, and 24 h after surgery. RESULTS Parecoxib reduced pain scores at 6 h and morphine use at 6 and 12 h after operation. However, overall, it had only minimal impact on postoperative analgesia. We found a wide variability in analgesic requirements where 11% of patients required no opioids and 16% required more than 15 mg i.v. morphine 1 h after the surgery. CONCLUSIONS We found only limited evidence to support parecoxib as an analgesic after craniotomy.
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Affiliation(s)
- S J Jones
- Department of Anaesthesia, Vincent's Hospital, PO Box 2900, Fitzroy, Melbourne, VIC 3065, Australia.
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Liu KZ, Xiang XM, Man A, Sowa MG, Cholakis A, Ghiabi E, Singer DL, Scott DA. In vivo determination of multiple indices of periodontal inflammation by optical spectroscopy. J Periodontal Res 2008; 44:117-24. [PMID: 18973538 DOI: 10.1111/j.1600-0765.2008.01112.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVE Visible, near-infrared (optical) spectroscopy can be used to measure regional tissue hemodynamics and edema and therefore may represent an ideal tool with which to study periodontal inflammation in a noninvasive manner. The study objective was to evaluate the ability of optical spectroscopy to determine simultaneously multiple inflammatory indices (tissue oxygenation, total tissue hemoglobin, deoxyhemoglobin, oxygenated hemoglobin and tissue edema) in periodontal tissues in vivo. MATERIAL AND METHODS Spectra were obtained, processed and evaluated from healthy, gingivitis and periodontitis sites (n = 133) using a portable optical, near-infrared spectrometer. A modified Beer-Lambert unmixing model that incorporates a nonparametric scattering loss function was used to determine the relative contribution of each inflammatory component to the overall spectrum. RESULTS Optical spectroscopy was harnessed to generate complex inflammatory profiles of periodontal tissues. Tissue oxygenation at periodontitis sites was significantly decreased (p < 0.05) compared to sites with gingivitis and healthy controls. This was largely the result of an increase in deoxyhemoglobin in the periodontitis sites compared with healthy (p < 0.01) and gingivitis (p = 0.05) sites. Tissue water content per se showed no significant difference between the sites, but a water index associated with tissue electrolyte levels and temperature differed significantly between periodontitis sites and both healthy and gingivitis sites (p < 0.03). CONCLUSION This study established that optical spectroscopy can simultaneously determine multiple inflammatory indices directly in the periodontal tissues in vivo. Visible, near-infrared spectroscopy has the potential to be developed into a simple, reagent-free, user-friendly, chairside, site-specific, diagnostic and prognostic test for periodontitis.
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Affiliation(s)
- K Z Liu
- Institute for Biodiagnostics, National Research Council of Canada, Winnipeg, MB, Canada.
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Kravchenko VV, Kaufmann GF, Mathison JC, Scott DA, Katz AZ, Grauer DC, Lehmann M, Meijler MM, Janda KD, Ulevitch RJ. Modulation of Gene Expression via Disruption of NF- B Signaling by a Bacterial Small Molecule. Science 2008; 321:259-63. [DOI: 10.1126/science.1156499] [Citation(s) in RCA: 176] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Khaira N, Palmer RM, Wilson RF, Scott DA, Wade WG. Periodontal Disease: Production of volatile sulphur compounds in diseased periodontal pockets is significantly increased in smokers. Oral Dis 2008; 6:371-5. [PMID: 11355269 DOI: 10.1111/j.1601-0825.2000.tb00129.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study was undertaken in order to test the hypothesis that the consequences of tobacco smoking may include increased synthesis of toxic volatile sulphur compounds in diseased periodontal pockets. DESIGN A cross-sectional, parallel study comparing groups of smokers and non-smokers with periodontitis and the level of volatile sulphur compounds in the gingival sulci of these subjects. PATIENTS AND METHODS Levels of volatile sulphur compounds were measured in diseased periodontal sites of 12 smokers and 11 non-smokers using a portable sulphide monitor. Anaerobic and aerobic counts of the total cultivable subgingival microflora of both groups were also determined. RESULTS The percentage of sites per subject with high levels of sulphides (> or = 10 units) detected in moderate (4-6 mm) and deep (> or = 7 mm) periodontal pockets was found to be significantly higher in smokers, compared to non-smokers (P = 0.040 and P = 0.005, respectively). No significant difference in the microbiological parameters tested were observed between the two groups. CONCLUSIONS Increased production of volatile sulphur compounds may represent a further mechanism of increased susceptibility to periodontitis in smokers and also help to explain the reported association between smoking and halitosis.
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Affiliation(s)
- N Khaira
- Department of Periodontology and Preventive Dentistry, Guy's, King's and St Thomas' Dental Institute, King's College London, UK
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