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Lockhart M, Dinneen SF, O'Keeffe DT. Plantar pressure measurement in diabetic foot disease: A scoping review. J Diabetes Investig 2024. [PMID: 38634342 DOI: 10.1111/jdi.14215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
AIMS/INTRODUCTION Patients with a healed diabetic foot ulcer (DFU) have a 40% risk of ulcer recurrence within a year. New and effective measures to prevent DFU recurrence are essential. We aimed to highlight emerging trends and future research opportunities in the use of plantar pressure measurement to prevent DFU recurrence. MATERIALS AND METHODS Our scoping review protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis - Scoping Review protocol. Peer-reviewed, English-language papers were included that addressed both plantar pressure measurement and diabetic foot disease, either as primary studies that have advanced the field or as review papers that provide summaries and/or opinion on the field as a whole, as well as specific papers that provide guidelines for future research and advancement in the field. RESULTS A total of 24 eligible publications were identified in a literature search using PubMed. A further 36 eligible studies were included after searching the references sections of these publications, leaving a total of 60 publications included in this scoping review. CONCLUSIONS Plantar pressure measurement can and will play a major role in the prevention of DFU. There is already a strong, albeit limited, evidence base in place to prove its benefit in reducing DFU recurrence. More research is required in larger populations, using remote monitoring in real-world settings, and with improved technology.
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Affiliation(s)
- Michael Lockhart
- Center for Endocrinology, Diabetes and Metabolism, Galway University Hospitals, Galway, Ireland
- Health Innovation via Engineering (HIVE) Laboratory, Lambe Institute, University of Galway, Galway, Ireland
| | - Sean F Dinneen
- Center for Endocrinology, Diabetes and Metabolism, Galway University Hospitals, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Derek T O'Keeffe
- Center for Endocrinology, Diabetes and Metabolism, Galway University Hospitals, Galway, Ireland
- Health Innovation via Engineering (HIVE) Laboratory, Lambe Institute, University of Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
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Husain M, Simpkin A, Gibbons C, Talkar T, Low D, Bonato P, Ghosh SS, Quatieri T, O'Keeffe DT. Artificial Intelligence for Detecting COVID-19 With the Aid of Human Cough, Breathing and Speech Signals: Scoping Review. IEEE Open J Eng Med Biol 2022; 3:235-241. [PMID: 36819937 PMCID: PMC9933914 DOI: 10.1109/ojemb.2022.3143688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/30/2021] [Accepted: 12/26/2021] [Indexed: 09/01/2023] Open
Abstract
Goal: Official tests for COVID-19 are time consuming, costly, can produce high false negatives, use up vital chemicals and may violate social distancing laws. Therefore, a fast and reliable additional solution using recordings of cough, breathing and speech data for preliminary screening may help alleviate these issues. Objective: This scoping review explores how Artificial Intelligence (AI) technology aims to detect COVID-19 disease by using cough, breathing and speech recordings, as reported in the literature. Here, we describe and summarize attributes of the identified AI techniques and datasets used for their implementation. Methods: A scoping review was conducted following the guidelines of PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). Electronic databases (Google Scholar, Science Direct, and IEEE Xplore) were searched between 1st April 2020 and 15th August 2021. Terms were selected based on the target intervention (i.e., AI), the target disease (i.e., COVID-19) and acoustic correlates of the disease (i.e., speech, breathing and cough). A narrative approach was used to summarize the extracted data. Results: 24 studies and 8 Apps out of the 86 retrieved studies met the inclusion criteria. Half of the publications and Apps were from the USA. The most prominent AI architecture used was a convolutional neural network, followed by a recurrent neural network. AI models were mainly trained, tested and run-on websites and personal computers, rather than on phone apps. More than half of the included studies reported area-under-the-curve performance of greater than 0.90 on symptomatic and negative datasets while one study achieved 100% sensitivity in predicting asymptomatic COVID-19 from cough-, breathing- or speech-based acoustic features. Conclusions: The included studies show that AI has the potential to help detect COVID-19 using cough, breathing and speech samples. The proposed methods (with some time and appropriate clinical testing) could prove to be an effective method in detecting various diseases related to respiratory and neurophysiological changes in the human body.
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Affiliation(s)
- Mouzzam Husain
- Health Innovation Via Engineering (HIVE) Lab, Curam, Lero, School of MedicineLambe Institute for Translational ResearchNational University of Ireland GalwayH91 TK33GalwayIreland
| | - Andrew Simpkin
- School of Mathematics, Statistics and Applied MathematicsNational University of IrelandH91 TK33GalwayIreland
| | - Claire Gibbons
- Health Innovation Via Engineering (HIVE) Lab, Curam, Lero, School of MedicineLambe Institute for Translational ResearchNational University of Ireland GalwayH91 TK33GalwayIreland
| | - Tanya Talkar
- MIT Lincoln LaboratoryLexingtonMA02421USA
- Program in Speech and Hearing Bioscience and TechnologyHarvard Medical SchoolBostonMA02115USA
| | - Daniel Low
- Program in Speech and Hearing Bioscience and TechnologyHarvard Medical SchoolBostonMA02115USA
- MIT McGovern Institute for Brain Research, CambridgeMA02139USA
| | - Paolo Bonato
- Department of Physical Medicine and RehabilitationHarvard Medical School, Spaulding Rehabilitation HospitalBostonMAUSA
| | - Satrajit S. Ghosh
- Program in Speech and Hearing Bioscience and TechnologyHarvard Medical SchoolBostonMA02115USA
- MIT McGovern Institute for Brain Research, CambridgeMA02139USA
| | - Thomas Quatieri
- MIT Lincoln LaboratoryLexingtonMA02421USA
- Program in Speech and Hearing Bioscience and TechnologyHarvard Medical SchoolBostonMA02115USA
| | - Derek T. O'Keeffe
- Health Innovation Via Engineering (HIVE) Lab, Curam, Lero, School of MedicineLambe Institute for Translational ResearchNational University of Ireland GalwayH91 TK33GalwayIreland
- University Hospital Galway, Saolta, Health Services ExecutiveIreland
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O'Connell J, Nathan DM, O'Brien T, O'Keeffe DT. Treatment of Diabetes - To Pump or Not to Pump. N Engl J Med 2021; 385:2092-2095. [PMID: 34818486 DOI: 10.1056/nejmclde2112076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Affiliation(s)
- James O'Connell
- From the School of Medicine, College of Medicine Nursing and Health Sciences and the Health Innovation Via Engineering Laboratory, Cúram, Lambe Institute for Translational Research, National University of Ireland Galway (J.O., D.O.), and University Hospital Galway, Saolta, Health Services Executive (D.O.), Galway, and Lero, the Irish Software Research Centre, University of Limerick, Limerick (D.O.) - all in Ireland
| | - Derek T O'Keeffe
- From the School of Medicine, College of Medicine Nursing and Health Sciences and the Health Innovation Via Engineering Laboratory, Cúram, Lambe Institute for Translational Research, National University of Ireland Galway (J.O., D.O.), and University Hospital Galway, Saolta, Health Services Executive (D.O.), Galway, and Lero, the Irish Software Research Centre, University of Limerick, Limerick (D.O.) - all in Ireland
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5
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Dunbar JP, Vitkauskaite A, O'Keeffe DT, Fort A, Sulpice R, Dugon MM. Clinical evidence of necrosis following bites by the Noble false widow spider Steatoda nobilis - a response to Paolino & colleagues. Clin Toxicol (Phila) 2021; 60:276-277. [PMID: 34282717 DOI: 10.1080/15563650.2021.1955130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- John P Dunbar
- Venom Systems & Proteomics Lab, School of Natural Sciences, Ryan Institute, National University of Ireland Galway, Galway, Ireland
| | - Aiste Vitkauskaite
- Venom Systems & Proteomics Lab, School of Natural Sciences, Ryan Institute, National University of Ireland Galway, Galway, Ireland
| | - Derek T O'Keeffe
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Antoine Fort
- Plant Systems Biology Lab, School of Natural Sciences, Ryan Institute & MaREI Centre for Marine, Climate and Energy, National University of Ireland Galway, Galway, Ireland
| | - Ronan Sulpice
- Plant Systems Biology Lab, School of Natural Sciences, Ryan Institute & MaREI Centre for Marine, Climate and Energy, National University of Ireland Galway, Galway, Ireland
| | - Michel M Dugon
- Venom Systems & Proteomics Lab, School of Natural Sciences, Ryan Institute, National University of Ireland Galway, Galway, Ireland
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Dunbar JP, Vitkauskaite A, O'Keeffe DT, Fort A, Sulpice R, Dugon MM. Bites by the noble false widow spider Steatoda nobilis can induce Latrodectus-like symptoms and vector-borne bacterial infections with implications for public health: a case series. Clin Toxicol (Phila) 2021; 60:59-70. [PMID: 34039122 DOI: 10.1080/15563650.2021.1928165] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
CONTEXT In recent years, the Noble false widow spider Steatoda nobilis (Thorell, 1875) has expanded its range globally and may represent a potential threat to native ecosystems and public health. Increasing numbers in synanthropic habitats have led to more human encounters and envenomations. Steatoda nobilis bites were previously classed as medically significant with similarities to bites from true black widows of the genus Latrodectus but deemed milder in onset, with symptoms generally ranging from mild to moderate. CASE DETAILS In this manuscript we present 16 new cases of S. nobilis envenomations bringing the total number of confirmed cases reported in the literature to 24. We report new symptoms and provide discussion on the contributing factors to pathology following bites by S. nobilis. DISCUSSION We report a range of pathologies including necrosis, Latrodectus-like envenomation symptoms that include debilitating pain, tremors, fatigue, nausea, hypotension, and vectored bacterial infections including cellulitis and dermatitis. Symptoms ranged from mild to severe, requiring hospitalisation in some cases.
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Affiliation(s)
- John P Dunbar
- Venom Systems & Proteomics Lab, School of Natural Sciences, Ryan Institute, National University of Ireland Galway, Galway, Ireland
| | - Aiste Vitkauskaite
- Venom Systems & Proteomics Lab, School of Natural Sciences, Ryan Institute, National University of Ireland Galway, Galway, Ireland
| | - Derek T O'Keeffe
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Antoine Fort
- Plant Systems Biology Lab, School of Natural Sciences, Ryan Institute & MaREI Centre for Marine, Climate and Energy, National University of Ireland Galway, Galway, Ireland
| | - Ronan Sulpice
- Plant Systems Biology Lab, School of Natural Sciences, Ryan Institute & MaREI Centre for Marine, Climate and Energy, National University of Ireland Galway, Galway, Ireland
| | - Michel M Dugon
- Venom Systems & Proteomics Lab, School of Natural Sciences, Ryan Institute, National University of Ireland Galway, Galway, Ireland
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Toloza FJ, Theriot SE, Singh Ospina NM, Nooruddin S, Keathley B, Johnson SM, Payakachat N, Ambrogini E, Rodriguez-Gutierrez R, O'Keeffe DT, Brito JP, Montori VM, Dajani NK, Maraka S. Knowledge, Attitudes, Beliefs, and Treatment Burden Related to the Use of Levothyroxine in Hypothyroid Pregnant Women in the United States. Thyroid 2021; 31:669-677. [PMID: 33176609 PMCID: PMC8195877 DOI: 10.1089/thy.2020.0629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/15/2022]
Abstract
Background: The use of prescribed medications during pregnancy is a challenge and an underestimated source of treatment burden. Levothyroxine (LT4) for the treatment of overt and subclinical hypothyroidism is extensively prescribed during pregnancy. To this end, we aimed to explore the patients' perceived benefits and risks, knowledge, beliefs, attitudes, and related burden of LT4 therapy during pregnancy. Methods: In this cross-sectional study, we surveyed pregnant women who were treated with LT4 during pregnancy from January 1, 2019, to December 31, 2019, in a tertiary academic medical center of the United States. The anonymous online survey included questions to gather demographic data and multiple-choice questions regarding the benefits and risks, knowledge, beliefs, attitudes, and burden related to LT4 use during pregnancy. Results: Sixty-four pregnant women (mean age 31.5 years) completed the study survey (response rate: 96%): 62% were diagnosed with hypothyroidism more than 12 months before pregnancy, 16% less than or about 12 months before pregnancy, and 22% during pregnancy. We found that one-third of pregnant women using LT4 had a feeling of uneasiness/anxiety due to their hypothyroidism diagnosis. About half of the respondents (45%) reported that they did not receive an explanation by their clinician regarding the maternal/fetal risks of uncontrolled hypothyroidism or the benefits of adequate control. Finally, two in three patients expressed various concerns of LT4-related treatment burden. Conclusions: Our findings support the need for increased effective communication and tailored counseling to address fears, anxiety, and uncertainties about the benefits and risks of LT4 use in pregnancy. For patients with clear benefits from LT4 treatment in pregnancy, it could help to overcome their concerns, promote adherence, and decrease adverse maternal/fetal outcomes. For patients with no clear benefits established, clinicians need to be aware of LT4-related treatment burden in pregnancy and implement patient-centered approaches in their clinical practices.
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Affiliation(s)
- Freddy J.K. Toloza
- Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sarah E. Theriot
- Department of Obstetrics and Gynecology, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Naykky M. Singh Ospina
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Sameen Nooruddin
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Brooke Keathley
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Stacey M. Johnson
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Nalin Payakachat
- Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Elena Ambrogini
- Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Rene Rodriguez-Gutierrez
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Endocrinology, Department of Internal Medicine, University Hospital “Dr. Jose E. Gonzalez,” Autonomous University of Nuevo León, Monterrey, Mexico
- Plataforma INVEST Medicina UANL-KER Unit (KER Unit México), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Derek T. O'Keeffe
- Division of Endocrinology, Department of Medicine, National University of Ireland, Galway, Ireland
| | - Juan P. Brito
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Victor M. Montori
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nafisa K. Dajani
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Spyridoula Maraka
- Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
- Address correspondence to: Spyridoula Maraka, MD, MS, Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, 4301 W. Markham Street, #587, Little Rock, AR 72205, USA
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Abdalgwad R, Rafey MF, Foy S, Newell M, Davenport C, O'Keeffe DT, Finucane FM. Long-Term Changes in Weight in Patients With Severe and Complicated Obesity After Completion of a Milk-Based Meal Replacement Programme. Front Nutr 2020; 7:551068. [PMID: 33117840 PMCID: PMC7561396 DOI: 10.3389/fnut.2020.551068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 09/02/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction: Even with very significant short term weight loss with intensive dietary restriction, subsequent weight regain remains a challenge for most patients. We sought to assess long-term weight change in patients with obesity following completion of a 24-week milk-based meal replacement programme. Methods: We conducted a retrospective cohort study of bariatric patients who completed our milk-based meal replacement programme. This programme started with an 8-week weight loss phase, followed by weight stabilization (8 weeks) and weight maintenance (8 weeks) phases, after which patients were followed up in the bariatric outpatient clinics. A paired sample t-test was used to compare mean differences in weight at the start and the end of the programme and at follow-up. Linear regression was used to identify predictors of weight regain. Results: In total, 78 patients had long term follow-up data at a mean of 34.4 ± 19.8 months after the start of the milk diet and were included in this analysis. Mean body mass index at baseline was 50.5 ± 7.6 kg m-2, 41 (52.6%) were female and the mean age was 51.6 ± 12.0 (range 18.0-71.5) years. Weight decreased from144 ± 26 kg at the start of the milk diet to 121.2 ± 24 kg at completion (P < 0.001), with a non-significant trend upwards in the 1st and 2nd years of follow-up to 129.0 ± 27.7 (P = 0.07 compared to nadir) and 123.4 ± 29.0kg (P = 0.17), respectively. Although regains in the 3rd and 4th follow-up years were substantial to 131.0 ± 22.3 (P < 0.001), and 139.8 ± 35.4 kg (P < 0.001), there was still a moderate net weight loss of 4.7 [9.5, 0.21] and 7.0 [13.9, 0.26] kg (both P = 0.04) between the start and the 3rd and 4th follow-up years, respectively. The amount of weight regain was inversely associated with weight loss at completion of the programme, age, and directly associated with the duration of follow up in months (β = 1.2 [0.46, 1.9] P = 0.002). Conclusion: In patients with severe obesity who completed a milk-based meal replacement programme and lost a large amount of weight, over 4 years of follow-up there was very substantial weight regain. Greater initial weight loss and older age were associated with less subsequent weight regain.
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Affiliation(s)
- Razk Abdalgwad
- Bariatric Medicine Service, Center for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland.,Health Research Board, Clinical Research Facility, National University of Ireland Galway, Galway, Ireland.,Department of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Mohammed F Rafey
- Bariatric Medicine Service, Center for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland.,Health Research Board, Clinical Research Facility, National University of Ireland Galway, Galway, Ireland.,Department of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Siobhan Foy
- Bariatric Medicine Service, Center for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland.,Health Research Board, Clinical Research Facility, National University of Ireland Galway, Galway, Ireland.,Department of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Micheál Newell
- Bariatric Medicine Service, Center for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland.,Health Research Board, Clinical Research Facility, National University of Ireland Galway, Galway, Ireland.,Department of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Colin Davenport
- Bariatric Medicine Service, Center for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland.,Health Research Board, Clinical Research Facility, National University of Ireland Galway, Galway, Ireland.,Department of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Derek T O'Keeffe
- Bariatric Medicine Service, Center for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland.,Health Research Board, Clinical Research Facility, National University of Ireland Galway, Galway, Ireland.,Department of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Francis M Finucane
- Bariatric Medicine Service, Center for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland.,Health Research Board, Clinical Research Facility, National University of Ireland Galway, Galway, Ireland.,Department of Medicine, National University of Ireland Galway, Galway, Ireland
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O'Keeffe DT, Johnson K, Maraka S. Provision of Bidirectional Remote Patient Care With an Unmanned Aerial Vehicle. Mayo Clin Proc 2020; 95:830. [PMID: 32247360 DOI: 10.1016/j.mayocp.2020.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/10/2020] [Accepted: 01/20/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Derek T O'Keeffe
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway
| | - Kevin Johnson
- Department of Nursing and Midwifery, University of Limerick, Ireland
| | - Spyridoula Maraka
- Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Health Care System, Little Rock
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10
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O'Keeffe DT, Maraka S. Hemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy. Ann Intern Med 2018; 169:510-511. [PMID: 30285191 DOI: 10.7326/l18-0369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Spyridoula Maraka
- University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas (S.M.)
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Maraka S, Singh Ospina NM, Mastorakos G, O'Keeffe DT. Subclinical Hypothyroidism in Women Planning Conception and During Pregnancy: Who Should Be Treated and How? J Endocr Soc 2018; 2:533-546. [PMID: 29850652 PMCID: PMC5961023 DOI: 10.1210/js.2018-00090] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/30/2018] [Indexed: 12/11/2022] Open
Abstract
Subclinical hypothyroidism (SCH), a mild form of hypothyroidism defined as elevated TSH with normal free thyroxine levels, is a common diagnosis among women of reproductive age. In some, but not all, studies, it has been associated with infertility, an increased risk of adverse pregnancy and neonatal outcomes, and possibly with an increased risk of neurocognitive deficits in offspring. Despite well-established recommendations on treatment of overt hypothyroid pregnant women, a consensus has not yet been reached on whether to treat women with SCH. This review focuses on examining the evidence informing the clinical strategy for using levothyroxine (LT4) in women with SCH during pregnancy and those who are planning conception. A crucial first step is to accurately diagnose SCH using the appropriate population-based reference range. For pregnant women, if this is unavailable, the recommended TSH upper normal limit cutoff is 4.0 mIU/L. There is evidence supporting a decreased risk for pregnancy loss and preterm delivery for pregnant women with TSH > 4.0 mIU/L receiving LT4 therapy. LT4 treatment has been associated with better reproductive outcomes in women with SCH undergoing artificial reproductive techniques, but not in those who are attempting natural conception. Thyroid function tests need to be repeated throughout pregnancy to monitor LT4 therapy. In addition to potential harms, LT4 contributes to treatment burden. During a consultation, clinicians and patients should engage in a careful consideration of the current evidence in the context of the patients’ values and preferences to determine whether LT4 therapy initiation is the best next step.
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Affiliation(s)
- Spyridoula Maraka
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Health Care System, Little Rock, Arkansas.,Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Naykky M Singh Ospina
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, Minnesota.,Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, Florida
| | - George Mastorakos
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, Aretaieion Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Derek T O'Keeffe
- Division of Endocrinology, Department of Medicine, National University of Ireland, Galway, Ireland
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12
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Maraka S, Mwangi R, McCoy RG, Yao X, Sangaralingham LR, Singh Ospina NM, O'Keeffe DT, De Ycaza AEE, Rodriguez-Gutierrez R, Coddington CC, Stan MN, Brito JP, Montori VM. Thyroid hormone treatment among pregnant women with subclinical hypothyroidism: US national assessment. BMJ 2017; 356:i6865. [PMID: 28122781 PMCID: PMC5266622 DOI: 10.1136/bmj.i6865] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To estimate the effectiveness and safety of thyroid hormone treatment among pregnant women with subclinical hypothyroidism. DESIGN Retrospective cohort study. SETTING Large US administrative database between 1 January 2010 and 31 December 2014. PARTICIPANTS 5405 pregnant women with subclinical hypothyroidism, defined as untreated thyroid stimulating hormone (TSH) concentration 2.5-10 mIU/L. EXPOSURE Thyroid hormone therapy. MAIN OUTCOME MEASURE Pregnancy loss and other pre-specified maternal and fetal pregnancy related adverse outcomes. RESULTS Among 5405 pregnant women with subclinical hypothyroidism, 843 with a mean pre-treatment TSH concentration of 4.8 (SD 1.7) mIU/L were treated with thyroid hormone and 4562 with a mean baseline TSH concentration of 3.3 (SD 0.9) mIU/L were not treated (P<0.01). Pregnancy loss was significantly less common among treated women (n=89; 10.6%) than among untreated women (n=614; 13.5%) (P<0.01). Compared with the untreated group, treated women had lower adjusted odds of pregnancy loss (odds ratio 0.62, 95% confidence interval 0.48 to 0.82) but higher odds of preterm delivery (1.60, 1.14 to 2.24), gestational diabetes (1.37, 1.05 to 1.79), and pre-eclampsia (1.61, 1.10 to 2.37); other pregnancy related adverse outcomes were similar between the two groups. The adjusted odds of pregnancy loss were lower in treated women than in untreated women if their pre-treatment TSH concentration was 4.1-10 mIU/L (odds ratio 0.45, 0.30 to 0.65) but not if it was 2.5-4.0 mIU/L (0.91, 0.65 to 1.23) (P<0.01). CONCLUSION Thyroid hormone treatment was associated with decreased risk of pregnancy loss among women with subclinical hypothyroidism, especially those with pre-treatment TSH concentrations of 4.1-10 mIU/L. However, the increased risk of other pregnancy related adverse outcomes calls for additional studies evaluating the safety of thyroid hormone treatment in this patient population.
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Affiliation(s)
- Spyridoula Maraka
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Health Care System, Little Rock, AR 72205, USA
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN 55905, USA
| | - Raphael Mwangi
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA
| | - Rozalina G McCoy
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Xiaoxi Yao
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA
- Division of Health Care Policy and Research, Department of Health Services Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Lindsey R Sangaralingham
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA
- Optum Labs, Cambridge, MA 02142, USA
| | - Naykky M Singh Ospina
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN 55905, USA
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Derek T O'Keeffe
- Division of Endocrinology, Department of Medicine, National University of Ireland, Galway, Ireland
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55905, USA
| | - Ana E Espinosa De Ycaza
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55905, USA
| | - Rene Rodriguez-Gutierrez
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN 55905, USA
- Division of Endocrinology, Department of Internal Medicine, University Hospital "Dr. Jose E. Gonzalez," Autonomous University of Nuevo Leon, Monterrey, 64460, Mexico
| | | | - Marius N Stan
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55905, USA
| | - Juan P Brito
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN 55905, USA
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55905, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN 55905, USA
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55905, USA
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O'Keeffe DT, Tebben PJ, Kumar R, Singh RJ, Wu Y, Wermers RA. Clinical and biochemical phenotypes of adults with monoallelic and biallelic CYP24A1 mutations: evidence of gene dose effect. Osteoporos Int 2016; 27:3121-5. [PMID: 27129455 DOI: 10.1007/s00198-016-3615-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/22/2016] [Indexed: 11/30/2022]
Abstract
UNLABELLED Mutations of the CYP24A1 gene can result in hypercalcemia, hyerpercalciuria, and nephrolithiasis, but disease severity is variable. Clinical and biochemical phenotypes were correlated with gene sequence information in a family with two CYP24A1 mutations. A gene dose effect was apparent with monoallelic mutations demonstrating milder disease manifestations than biallelic mutations. INTRODUCTION The objective was to examine the spectrum of clinical and biochemical phenotypes in a family with monoallelic and biallelic mutations of CYP24A1 after identification of the proband with two mutations of the CYP24A1 gene: (A) p.R396W and (B) E143del-Het. METHODS Clinical and biochemical phenotypes were correlated with CYP24A1 sequence information in the proband and four siblings, a daughter, and two nieces of the proband. The subjects' medical histories were evaluated, and measurement of serum minerals, vitamin D metabolites, PTH, bone turnover markers, and urinary calcium and sequencing of the CYP24A1 gene were performed. RESULTS The proband had nephrolithiasis, osteopenia, hypercalcemia, hypercalciuria, elevated serum 1,25(OH)2D, undetectable 24,25(OH)2D, and inappropriately low PTH concentrations. Two subjects with biallelic (A/B) mutations had nephrolithiasis, marked hypercalciuria (583 ± 127 mg/24 h, mean ± SD), compared with five subjects with monoallelic mutations (A or B) with a urine calcium of 265 ± 85 mg/24 h. Two subjects with monoallelic mutations had nephrolithiasis and one had non-PTH dependent hypercalcemia. Five subjects had high 1,25(OH)2D measurements, including three with monoallelic mutations. The 25OHD/24,25(OH)2D ratio, in subjects with biallelic mutations was 291 versus 19.8 in the subjects with monoallelic mutations. CONCLUSIONS In this family, adults with CYP24A1 mutations a gene dose effect is apparent: subjects with biallelic, compound heterozygous mutations (A/B) have a more severe clinical and biochemical phenotype, whereas, subjects with monoallelic mutations demonstrate milder disease manifestations which are not easily characterized through biochemical assessment.
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Affiliation(s)
- D T O'Keeffe
- Division of Endocrinology, Diabetes, Metabolism and Nutrition/Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - P J Tebben
- Division of Endocrinology, Diabetes, Metabolism and Nutrition/Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Pediatric Endocrinology/Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - R Kumar
- Division of Endocrinology, Diabetes, Metabolism and Nutrition/Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Nephrology and Hypertension/Department of Medicine and Biochemistry and Molecular Biology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - R J Singh
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Y Wu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - R A Wermers
- Division of Endocrinology, Diabetes, Metabolism and Nutrition/Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Maraka S, Kearns AE, Kittah NEN, O'Keeffe DT. Recurrent euglycemic diabetic ketoacidosis after discontinuation of sodium-glucose cotransporter 2 inhibitor. Diabetes Res Clin Pract 2016; 118:77-8. [PMID: 27351797 DOI: 10.1016/j.diabres.2016.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 06/06/2016] [Indexed: 02/08/2023]
Affiliation(s)
- Spyridoula Maraka
- Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States.
| | - Ann E Kearns
- Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States.
| | - Nana Esi N Kittah
- Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States.
| | - Derek T O'Keeffe
- Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States; Division of Endocrinology, Department of Medicine, National University of Ireland, Galway, Ireland.
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O'Keeffe DT, Maraka S. Blood pressure lowering for cardiovascular disease. Lancet 2016; 388:125. [PMID: 27411871 DOI: 10.1016/s0140-6736(16)30972-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Derek T O'Keeffe
- Department of Medicine, National University of Ireland Galway, Galway SW4 794, Ireland.
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Maraka S, Singh Ospina NM, O'Keeffe DT, Rodriguez-Gutierrez R, Espinosa De Ycaza AE, Wi CI, Juhn YJ, Coddington CC, Montori VM, Stan MN. Effects of Levothyroxine Therapy on Pregnancy Outcomes in Women with Subclinical Hypothyroidism. Thyroid 2016; 26:980-6. [PMID: 27112035 PMCID: PMC4939379 DOI: 10.1089/thy.2016.0014] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Subclinical hypothyroidism (SCH) has been associated with increased risk of adverse pregnancy outcomes in some, but not all, studies. Uncertainty remains regarding the impact of levothyroxine (LT4) therapy on improving health outcomes in pregnant women with SCH. The objective of this study was to assess the potential benefits of LT4 therapy in pregnant women with SCH. METHODS The medical records were reviewed of pregnant women with SCH, defined as an elevated serum thyrotropin (TSH) of >2.5 mIU/L for the 1st trimester or >3 mIU/L for the 2nd and 3rd trimesters, but ≤10 mIU/L. Pregnant women were divided into two groups depending on whether they received LT4 (group A) or not (group B). Pregnancy loss and other pre-specified adverse outcomes were evaluated during follow-up. RESULTS There were 82 women in group A and 284 in group B. Group A had a higher body mass index (p = 0.04) and a higher serum TSH level (p < 0.0001) compared with group B. Group A had fewer pregnancies lost (n = 5 [6.1%] vs. n = 25 [8.8%]; p = 0.12), low birth weight (LBW) offspring (1.3% vs. 10%; p < 0.001), and no neonates with a five-minute Apgar score ≤7 (0% vs. 7%; p < 0.001) compared with group B. Other pregnancy-related adverse outcomes were similar between the two groups. Inferences remained unchanged after considering different models to adjust for potential predictors of outcome. CONCLUSIONS LT4 therapy is associated with a decreased risk of LBW and a low Apgar score among women with SCH. This association awaits confirmation in randomized trials before the widespread use of LT4 therapy in pregnant women with SCH.
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Affiliation(s)
- Spyridoula Maraka
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
- Knowledge and Evaluation Research Unit (KER-Endo), Mayo Clinic, Rochester, Minnesota
| | - Naykky M. Singh Ospina
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
- Knowledge and Evaluation Research Unit (KER-Endo), Mayo Clinic, Rochester, Minnesota
| | - Derek T. O'Keeffe
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
- Division of Endocrinology, Department of Medicine, National University of Ireland, Galway, Ireland
| | - Rene Rodriguez-Gutierrez
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
- Knowledge and Evaluation Research Unit (KER-Endo), Mayo Clinic, Rochester, Minnesota
- Division of Endocrinology, Department of Internal Medicine, University Hospital “Dr. Jose E. Gonzalez,” Autonomous University of Nuevo Leon, Monterrey, Mexico
| | - Ana E. Espinosa De Ycaza
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Young J. Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Victor M. Montori
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
- Knowledge and Evaluation Research Unit (KER-Endo), Mayo Clinic, Rochester, Minnesota
| | - Marius N. Stan
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
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O'Keeffe DT, Montori VM. What's up #DOC? The role of social media in diabetes management. Diabet Med 2016; 33:853-4. [PMID: 26337176 DOI: 10.1111/dme.12955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 08/03/2015] [Accepted: 09/01/2015] [Indexed: 11/29/2022]
Affiliation(s)
- D T O'Keeffe
- Department of Medicine, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - V M Montori
- Department of Medicine, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
- The Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
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Maraka S, Ospina NMS, O'Keeffe DT, Espinosa De Ycaza AE, Gionfriddo MR, Erwin PJ, Coddington CC, Stan MN, Murad MH, Montori VM. Subclinical Hypothyroidism in Pregnancy: A Systematic Review and Meta-Analysis. Thyroid 2016; 26:580-90. [PMID: 26837268 PMCID: PMC4827301 DOI: 10.1089/thy.2015.0418] [Citation(s) in RCA: 206] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The impact of subclinical hypothyroidism (SCH) and of levothyroxine replacement in pregnant women with SCH is unclear. The aims of this study were to assess (i) the impact of SCH during pregnancy on maternal and neonatal outcomes, and (ii) the effect of levothyroxine replacement therapy in these patients. METHODS Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, the Cochrane Controlled Trials Register, Ovid EMBASE, Web of Science, and Scopus were searched from inception to January 2015. Randomized trials and cohort studies of pregnant women with SCH that examined adverse pregnancy and neonatal outcomes were included. Reviewers extracted data and assessed methodological quality in duplicate. Eighteen cohort studies at low-to-moderate risk of bias were included. Compared with euthyroid pregnant women, pregnant women with SCH were at higher risk for pregnancy loss (relative risk [RR] 2.01 [confidence interval (CI) 1.66-2.44]), placental abruption (RR 2.14 [CI 1.23-3.70]), premature rupture of membranes (RR 1.43 [CI 1.04-1.95]), and neonatal death (RR 2.58 [CI 1.41-4.73]). One study at high risk of bias compared pregnant women with SCH who received levothyroxine to those who did not and found no significant decrease in the rate of pregnancy loss, preterm delivery, gestational hypertension, low birth weight, or low Apgar score. CONCLUSIONS SCH during pregnancy is associated with multiple adverse maternal and neonatal outcomes. The value of levothyroxine therapy in preventing these adverse outcomes remains uncertain.
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Affiliation(s)
- Spyridoula Maraka
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Naykky M. Singh Ospina
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Derek T. O'Keeffe
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Ana E. Espinosa De Ycaza
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Michael R. Gionfriddo
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
- Mayo Graduate School, Mayo Clinic, Rochester, Minnesota
| | | | | | - Marius N. Stan
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - M. Hassan Murad
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota
| | - Victor M. Montori
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
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Affiliation(s)
- Derek T O'Keeffe
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota2Division of Endocrinology, Department of Medicine, National University of Ireland, Galway, Ireland
| | - Spyridoula Maraka
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota3Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Cl
| | - Robert A Rizza
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
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O'Keeffe DT, Mikhail MA, Lanzino G, Kallmes DF, Weinshenker BG. Corticosteroid-Induced Paraplegia—A Diagnostic Clue for Spinal Dural Arterial Venous Fistula. JAMA Neurol 2015; 72:833-4. [PMID: 26167899 DOI: 10.1001/jamaneurol.2015.0757] [Citation(s) in RCA: 18] [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: 11/14/2022]
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Abstract
Medical devices have transformed modern health care, and ongoing experimental medical technology trials (such as the artificial pancreas) have the potential to significantly improve the treatment of several chronic conditions, including diabetes mellitus. However, we suggest that, to date, the essential concept of cybersecurity has not been adequately addressed in this field. This article discusses several key issues of cybersecurity in medical devices and proposes some solutions. In addition, it outlines the current requirements and efforts of regulatory agencies to increase awareness of this topic and to improve cybersecurity.
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Affiliation(s)
| | | | - Ananda Basu
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Patrick Keith-Hynes
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia
| | - Yogish C. Kudva
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
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Affiliation(s)
- Spyridoula Maraka
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota2Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Derek T O'Keeffe
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Victor M Montori
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota2Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
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O'Keeffe DT, Maraka S, Wermers R. The significance of bone mineral density in the depiction of memento mori. J Bone Miner Res 2015; 30:747. [PMID: 25359674 DOI: 10.1002/jbmr.2395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Manohar C, O'Keeffe DT, Hinshaw L, Lingineni R, McCrady-Spitzer SK, Levine JA, Carter RE, Basu A, Kudva YC. Comparison of physical activity sensors and heart rate monitoring for real-time activity detection in type 1 diabetes and control subjects. Diabetes Technol Ther 2013; 15:751-7. [PMID: 23937615 PMCID: PMC3757536 DOI: 10.1089/dia.2013.0044] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Currently, patients with type 1 diabetes decide on the amount of insulin to administer based on several factors, including current plasma glucose value, expected meal input, and physical activity (PA). One future therapeutic modality for patients with type 1 diabetes is the artificial endocrine pancreas (AEP). Incorporation of PA could enhance the efficacy of AEP significantly. We compared the main technologies used for PA quantitation. SUBJECTS AND METHODS Data were collected during inpatient studies involving healthy control subjects and type 1 diabetes. We report PA quantified from accelerometers (acceleration units [AU]) and heart rate (HR) monitors during a standardized activity protocol performed after a dinner meal at 7 p.m. from nine control subjects (four were males, 37.4±12.7 years old, body mass index of 24.8±3.8 kg/m(2), and fasting plasma glucose of 4.71±0.63 mmol/L) and eight with type 1 diabetes (six were males, 45.2±13.4 years old, body mass index of 25.1±2.9 kg/m(2), and fasting plasma glucose of 8.44±2.31 mmol/L). RESULTS The patient-to-patient variability was considerably less when examining AU compared with HR monitors. Furthermore, the exercise bouts and rest periods were more evident from the data streams when AUs were used to quantify activity. Unlike the AU, the HR measurements provided little insight for active and rest stages, and HR data required patient-specific standardizations to discern any meaningful pattern in the data. CONCLUSIONS Our results indicated that AU provides a reliable signal in response to PA, including low-intensity activity. Correlation of this signal with continuous glucose monitoring data would be the next step before exploring inclusion as input for AEP control.
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Affiliation(s)
- Chinmay Manohar
- Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Derek T. O'Keeffe
- Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Ling Hinshaw
- Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Ravi Lingineni
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - James A. Levine
- Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Rickey E. Carter
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Ananda Basu
- Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Yogish C. Kudva
- Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
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Abstract
INTRODUCTION Human performance is affected by sleep disruption and sleep deprivation can critically affect mission outcome in both spaceflight and other extreme environments. In this study, the seven-person crew (four men, three women) lived a Martian sol (24.65 h) for 37 d during a long-term stay at the Flashline Mars Arctic Research Station (FMARS) on Devon Island, Canada. Crewmembers underwent cardiopulmonary monitoring for signs of circadian disruption and completed a modified Pittsburgh Sleep Diary to monitor subjective fatigue. Crewmembers underwent cognitive testing to identify the effects, if any, of sleep disruption upon cognitive skill. METHODS A Martian sol was implemented for 37 d during the Arctic mission. Each crewmember completed an adapted version of the Pittsburgh Sleep Diary in tandem with electrocardiograph (ECG) cardiopulmonary monitoring of sleep by the Cardiac Adapted Sleep Parameters Electrocardiogram Recorder (CASPER). Crewmembers also underwent cognitive testing during this time period. RESULTS Sleep diary data indicate improvement in alertness with the onset of the sol (fatigue decreasing from 5.1 to 4.0, alertness increasing from 6.1 to 7.0). Cardiopulmonary data suggest sleep instability, though trends were not statistically significant. Crewmember decision speed time scores improved from pre-Mars to Mars (average improving from 66.5 to 84.0%), though the remainder of cognitive testing results were not significant. DISCUSSION While subjective data demonstrate improved sleep and alertness during the sol, objective data demonstrate no significant alteration of sleep patterns. There was no apparent cognitive decline over the course of the mission.
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Affiliation(s)
- Marc O Gríofa
- Innovative Health Applications, Kennedy Space Center, FL, USA
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Breen PP, Corley GJ, O'Keeffe DT, Conway R, Olaighin G. A programmable and portable NMES device for drop foot correction and blood flow assist applications. Med Eng Phys 2008; 31:400-8. [PMID: 18667351 DOI: 10.1016/j.medengphy.2008.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 03/13/2008] [Accepted: 05/15/2008] [Indexed: 10/21/2022]
Abstract
The Duo-STIM, a new, programmable and portable neuromuscular stimulation system for drop foot correction and blood flow assist applications is presented. The system consists of a programmer unit and a portable, programmable stimulator unit. The portable stimulator features fully programmable, sensor-controlled, constant-voltage, dual-channel stimulation and accommodates a range of customized stimulation profiles. Trapezoidal and free-form adaptive stimulation intensity envelope algorithms are provided for drop foot correction applications, while time dependent and activity dependent algorithms are provided for blood flow assist applications. A variety of sensor types can be used with the portable unit, including force sensitive resistor-based foot switches and MEMS-based accelerometer and gyroscope devices. The paper provides a detailed description of the hardware and block-level system design for both units. The programming and operating procedures for the system are also presented. Finally, functional bench test results for the system are presented.
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Affiliation(s)
- Paul P Breen
- Department of Electronic Engineering, National University of Ireland, Galway, Galway, Ireland
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O'Donovan KJ, Bourke AK, O'Keeffe DT, Olaighin G. The application of inertial and magnetic sensors to the monitoring of calf muscle pump activity. Med Eng Phys 2008; 31:55-60. [PMID: 18595764 DOI: 10.1016/j.medengphy.2008.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 04/21/2008] [Accepted: 04/23/2008] [Indexed: 11/17/2022]
Abstract
On long distance journeys passengers at high risk from deep vein thrombosis (DVT) are recommended to exercise on a regular basis to contract the calf muscle pump and encourage venous return. If a passenger fails to complete an exercise program that induces active contraction of the calf muscle pump they will remain at increased risk of DVT. This paper presents a novel inertial and magnetic sensor-based technique for monitoring calf muscle pump activity. The technique could be implemented into a system for monitoring the level of calf muscle pump activity in persons with limited mobility. Such a system could be used to provide a reminder to the user that there is a need to exercise should they have forgotten to exercise, failed to exercise sufficiently or exercised incorrectly. The proposed technique was evaluated by comparison with calf muscle pump activity measured using an electromyography (EMG) sensor. Results show that the technique can be used to monitor calf muscle pump activity over a wide range of leg exercises.
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Affiliation(s)
- Karol J O'Donovan
- Biomedical Electronics Laboratory, Department of Electronic and Computer Engineering, University of Limerick, Limerick, Ireland.
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Abstract
A novel wearable pelvic sensor design for gait analysis was developed and evaluated in both normal and pathological gait. The device is a hip worn fusion of gyroscopes and accelerometers which allows for monitoring of the periodic vertical rotation of the pelvis during the walking cycle and uses this information as a predictor of gait events such as Heel-Strike (HS) and Toe-Off (TO). The gait pattern of two age and gender-matched groups (40-65 years) of 10 healthy subjects (5 male, 5 female) and 10 subjects with hemiplegic drop foot were examined. The pelvic sensor method was correlated against an optical motion system and footswitches, to evaluate the technique's efficacy at detecting foot contact events in walking and hip pattern. Data analysis showed the device was able to predict foot contact events from recorded maximum and minimum pelvic angle (TO: Healthy - 130ms Hemiplegic - 95ms; HS: Healthy - 127ms, Hemiplegic - 96ms). This ability to detect gait events would allow this sensor design to be used in simplifying drop foot stimulation systems. The proposed method also records the relative range of motion of the pelvis from which useful information on gait symmetry can be obtained and used in ambulatory monitoring or treatment intervention analysis.
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Affiliation(s)
- Derek T O'Keeffe
- Department of Electronic and Computer Engineering, University of Limerick, Limerick, Ireland.
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Byrne CA, O'Keeffe DT, Donnelly AE, Lyons GM. Effect of walking speed changes on tibialis anterior EMG during healthy gait for FES envelope design in drop foot correction. J Electromyogr Kinesiol 2007; 17:605-16. [PMID: 16990012 DOI: 10.1016/j.jelekin.2006.07.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Revised: 05/28/2006] [Accepted: 07/17/2006] [Indexed: 11/25/2022] Open
Abstract
Functional electrical stimulation may be used to correct hemiplegic drop foot. An optimised stimulation envelope to reproduce the EMG pattern observed in the tibialis anterior (TA) during healthy gait has been proposed by O'Keeffe et al. [O'Keeffe, D.T., Donnelly, A.E., Lyons, G.M., 2003. The development of a potential optimised stimulation intensity envelope for drop foot applications. IEEE Transactions on Neural Systems and Rehabilitation Engineering]. However this envelope did not attempt to account for changes in TA activity with walking speed. The objective of this paper was to provide data to enable the specification of an algorithm to control the adaptation of an envelope with walking speed. Ten young healthy subjects walked on a treadmill at 11 different walking speeds while TA EMG was recorded. The results showed that TA EMG recorded around initial contact and at toe off changed with walking speed. At the slowest velocities, equivalent to hemiplegic walking, the toe-off burst (TOB) of EMG activity had larger peak amplitude than that of the heel-strike burst (HSB). The peak amplitude ratio of TOB:HSB was 1:0.69 at the slowest speed compared to, 1:1.18 and 1:1.5 for the self-selected and fastest speed, respectively. These results suggest that an FES envelope, which produces larger EMG amplitude for the TOB than the HSB, would be more appropriate at walking speeds typical of hemiplegic patients.
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Affiliation(s)
- C A Byrne
- Biomedical Electronics Laboratory, Department of Electronic and Computer Engineering, University of Limerick, National Technological Park, Limerick, Ireland
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30
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O'Donovan KJ, Kamnik R, O'Keeffe DT, Lyons GM. An inertial and magnetic sensor based technique for joint angle measurement. J Biomech 2007; 40:2604-11. [PMID: 17346716 DOI: 10.1016/j.jbiomech.2006.12.010] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Accepted: 12/20/2006] [Indexed: 11/28/2022]
Abstract
This paper describes the design and evaluation of a miniature kinematic sensor based three dimensional (3D) joint angle measurement technique. The technique uses a combination of rate gyroscope, accelerometer and magnetometer sensor signals. The technique enables 3D inter-segment joint angle measurement and could be of benefit in a variety of applications which require monitoring of joint angles. The technique is not dependent on a fixed reference coordinate system and thus may be suitable for use in a dynamic system such as a moving vehicle. The technique was evaluated by applying it to joint angle measurement of the ankle joint. Experimental results show that accurate measurement of ankle joint angles is achieved by the technique during a variety of lower leg exercises including walking.
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Affiliation(s)
- Karol J O'Donovan
- Biomedical Electronics Laboratory, Department of Electronic and Computer Engineering, University of Limerick, Limerick, Ireland.
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31
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Breen PP, Corley GJ, O'Keeffe DT, Conway R, OLaighin G. A programmable and portable NMES device for drop foot correction and blood flow assist applications. Annu Int Conf IEEE Eng Med Biol Soc 2007; 2007:2416-2419. [PMID: 18002481 DOI: 10.1109/iembs.2007.4352815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The Duo-STIM, a new, programmable and portable neuromuscular stimulation system for drop foot correction and blood flow assist applications is presented. The system consists of a programmer unit and a portable, programmable stimulator unit. The portable stimulator features fully programmable, sensor-controlled, constant-voltage, dual-channel stimulation and accommodates a range of customized stimulation profiles. Trapezoidal and free-form adaptive stimulation intensity envelope algorithms are provided for drop foot correction applications, while time dependent and activity dependent algorithms are provided for blood flow assist applications. A variety of sensor types can be used with the portable unit, including force sensitive resistor based foot switches and NMES based accelerometer and gyroscope devices. The paper provides a detailed description of the hardware and block-level system design for both units. The programming and operating procedures for the system are also presented. Finally, functional bench test results for the system are presented.
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Affiliation(s)
- Paul P Breen
- National Centre for Biomedical Engineering Science, National University of Ireland, Galway, Galway, Ireland.
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32
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O'Dwyer SB, O'Keeffe DT, Coote S, Lyons GM. An electrode configuration technique using an electrode matrix arrangement for FES-based upper arm rehabilitation systems. Med Eng Phys 2006; 28:166-76. [PMID: 15936975 DOI: 10.1016/j.medengphy.2005.03.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [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: 06/16/2004] [Revised: 02/01/2005] [Accepted: 03/22/2005] [Indexed: 11/19/2022]
Abstract
An upper limb electrical stimulation technique has been developed which features a novel self-configuration approach, to obtain an ideal wrist response from the patient. The system uses an analogue de-multiplexer in conjunction with an electrode matrix so that different electrode sites can be tested using only one channel of stimulation. A twin axis goniometer is attached to the patient's wrist and flex sensors are attached to the patient's fingers so that the control algorithm can assess the wrist response. A data acquisition unit logs the data for further analysis. A clinical investigation on healthy subjects was conducted to test the proposed system. The results show a high variation in hand response across different subjects. In addition, for all subjects tested an ideal response was found which shows some justification for the use of the proposed technique.
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Affiliation(s)
- S B O'Dwyer
- Biomedical Electronics Laboratory, Department of Electronic and Computer Engineering, University of Limerick, Ireland
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33
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Breen PP, O'Keeffe DT, Conway R, Lyons GM. A system for the delivery of programmable, adaptive stimulation intensity envelopes for drop foot correction applications. Med Eng Phys 2006; 28:177-86. [PMID: 15927517 DOI: 10.1016/j.medengphy.2005.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2003] [Revised: 03/04/2005] [Accepted: 04/08/2005] [Indexed: 11/23/2022]
Abstract
We describe the design of an intelligent drop foot stimulator unit for use in conjunction with a commercial neuromuscular electrical nerve stimulation (NMES) unit, the NT2000. The developed micro-controller unit interfaces to a personal computer (PC) and a graphical user interface (GUI) allows the clinician to graphically specify the shape of the stimulation intensity envelope required for a subject undergoing drop foot correction. The developed unit is based on the ADuC812S micro-controller evaluation board from Analog Devices and uses two force sensitive resistor (FSR) based foot-switches to control application of stimulus. The unit has the ability to display to the clinician how the stimulus intensity envelope is being delivered during walking using a data capture capability. The developed system has a built-in algorithm to dynamically adjust the delivery of stimulus to reflect changes both within the gait cycle and from cycle to cycle. Thus, adaptive control of stimulus intensity is achieved.
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Affiliation(s)
- P P Breen
- Biomedical Electronics Laboratory, Department of Electronic and Computer Engineering, University of Limerick, National Technological Park, Limerick, Ireland
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34
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Byrne CA, Lyons GM, Donnelly AE, O'Keeffe DT, Hermens H, Nene A. Rectus femoris surface myoelectric signal cross-talk during static contractions. J Electromyogr Kinesiol 2005; 15:564-75. [PMID: 15946862 DOI: 10.1016/j.jelekin.2005.03.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [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: 06/03/2003] [Revised: 02/02/2005] [Accepted: 03/25/2005] [Indexed: 10/25/2022] Open
Abstract
The clinical application of EMG requires that the recorded signal is representative of the muscle of interest and is not contaminated with signals from adjacent muscles. Some authors report that surface EMG is not suitable for obtaining information on a single muscle but rather reflects muscle group function [J. Perry, C.S. Easterday, D.J. Antonelli, Surface versus intramuscular electrodes for electromyography of superficial and deep muscles. Physical Therapy 61 (1981) 7-15]. Other authors report however, that surface EMG is adequate to determine individual muscle function, once guidelines pertaining to data acquisition are followed [D.A. Winter, A.J. Fuglevand, S.E. Archer. Cross-talk in surface electromyography: theoretical and practical estimates. Journal of Electromyography and Kinesiology 4 (1994) 15-26]. The aim of this study was to determine whether surface EMG was suitable for monitoring rectus femoris (RF) activity during static contractions. Five healthy subjects, having given written informed consent, participated in this trial. Surface and fine wire EMG from the rectus femoris and the vastus lateralis (VL) muscles were recorded simultaneously during a protocol of static contractions consisting of knee extensions and hip flexions. Ratios were used to quantify the relationship between the surface EMG amplitude value and the fine wire EMG amplitude value for the same contraction. The results showed that hip flexion contractions elicited RF activation only and that knee extension contractions elicited fine wire activity in VL only. When the relationship between RF surface and RF fine wire electrodes was compared for hip flexion and knee extension contractions, it was observed that for all subjects, there was a tendency for increased RF surface activity in the absence of RF fine wire activity during knee extensions. It was concluded that the activity recorded by the RF surface electrode arrangement during knee extension consisted of EMG from the vastii, i.e., cross-talk and that vastus intermedius was the most likely origin of the erroneous signal. Therefore it is concluded that for accurate EMG information from RF, fine wire electrodes are necessary during a range of static contractions.
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Affiliation(s)
- C A Byrne
- Biomedical Electronics Laboratory, Department of Electronic and Computer Engineering, University of Limerick, National Technological Park, Limerick, Ireland
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35
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O'Donovan KJ, O'Keeffe DT, Grace PA, Lyons GM. Accelerometer based calf muscle pump activity monitoring. Med Eng Phys 2005; 27:717-22. [PMID: 16139770 DOI: 10.1016/j.medengphy.2005.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2003] [Revised: 12/10/2004] [Accepted: 02/02/2005] [Indexed: 11/30/2022]
Abstract
Long distance travel is associated with increased risk of deep vein thrombosis (DVT). There is an increased risk of travel related DVT in passengers with a predisposition to thrombosis. Assisting blood circulation in the lower limb will reduce the risk of DVT. Leg exercises are recommended as a DVT preventative measure while flying but this fails to account for a passenger who is distracted by in flight entertainment or who falls asleep for an extended period. A method for monitoring calf muscle pump activity using accelerometers has been developed and evaluated. The proposed technique could be used to alert the traveller that there is a need to exercise their calf muscle, thus reducing the risk of DVT.
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Affiliation(s)
- Karol J O'Donovan
- Biomedical Electronics Laboratory, Department of Electronic and Computer Engineering, University of Limerick, Limerick, Ireland.
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O'Keeffe DT, Donnelly AE, Lyons GM. The development of a potential optimized stimulation intensity envelope for drop foot applications. IEEE Trans Neural Syst Rehabil Eng 2003; 11:249-56. [PMID: 14518788 DOI: 10.1109/tnsre.2003.817678] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An optimized stimulation intensity envelope for use in hemiplegic drop foot applications has been developed. The traditional trapezoidal stimulation intensity approach has been examined and found to be inconsistent with the muscle activity patterns observed in healthy gait and therefore unsuitable. Experimental functional electrical stimulation (FES)-elicited tibialis anterior (TA) electromyography (EMG) data was taken over the ankle range of interest (occurring during active dorsiflexion and loading response) while also taking into account the type of TA muscle contraction occurring (concentric, eccentric, and isometric) and the speed of hemiplegic ankle joint rotation. Using the processed data, a model of normalized EMG versus pulsewidth was developed. Implementation of this model showed the unsuitability of the trapezoidal approach in the reproducing of a natural EMG profile. An optimized stimulation intensity profile is proposed which is expected to accurately reproduce the natural TA EMG profile during gait.
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Affiliation(s)
- Derek T O'Keeffe
- Biomedical Electronics Laboratory, Department of Electronic and Computer Engineering, University of Limerick, Limerick, Ireland.
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37
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Abstract
Drop Foot Stimulators are used to correct hemiplegic drop foot by synchronising the application of Functional Electrical Stimulation (FES) of the Common Peroneal Nerve (CPN) to the swing phase of the gait cycle. A research Drop Foot Stimulator (DFS) has been developed with a very flexible architecture to enable the investigation of a variety of gait-correction strategies. The portable unit has been carefully designed to optimise functionality while keeping its size and power consumption to a minimum. The device has two channels of stimulation, with all parameters of stimulation for each channel independently programmable. Four analogue and four digital sensor input channels are provided with a wide variety of sensor types possible. A microcontroller core is utilised to enable the implementation of different control algorithms. A PC-based user interface enables easy programming of the system configuration.
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Affiliation(s)
- D T O'Keeffe
- Biomedical Electronics Laboratory, Department of Electronic and Computer Engineering, University of Limerick, Limerick, Ireland.
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38
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Abstract
The analysis of stimulus evoked neuromuscular potentials or m-waves is a useful technique for improved feedback control in functional electrical stimulation systems. Usually, however, these signals are contaminated by stimulus artifact. A novel software technique, which uses a two-stage peak detection algorithm, has been developed to remove the unwanted artifact from the recorded signal. The advantage of the technique is that it can be used on all stimulation artifact-contaminated electroneurophysiologic data provided that the artifact and the biopotential are non-overlapping. The technique does not require any estimation of the stimulus artifact shape or duration. With the developed technique, it is not necessary to record a pure artifact signal for template estimation, a process that can increase the complexity of experimentation. The technique also does not require the recording of any external hardware synchronisation pulses. The method avoids the use of analogue or digital filtering techniques, which endeavour to remove certain high frequency components of the artifact signal, but invariably have difficulty, resulting in the removal of frequencies in the same spectrum as the m-wave. With the new technique the signal is sampled at a high frequency to ensure optimum fidelity. Instrumentation saturation effects due to the artifact can be avoided with careful electrode placement. The technique was fully tested with a wide variety of electrical stimulation parameters (frequency and pulse width) applied to the common peroneal nerve to elicit contraction in the tibialis anterior. The program was also developed to allow batch processing of multiple files, using closed loop feedback correction. The two-stage peak detection artifact removal algorithm is demonstrated as an efficient post-processing technique for acquiring artifact free m-waves.
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Affiliation(s)
- D T O'Keeffe
- Biomedical Electronics Laboratory, Department of Electronic and Computer Engineering, University of Limerick, Limerick, Ireland.
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Beardmore-Gray M, O'Keeffe DT, Anthony C. The autoreducible cytochromes c of the methylotrophs Methylophilus methylotrophus and Pseudomonas AM1. Biochem J 1982; 207:161-5. [PMID: 6295363 PMCID: PMC1153837 DOI: 10.1042/bj2070161] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The two types of soluble cytochrome c (cytochrome cH and cytochrome cL) found in methylotrophs are completely distinct proteins; one type is not a dimer or degradation product of the other. Free thiol groups are probably not involved in the unusually rapid autoreduction of the cytochromes at high pH. The axial ligands to the haem iron, histidine and methionine, are the same as in other low-spin cytochromes c. The methionine ligand is displaced at high pH by an alternative strong-field ligand. This displacement does not occur on reduction of cytochrome cL by methanol dehydrogenase, but this does not rule out the possibility that the autoreduction mechanism is involved in the interaction of the dehydrogenase and cytochrome c.
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Abstract
It was previously suggested that there is only one soluble cytochrome c in Pseudomonas AM1, having a molecular weight of 20000, a redox midpoint potential of about +260mV and a low isoelectric pint [Anthony (1975) Biochem. J.146, 289-298; Widdowson & Anthony (1975) Biochem. J.152, 349-356]. A more thorough examination of the soluble fraction of methanol-grown Pseudomonas AM1 has now revealed the presence of two different cytochromes c. These were both purified to homogeneity by acid treatment, ion-exchange chromatography, gel filtration, chromatography on hydroxyapatite and preparative isoelectric focusing. Molecular weights were determined by sodium dodecyl sulphate/polyacrylamide-gel electrophoresis; midpoint redox potentials were determined directly by using platinum and calomel electrodes; isoelectric points were estimated by electrophoresis and by the behaviour of the two cytochromes on ion-exchange celluloses. The more abundant cytochrome c(H) (lambda(max.) 550.5nm) had a low molecular weight (11000), a midpoint potential of about +294mV and a high isoelectric point, not being adsorbed on DEAE-cellulose in 20mm-Tris/HCl buffer, pH8.0. The less abundant cytochrome c(L) (lambda(max.) 549nm) was about 30% of the total; it had a high molecular weight (20900), a midpoint potential of about +256mV and a low isoelectric point, binding strongly to DEAE-cellulose in 20mm-Tris/HCl buffer, pH8.0. The pH-dependence of the midpoint redox potentials of the two cytochromes c were very similar. There were four ionizations affecting the redox potentials in the pH range studied (pH4.0-9.5), two in the oxidized form (pK values about 3.5 and 5.5) and two in the reduced form (pK values about 4.5 and 6.5), suggesting that the ionizing groups involved may be the two propionate side chains of the haem. Neither of the cytochromes c was present in mutant PCT76, which was unable to oxidize or grow on C(1) compounds, although still able to grow well on multicarbon compounds such as succinate. Whether or not these two cytochromes c have separate physiological functions is not yet certain.
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O'Keeffe DT, Anthony C. The interaction between methanol dehydrogenase and the autoreducible cytochromes c of the facultative methylotroph Pseudomonas AM1. Biochem J 1980; 190:481-4. [PMID: 6258570 PMCID: PMC1162118 DOI: 10.1042/bj1900481] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cytochromes cH and cL were autoreduced at high pH (pK greater than 10) and the autoreduced cytochromes reacted with CO. The autoreduction was first-order with respect to oxidized cytochrome c and was reversible by lowering the pH. Pure methanol dehydrogenase reduced cytochrome c (in the absence of methanol) by lowering the pK for autoreduction to less than 8.5. A mechanism is proposed for the autoreduction of cytochrome c and its involvement in the reaction with methanol dehydrogenase.
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