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The empty pelvis syndrome: a core data set from the PelvEx collaborative. Br J Surg 2024; 111:znae042. [PMID: 38456677 PMCID: PMC10921833 DOI: 10.1093/bjs/znae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored. METHOD Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition. RESULTS One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus-where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed. CONCLUSIONS EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.
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Somatosensory input in the context of transcranial magnetic stimulation coupled with electroencephalography: An evidence-based overview. Neurosci Biobehav Rev 2023; 155:105434. [PMID: 37890602 DOI: 10.1016/j.neubiorev.2023.105434] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/11/2023] [Accepted: 10/22/2023] [Indexed: 10/29/2023]
Abstract
The transcranial evoked potential (TEP) is a powerful technique to investigate brain dynamics, but some methodological issues limit its interpretation. A possible contamination of the TEP by electroencephalographic (EEG) responses evoked by the somatosensory input generated by transcranial magnetic stimulation (TMS) has been postulated; nonetheless, a characterization of these responses is lacking. The aim of this work was to review current evidence about possible somatosensory evoked potentials (SEP) induced by sources of somatosensory input in the craniofacial region. Among these, only contraction of craniofacial muscle and stimulation of free cutaneous nerve endings may be able to induce EEG responses, but direct evidence is lacking due to experimental difficulties in isolating these inputs. Notably, EEG evoked activity in this context is represented by a N100/P200 complex, reflecting a saliency-related multimodal response, rather than specific activation of the primary somatosensory cortex. Strategies to minimize or remove these responses by EEG processing still yield uncertain results; therefore, data inspection is of paramount importance to judge a possible contamination of the TEP by multimodal potentials caused by somatosensory input.
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Empty pelvis syndrome: PelvEx Collaborative guideline proposal. Br J Surg 2023; 110:1730-1731. [PMID: 37757457 PMCID: PMC10805575 DOI: 10.1093/bjs/znad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
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Evaluation of Radiotherapy Dose and Survival Outcomes for Teenagers, and Young Adults with Nasopharyngeal Carcinoma in UK and Ireland. Int J Radiat Oncol Biol Phys 2023; 117:e582. [PMID: 37785767 DOI: 10.1016/j.ijrobp.2023.06.1924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Nasopharyngeal carcinoma (NPC) follows a bimodal distribution with a smaller incidence peak in teenagers and young adults (TYAs). In TYAs, an over-whelming proportion are associated with Epstein-Barr virus (EBV). We have evaluated the variation in TYA NPC practice patterns across the UK and Ireland, along with survival outcomes. MATERIALS/METHODS We performed a multicenter, observational cohort study, of patients aged 13-25 years, with histologically confirmed NPC, treated between the years 2002-2022. An initial expression of interest was sent to selected centers treating H&N patients in the UK and Ireland. For analysis, patients were assessed based on total prescribed dose, with a cut off for low dose (LD) (≤61.2Gy) versus a high dose (HD)(>61.2Gy). RESULTS Ninety-five patients, from 9 centers, were eligible for inclusion. Patient demographics are shown in table1. At a median follow up of 45 months (IQR 23-111), 3-year overall survival (OS) was 98% (95% CI 93%-100%) with LD versus 91% (95% CI 83%-99%) with HD (Hazard ratio (HR) = 3.0; 95% CI 0.3-27, p = 0.3). 3-year progression free survival (PFS) was 84% (95% CI 71%-97%) with LD versus 83% (95% CI 72%-94%) with HD (HR 1.3; 95% CI 0.4-4.0, p = 0.6), and 5-year PFS was 84% (95% CI 71%-97%) with LD versus 83% (95% CI 72%-94%) with HD (HR 1.3; 95% CI 0.4-4.0, p = 0.6). Incidence of distant metastasis (DM) was 9.9%. 2 patients (6%) with T3-T4 tumors, treated with LD, had locoregional failure (LRF) compared to 1 patient (3%) treated with HD. CONCLUSION We have demonstrated excellent survival outcomes for the UK & Ireland TYA NPC patients. As the majority of cases in this age group have EBV+ NPC, with survival similar between LD and HD protocols, we propose that pediatric protocols, with lower radiotherapy doses should be considered for all TYA NPC, with the aim of reducing late effects. Additional analysis to better understand the impact of heterogeneity between both groups, including choice of protocol, induction and adjuvant treatment will follow this study. Prospective evaluation, as part of an international collaboration, is required to optimize the management strategy for this rare cohort of patients.
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Toward Global Consensus for MR-Guided Treatment Planning for Pancreatic Tumors on a 1.5 T MR-Linac. Int J Radiat Oncol Biol Phys 2023; 117:e305. [PMID: 37785110 DOI: 10.1016/j.ijrobp.2023.06.2326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) MR-guided SBRT with a 1.5 T MR-Linac is a relatively new therapy for pancreatic tumors with varying expertise levels. Moreover, treatment planning in the upper abdomen can be challenging as target coverage is often compromised by dosimetric constraints of abutting bowel structures. This may lead to large differences between centers in protocols, practices. To increase harmonization a worldwide consortium was founded among 1.5 T MR-Linac users. In this work we report on the outcome of the first phase within this collaboration, which is the assessment of the baseline variation between the treatment planning protocols and subsequent dose distributions. MATERIALS/METHODS Twelve centers across three continents (North America, Europe, and Australia) participated in this consortium. Each center was sent the same two anonymized data sets reflecting two cases of locally advanced pancreatic cancer of different complexity levels. The data sets included a CT scan, a predefined structure set containing the gross target volume (GTV) and the OARs, a brief medical history, tumor motion characteristics, and auxiliary CT and MR imaging. Centers were asked to create an MRgRT treatment plan according to their clinical five-fraction SBRT protocol, using their institutional margin structures, beam setup, target prescriptions, and OAR constraints. Key DVH parameters that were evaluated are D99%, D90%, D50%, D1% for the GTV and D0.5cc for the duodenum, small bowel, and stomach. RESULTS In general, large variations were observed in planning objectives and machine settings yielding widely varying inhomogeneous dose distributions to both the tumor and organs at risk (Table 1). This was especially manifest for case 2 where the tumor abutted with both the duodenum and small bowel over a trajectory of multiple centimeters. Not only were different trade-offs between target coverage and OAR sparing observed, but also different strategies for optimizing the integral dose to the tumor. CONCLUSION These results indicate a large variety in the treatment planning strategies that could well translate to differences in outcome. Based on this first evaluation, the consortium will work towards a collective consensus protocol with a second evaluation round after internal discussions.
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Extended Field Radiosurgery of Spinal Metastases with MRI-Guided Adaptive Planning: A Dosimetric Study. Int J Radiat Oncol Biol Phys 2023; 117:S164. [PMID: 37784412 DOI: 10.1016/j.ijrobp.2023.06.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Spinal metastases occur in ∼40% of cancer patients. Stereotactic body radiotherapy (SBRT) precisely delivers high doses of RT to enhance local control and reduce chronic pain. Eligibility for spine SBRT can depend on number of spine vertebrae involved. For example, RTOG 0631 was limited to two contiguous levels due to concerns about spinal cord (SC) tolerance when aligning to long targets in the mobile spine. The purpose of this study was to determine whether adaptive replanning on an MRI-Linear Accelerator could permit SBRT of longer spinal segments. MATERIALS/METHODS We randomly selected ten patients treated in the abdomen on a 0.35T MRI-Linac with MRI including L2-T8. For each patient, their simulation MRI was used to generate six distinct plans starting at 2 spinal levels incrementing to 7 spinal levels. Coverage was 90% at 16 Gy to the entire vertebrae including processes and TG-101 constraints were used for SC and other nearby organs at risk (OAR). Each plan was then rigidly fused in 6-dimensions to a treatment MRI obtained on another day (non-adaptive) and evaluated. An adaptive plan was then generated for each non-adaptive plan. Target coverage between non-adaptive and adaptive techniques was compared using paired t tests. McNemar's tests were used to compare proportions of dose objective failures for OAR between sets. RESULTS The target-coverage and number of patients meeting V10 Gy <0.35 and Dose max <14 Gy are shown in the table below with respective p-values. Statistically significant p-values (<0.05) were obtained for all criteria analyzed, especially above 4 vertebral body (VB) levels. CONCLUSION This dosimetric analysis suggests that adaptive replanning using a hybrid MR/Linac platform has the potential to safely extend spine SRS beyond the currently accepted practice of 2-3 consecutive VB levels. Future directions include applying this innovative approach in a clinical trial.
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Reducing gut microbiome-driven adipose tissue inflammation alleviates metabolic syndrome. MICROBIOME 2023; 11:208. [PMID: 37735685 PMCID: PMC10512512 DOI: 10.1186/s40168-023-01637-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 08/01/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The gut microbiota contributes to macrophage-mediated inflammation in adipose tissue with consumption of an obesogenic diet, thus driving the development of metabolic syndrome. There is a need to identify and develop interventions that abrogate this condition. The hops-derived prenylated flavonoid xanthohumol (XN) and its semi-synthetic derivative tetrahydroxanthohumol (TXN) attenuate high-fat diet-induced obesity, hepatosteatosis, and metabolic syndrome in C57Bl/6J mice. This coincides with a decrease in pro-inflammatory gene expression in the gut and adipose tissue, together with alterations in the gut microbiota and bile acid composition. RESULTS In this study, we integrated and interrogated multi-omics data from different organs with fecal 16S rRNA sequences and systemic metabolic phenotypic data using a Transkingdom Network Analysis. By incorporating cell type information from single-cell RNA-seq data, we discovered TXN attenuates macrophage inflammatory processes in adipose tissue. TXN treatment also reduced levels of inflammation-inducing microbes, such as Oscillibacter valericigenes, that lead to adverse metabolic phenotypes. Furthermore, in vitro validation in macrophage cell lines and in vivo mouse supplementation showed addition of O. valericigenes supernatant induced the expression of metabolic macrophage signature genes that are downregulated by TXN in vivo. CONCLUSIONS Our findings establish an important mechanism by which TXN mitigates adverse phenotypic outcomes of diet-induced obesity and metabolic syndrome. TXN primarily reduces the abundance of pro-inflammatory gut microbes that can otherwise promote macrophage-associated inflammation in white adipose tissue. Video Abstract.
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Preservation of deep epigastric perforators during anterior component separation technique (ACST) results in equivalent wound complications compared to transversus abdominis release (TAR). Hernia 2023; 27:819-827. [PMID: 37233922 DOI: 10.1007/s10029-023-02811-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/21/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE The use of component separation results in myofascial release and increased rates of fascial closure in abdominal wall reconstruction(AWR). These complex dissections have been associated with increased rates of wound complications with anterior component separation having the greatest wound morbidity. The aim of this paper was to compare the wound complication rate between perforator sparing anterior component separation(PS-ACST) and transversus abdominus release(TAR). METHODS Patients were identified from a prospective, single institution hernia center database who underwent PS-ACST and TAR from 2015 to 2021. The primary outcome was wound complication rate. Standard statistical methods were used, univariate analysis and multivariable logistic regression were performed. RESULTS A total of 172 patients met criteria, 39 had PS-ACST and 133 had TAR performed. The PS-ACST and TAR groups were similar in terms of diabetes (15.4% vs 28.6%, p = 0.097), but the PS-ACST group had a greater percentage of smokers (46.2% vs 14.3%, p < 0.001). The PS-ACST group had a larger hernia defect size (375.2 ± 156.7 vs 234.4 ± 126.9cm2, p < 0.001) and more patients who underwent preoperative Botulinum toxin A (BTA) injections (43.6% vs 6.0%, p < 0.001). The overall wound complication rate was not significantly different (23.1% vs 36.1%, p = 0.129) nor was the mesh infection rate (0% vs 1.6%, p = 0.438). Using logistic regression, none of the factors that were significantly different in the univariate analysis were associated with wound complication rate (all p > 0.05). CONCLUSION PS-ACST and TAR are comparable in terms of wound complication rates. PS-ACST can be used for large hernia defects and promote fascial closure with low overall wound morbidity and perioperative complications.
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111P Application of radiomics signatures and unidimensional vs volumetric measurement of early tumor growth dynamics (TGD) to predict first-line treatment outcomes in patients with stage IV non-small cell lung cancer (NSCLC). J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00366-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
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Dietary soy galactooligosaccharides affect the performance, intestinal function, and gut microbiota composition of growing chicks. Poult Sci 2023; 102:102440. [PMID: 36736136 PMCID: PMC10102551 DOI: 10.1016/j.psj.2022.102440] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 01/07/2023] Open
Abstract
The objective of this experiment was to investigate the effects of the dietary soy galactooligosaccharides (GOS), raffinose and stachyose, on performance, gastrointestinal health, and systemic stress in young broilers. Birds were fed a GOS-devoid diet based on soy protein isolate (SPI) or the SPI diet with 0.9, 1.8, 2.7, or 3.6% added stachyose and raffinose in a ratio of 4:1 at the expense of corn starch. These 5 treatments were administered to 10 replicate cages of 8 birds. Performance was measured weekly and excreta moisture, N retention, apparent metabolizeable energy, and complete blood cell counts were determined at 14 and 21 d. At 21 d, 2 birds per cage were orally gavaged with fluorescein isothiocyanate-dextran (FITC-d) and serum samples were analyzed for FITC-d as a marker of gut leakage. Additionally, intestinal morphology, crop presumptive lactic acid bacteria (LAB) counts, crop and cecal pH, and cecal microbiota via16S rRNA microbial sequencing were evaluated at 21 d. From 0 to 21 d, feed intake increased linearly (P < 0.01) as dietary GOS increased, whereas BWG increased (P < 0.05) quadratically. Feed conversion ratio increased (P < 0.01) linearly as GOS increased. There were linear increases (P < 0.05) in excreta moisture as dietary GOS increased at 14 and 21 d, as well as dose-dependent responses (P < 0.05) in N retention, AME, and AMEn. There was a quadratic increase (P < 0.05) in crop LAB recovery and a linear decrease (P < 0.01) in ceca pH as GOS increased. At 14 d, a linear increase (P < 0.05) in blood heterophil to lymphocyte ratio was observed as dietary GOS increased. Serum concentrations of FITC-d increased quadratically (P < 0.01) to dietary GOS. Increasing levels of GOS influenced alpha and beta diversities and composition of gut microbiota, including the abundance of Ruminococcus and Bifidobacterium. Results from this trial indicate that soy-derived GOS exert dose-dependent effects on nutrient utilization and intestinal health in young broilers.
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Association of Objective Risk Stratification With Frailty, Sarcopenia and Myopenia in Patients With Aortic Aneurysms. EJVES Vasc Forum 2023. [DOI: 10.1016/j.ejvsvf.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
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Fertility preservation decisions in young women with breast cancer: a qualitative study of health care professionals' views and experiences. HUM FERTIL 2022; 25:903-911. [PMID: 34096435 DOI: 10.1080/14647273.2021.1933219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Fertility preservation (FP) discussions prior to breast cancer treatment are an important aspect of care and considered routine practice. However, studies show that women diagnosed with breast cancer have unmet needs about FP discussions. To better understand them, a qualitative study was conducted to explore the perceptions of healthcare professionals (HCPs) regarding FP for young women diagnosed with breast cancer. Semi-structured interviews were performed in a University teaching hospital to explore the knowledge, attitudes and reported behaviours of HCPs (oncologists, breast surgeons, breast care specialist nurses and fertility specialists) who offer FP discussions (n = 20). Data were analysed thematically. HCPs in this study were aware of the need to discuss FP with patients but were not confident in their knowledge and were unsure of their role in the discussion. Patient characteristics of younger age, nulliparity and ethnicity appeared to influence if and how HCPs discussed FP, in addition to the personal attitudes and knowledge of HCPs. Specialist nurses were identified as having an important role in FP discussions. Raising awareness of the essential components of FP discussions by a checklist or algorithm may help in addressing ambiguity and promoting consistent FP discussions by HCPs.
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Evaluation of immunogenicity and reactogenicity of COVID-19 vaccines in pregnant women. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:673-680. [PMID: 36318630 PMCID: PMC9538835 DOI: 10.1002/uog.26050] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 07/22/2022] [Accepted: 07/29/2022] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy is associated with increased risk of adverse maternal and perinatal outcomes. Vaccines are highly effective at preventing severe coronavirus disease 2019 (COVID-19), but there are limited data on COVID-19 vaccines in pregnancy. This study aimed to investigate the reactogenicity and immunogenicity of COVID-19 vaccines in pregnant women when administered according to the 12-week-interval dosing schedule recommended in the UK. METHODS This was a cohort study of pregnant women receiving COVID-19 vaccination between April and September 2021. The outcomes were immunogenicity and reactogenicity after COVID-19 vaccination. Pregnant women were recruited by phone, e-mail and/or text and were vaccinated according to vaccine availability at their local vaccination center. For immunogenicity assessment, blood samples were taken at specific timepoints after each dose to evaluate nucleocapsid protein (N) and spike protein (S) antibody titers. The comparator group comprised non-pregnant female healthcare workers in the same age group who were vaccinated as part of the national immunization program in a contemporaneous longitudinal cohort study. Longitudinal changes in serum antibody titers and association with pregnancy status were assessed using a two-step regression approach. Reactogenicity assessment in pregnant women was undertaken using an online questionnaire. The comparator group comprised non-pregnant women aged 18-49 years who had received two vaccine doses in primary care. The association of pregnancy status with reactogenicity was assessed using logistic regression analysis. RESULTS Overall, 67 pregnant women, of whom 66 had received a mRNA vaccine, and 79 non-pregnant women, of whom 50 had received a mRNA vaccine, were included in the immunogenicity study. Most (61.2%) pregnant women received their first vaccine dose in the third trimester, while 3.0% received it in the first trimester and 35.8% in the second trimester. SARS-CoV-2 S-antibody geometric mean concentrations after mRNA vaccination were not significantly different at 2-6 weeks after the first dose but were significantly lower at 2-6 weeks after the second dose in infection-naïve pregnant compared with non-pregnant women. In pregnant women, prior infection was associated with higher antibody levels at 2-6 weeks after the second vaccine dose. Reactogenicity analysis included 108 pregnant women and 116 non-pregnant women. After the first dose, tiredness and chills were reported less commonly in pregnant compared with non-pregnant women (P = 0.043 and P = 0.029, respectively). After the second dose, feeling generally unwell was reported less commonly (P = 0.046) in pregnant compared with non-pregnant women. CONCLUSIONS Using an extended 12-week interval between vaccine doses, antibody responses after two doses of mRNA COVID-19 vaccine were found to be lower in pregnant compared with non-pregnant women. Strong antibody responses were achieved after one dose in previously infected women, regardless of pregnancy status. Pregnant women reported fewer adverse events after both the first and second dose of vaccine. These findings should now be addressed in larger controlled studies. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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FP.28 IGNITE DMD phase I/II study of SGT-001 microdystrophin gene therapy for DMD: Long-term outcomes and expression update. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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207 Accuracy of Reviewing NELA Operation Data Entry in Emergency Laparotomy. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim
The National Emergency Laparotomy Audit (NELA) is part of the National Clinical Audit and data can often be submitted by a non-surgical clinician who do not perform the procedure, whereas operating notes are written mostly by the primary surgeon. A concern for possible discrepancies prompted a comparison between the operation notes and the NELA audit data, to assess for accuracy and understanding of the NELA inclusion/exclusion criteria.
Method
Operation data was collected retrospectively from the NELA database from January to December 2020. The surgeon's operation notes were reviewed and compared. Main parameters compared included ‘indication of surgery’, ‘main operation procedure’, ‘operative findings', ‘peritoneal contamination’ and ‘level of contamination’. The inclusion and exclusion criteria for NELA audit was also assessed and compared. A further questionnaire survey was performed to review the understanding of the procedure
Results
Total of 171 data was retrieved from the NELA database from the selected time-period.
Out of these, 4.6% fulfilled the exclusion criteria. ‘Indication of operation’ were not consistent in 14 entries while in Operation procedure 4.9%. ‘Main operative findings’ were inconsistent in 11% cases. The Survey showed surgical difference in reviewing the operation notes.
Conclusions
There were significant portion of discrepancies between the surgical operating notes and NELA data entry when compared, due to retrospective entry and two different clinicians. There is a lack of clear understanding for the inclusion/exclusion criteria. We would like to recommend that the primary surgeon who performs the procedure records both the operating notes and the NELA data entry.
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Vessel wall magnetic resonance and arterial spin labelling imaging in the management of presumed inflammatory intracranial arterial vasculopathy. Brain Commun 2022; 4:fcac157. [PMID: 35813881 PMCID: PMC9263889 DOI: 10.1093/braincomms/fcac157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 02/08/2022] [Accepted: 06/17/2022] [Indexed: 11/25/2022] Open
Abstract
Optimal criteria for diagnosing and monitoring response to treatment for infectious and inflammatory medium–large vessel intracranial vasculitis presenting with stroke are lacking. We integrated intracranial vessel wall MRI with arterial spin labelling into our routine clinical stroke pathway to detect presumed inflammatory intracranial arterial vasculopathy, and monitor disease activity, in patients with clinical stroke syndromes. We used predefined standardized radiological criteria to define vessel wall enhancement, and all imaging findings were rated blinded to clinical details. Between 2017 and 2018, stroke or transient ischaemic attack patients were first screened in our vascular radiology meeting and followed up in a dedicated specialist stroke clinic if a diagnosis of medium–large inflammatory intracranial arterial vasculopathy was radiologically confirmed. Treatment was determined and monitored by a multi-disciplinary team. In this case series, 11 patients were managed in this period from the cohort of young stroke presenters (<55 years). The median age was 36 years (interquartile range: 33,50), of which 8 of 11 (73%) were female. Two of 11 (18%) had herpes virus infection confirmed by viral nucleic acid in the cerebrospinal fluid. We showed improvement in cerebral perfusion at 1 year using an arterial spin labelling sequence in patients taking immunosuppressive therapy for >4 weeks compared with those not receiving therapy [6 (100%) versus 2 (40%) P = 0.026]. Our findings demonstrate the potential utility of vessel wall magnetic resonance with arterial spin labelling imaging in detecting and monitoring medium–large inflammatory intracranial arterial vasculopathy activity for patients presenting with stroke symptoms, limiting the need to progress to brain biopsy. Further systematic studies in unselected populations of stroke patients are needed to confirm our findings and establish the prevalence of medium–large artery wall inflammation.
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"Can we have a little humanity here?": Patient perspectives on the impact of a standardized care process for patients who use opioids for the management of chronic pain. PATIENT EDUCATION AND COUNSELING 2022; 105:2404-2409. [PMID: 35184907 DOI: 10.1016/j.pec.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 01/25/2022] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Standardized processes have evolved in response to the opioid epidemic. The impact of standardized processes on patients has not been adequately described. METHODS Five focus groups were held at four affiliated academic family medicine clinics. All participants experienced a transition to a standardized process for their ongoing opioid use for chronic, non-cancer pain. Data was analyzed and coded using a grounded theory approach with NVivo12 (QSR International). RESULTS Thirty patients participated. Five main themes emerged: experience of pain; view of opioid medications; view of opioid prescribing process changes; "good patients" and trust; and experience with medical clinicians and clinics. CONCLUSIONS Standardized processes created to improve the safety of opioid prescribing have burdened patients and resulted in a loss of trust and autonomy. Patients perceived greater risks for other patients prescribed opioids and processes are a result of their actions. PRACTICE IMPLICATIONS Healthcare systems must acknowledge patients' burden, shift away from interventions that are limited in supporting data, reinforce patient agency and shift the conversation to unsafe medications rather than supervision of "bad actors".
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Knowledge Retention Using "Relay": A Novel Active-Learning Technique. PRIMER (LEAWOOD, KAN.) 2022; 6:12. [PMID: 35801197 PMCID: PMC9256294 DOI: 10.22454/primer.2022.586676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Many residency programs utilize passive didactic lectures despite mixed evidence for knowledge retention. This prospective study investigated the efficacy of "relay," an active-learning technique, as measured by residents' knowledge retention and attitudes compared to traditional format. METHODS Faculty presented lectures to four family medicine residency programs on a randomized schedule. Lectures were followed by a 15-minute question-and-answer (Q&A) session or relay session. A relay is a collaborative, question-based game. The primary outcome was knowledge retention at 3 months, comparing Q&A to relay sessions as measured by a multiple-choice assessment. Responses were only included if a given resident completed knowledge assessments for both Q&A and relay sessions, to allow for intraresident adjustments, in addition to program, training year, and lecturer/topic. Secondary outcomes included residents' self-perceived knowledge and engagement as surveyed by an ordinal scale immediately following the learning session. RESULTS The primary analysis included 51 responses from 18 unique residents. The adjusted mean knowledge assessment score at 3 months was not statistically different after the relay sessions compared to Q&A (67% vs 60%, respectively; 7% difference, 95% CI: -4 to 18%, P=.20). For the secondary outcomes of learner attitudes (n=143 responses), learners reported greater engagement after the relay sessions compared to Q&A (51% vs 28% "very engaged"; overall P=.003), but self-perceived knowledge was not significantly different (overall P=.05, rounded down). CONCLUSIONS The relay technique did not show significant difference in 3-month knowledge retention, nor immediate self-perceived knowledge, despite greater learner self-perceived engagement.
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The exercise in pulmonary arterial hypertension (ExPAH) study: a randomised controlled pilot of exercise training and multidisciplinary rehabilitation in pulmonary arterial hypertension. Pulm Circ 2022; 12:e12069. [PMID: 35795491 PMCID: PMC9248794 DOI: 10.1002/pul2.12069] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 11/09/2022] Open
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242 The Importance of Frailty Assessment as a Mortality Indicator and Surgical Decision-Making Tool. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Frailty is a multidimensional syndrome, which can lead to poorer health outcome. Frailty score is a proven reliable indicator of post-operative morbidity and mortality; however, its application in clinical practice is limited.
Aim
The study aimed to assess the association between frailty marker and one- year mortality rate and explore its impact in clinical decision making in patients with abdominal aortic aneurysms.
Method
Consecutive patients with abdominal, thoracic, and thoracoabdominal aortic aneurysms presented at dedicated aortic clinic between July 2019 and April 2020 were included. Markers for frailty and sarcopenia using Rockwood Clinical Frailty Scale, SARC-F questionnaire, morphometric analysis for sarcopenia, one-year mortality and fitness were recorded. Multi-disciplinary team (MDT) was blinded to frailty and sarcopenia data; surgical decisions made by MDT were recorded separately.
Results
We assessed 83 patients (median age 75 [72,82], 85% male; median aneurysm diameter 6cm [5.8,7.0]. Sixteen patients were deemed frail, five patients had sarcopenia and thirty-one patients had myopenia. Seventeen patients were deemed not fit for surgery; 41% of these were frail compared with 14% out of those who were deemed fit. The odds ratio of being frail and unfit for surgery was 4.33 (95% CI 1.27–14.82, p = 0.010). Frailty was significantly associated with one-year mortality irrespective of fitness for surgery, sarcopenia and myopenia (OR 10.28, 95%CI 1.82–57.93, p = 0.009). SARC-F and myopenia was not associated with one-year mortality at (OR 1.66, 95%CI 0.03–19.25, p = 0.523) and (OR 0.59, 95%CI 0.09–2.85, p = 0.514), respectively.
Conclusions
Frailty score was associated with both one-year mortality and fitness for surgery decision made by MDT.
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Association of SARC-F Score and Rockwood Clinical Frailty Scale with CT-Derived Muscle Mass in Patients with Aortic Aneurysms. J Nutr Health Aging 2022; 26:792-798. [PMID: 35934824 DOI: 10.1007/s12603-022-1828-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Patients with aortic aneurysms (AA) are often co-morbid and susceptible to frailty. Low core muscle mass has been used as a surrogate marker of sarcopenia and indicator of frailty. This study aimed to assess association between core muscle mass with sarcopenia screening tool SARC-F and Clinical Frailty Scale (CFS) in patients with AA. METHODS Prospective audit of patients in pre-operative aortic clinic between 01/07/2019-31/01/2020 including frailty assessment using Rockwood CFS and sarcopenia screening using SARC-F questionnaire. Psoas and sartorius muscle area were measured on pre-operative CT scans and adjusted for height. Association was assessed using Spearman's rank correlation coefficient. RESULTS Of 84 patients assessed, median age was 75 years [72,82], 84.5% were men, 65.5% were multimorbid and 63.1% had polypharmacy. Nineteen percent were identified as frail (CFS score >3) and 6.1% positively screened for sarcopenia (SARC-F score 4 or more). Median psoas area (PMA) at L3 was 5.6cm2/m2 [4.8,6.6] and L4 was 7.4cm2/m2 [6.3,8.6]. Median sartorius area (SMA) was 1.8 cm2/m2 [1.5,2.2]. CFS demonstrated weak but statistically significant negative correlation with height-adjusted PMA at L3 (r=-0.25, p=0.034) but not at L4 (r=-0.23, p=0.051) or with SMA (r=-0.22, p=0.065). No association was observed between SARC-F score and PMA or SMA (L3 PMA r=-0.015, p=0.9; L4 PMA r=-0.0014, p= 0.99; SMA r=-0.051, p=0.67). CONCLUSION CFS showed higher association with CT-derived muscle mass than SARC-F. Comprehensive pre-operative risk-stratification tools which incorporate frailty assessment and body composition analysis may assist in decision making for surgery and allow opportunity for pre-habilitation.
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Female Urgency, Trial of Urodynamics as Routine Evaluation (FUTURE study): a superiority randomised clinical trial to evaluate the effectiveness and cost-effectiveness of invasive urodynamic investigations in management of women with refractory overactive bladder symptoms. Trials 2021; 22:745. [PMID: 34702331 PMCID: PMC8546752 DOI: 10.1186/s13063-021-05661-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 09/24/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Overactive bladder (OAB) syndrome is a symptom complex affecting 12-14% of the UK adult female population. Symptoms include urinary urgency, with or without urgency incontinence, increased daytime urinary frequency and nocturia. OAB has a negative impact on women's social, physical, and psychological wellbeing. Initial treatment includes lifestyle modifications, bladder retraining, pelvic floor exercises and pharmacological therapy. However, these measures are unsuccessful in 25-40% of women (refractory OAB). Before considering invasive treatments, such as Botulinum toxin injection or sacral neuromodulation, most guidelines recommend urodynamics to confirm diagnosis of detrusor overactivity (DO). However, urodynamics may fail to show evidence of DO in up to 45% of cases, hence the need to evaluate its effectiveness and cost-effectiveness. FUTURE (Female Urgency, Trial of Urodynamics as Routine Evaluation) aims to test the hypothesis that, in women with refractory OAB, urodynamics and comprehensive clinical assessment is associated with superior patient-reported outcomes following treatment and is more cost-effective, compared to comprehensive clinical assessment only. METHODS FUTURE is a pragmatic, multi-centre, superiority randomised controlled trial. Women aged ≥ 18 years with refractory OAB or urgency predominant mixed urinary incontinence, and who have failed/not tolerated conservative and medical treatment, are considered for trial entry. We aim to recruit 1096 women from approximately 60 secondary/tertiary care hospitals across the UK. All consenting women will complete questionnaires at baseline, 3 months, 6 months and 15 months post-randomisation. The primary outcome is participant-reported success at 15 months post-randomisation measured using the Patient Global Impression of Improvement. The primary economic outcome is incremental cost per quality-adjusted life year gained at 15 months. The secondary outcomes include adverse events, impact on other urinary symptoms and health-related quality of life. Qualitative interviews with participants and clinicians and a health economic evaluation will also be conducted. The statistical analysis of the primary outcome will be by intention-to-treat. Results will be presented as estimates and 95% CIs. DISCUSSION The FUTURE study will inform patients, clinicians and policy makers whether routine urodynamics improves treatment outcomes in women with refractory OAB and whether it is cost-effective. TRIAL REGISTRATION ISRCTN63268739 . Registered on 14 September 2017.
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281 The Impact of Documenting Patient Weight in Kilograms on Pediatric Medication Dosing Errors in Emergency Medical Services. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Temporomandibular joint dysfunction following the use of a supraglottic airway device during general anaesthesia: a prospective observational study. Anaesthesia 2021; 76:1511-1517. [PMID: 34289084 DOI: 10.1111/anae.15533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 11/29/2022]
Abstract
Supraglottic airway devices are commonly used to manage the airway during general anaesthesia. There are sporadic case reports of temporomandibular joint dysfunction and dislocation following supraglottic airway device use. We conducted a prospective observational study of adult patients undergoing elective surgery where a supraglottic airway device was used as the primary airway device. Pre-operatively, all participants were asked to complete a questionnaire involving 12 points adapted from the Temporomandibular Joint Scale and the Liverpool Oral Rehabilitation Questionnaire. Objective measurements included inter-incisor distance as well as forward and lateral jaw movements. The primary outcome was the inter-incisor distance, an accepted measure of temporomandibular joint mobility. Both the questionnaire and measurements were repeated in the postoperative period and we analysed data from 130 participants. Mean (SD) inter-incisor distance in the pre- and postoperative period was 46.5 (7.2) mm and 46.3 (7.5) mm, respectively (p = 0.521) with a difference (95%CI) of 0.2 (-0.5 to 0.9) mm. Mean (SD) forward jaw movement in the pre- and postoperative period was 3.6 (2.4) mm and 3.9 (2.4) mm, respectively (p = 0.018). Mean (SD) lateral jaw movement to the right in the pre- and postoperative period was 8.9 (4.1) mm and 9.1 (4.0) mm, respectively (p = 0.314). Mean (SD) lateral jaw movement to the left in the pre- and postoperative period was 8.8 (4.0) mm and 9.3 (3.6) mm, respectively (p = 0.008). The number of patients who reported jaw clicks or pops before opening their mouth as wide as possible was 28 (21.5%) vs. 12 (9.2%) in the pre- and postoperative period, respectively (p < 0.001) with a difference (95%CI) of 12.3% (6.7-17.9%). There was no significant difference in the responses to the other 11 questions or in the number of patients who reported pain in the temporomandibular joint area postoperatively. No clinically significant dysfunction of the temporomandibular joint following the use of supraglottic airway devices in the postoperative period was identified by either patient questionnaires or objective measurements.
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Creating a Path for Systematic Investigation of Children With Cortical Visual Impairment Who Use Augmentative and Alternative Communication. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1880-1893. [PMID: 34081538 DOI: 10.1044/2021_ajslp-20-00203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose There is limited information about how to support children with cortical visual impairment (CVI) who require augmentative and alternative communication (AAC). An initial review designed to explore the available evidence was used to outline critical needs in moving research and intervention forward for children who use AAC and have CVI. Method Previous systematic reviews, six databases, and theses and dissertations were systematically searched, along with reviews of the resulting works cited. An initial yield of 575 articles was narrowed to 10, which discussed AAC interventions that included children with CVI. Results Three interventions were technology based, and seven were instructional based. The use of textured microswitches was the most frequent form of technology intervention, with the frequency of switch activations being the most frequently coded outcome. Overall, the studies represent explorations in the area rather than systematic lines of inquiry. Conclusions While evidence shows at least some children with CVI have been included in AAC research to date, the inclusion is more incidental than deliberate. Issues such as clear descriptions of the vision capabilities and needs of participants may have impacted study results.
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Sevelamer crystals-an unusual cause of large bowel obstruction. J Surg Case Rep 2021; 2021:rjab228. [PMID: 34150192 PMCID: PMC8208801 DOI: 10.1093/jscr/rjab228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Abstract
Sevelamer is a common phosphate binder used to manage hyperphosphatemia in end-stage renal disease. The medication has a well-documented gastrointestinal side-effect profile including nausea, vomiting and abdominal pain. There are few case reports of Sevelamer crystal deposition causing gastrointestinal mucosal injury, pseudotumor or obstruction. Here, we discuss a patient on Sevelamer who required operative management of a sigmoid obstruction. Surgical pathology showed pericolonic abscess with Sevelamer crystals.
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Abstract
Ammonium fluoride, NH4F, is often seen as an analog to ice, with several of its solid phases closely resembling known ice phases. While its ionic and hydrogen-ordered nature puts topological constraints on the ice-like network structures it can form, it is not clear what consequences these constraints have for NH4F compound formation and evolution. Here, we explore computationally the reach and eventual limits of the ice analogy for ammonium fluoride. By combining data mining of known and hypothetical ice networks with crystal structure prediction and density functional calculations, we explore the high-pressure phase diagram of NH4F and host-guest compounds of its hydrides. Pure NH4F departs from ice-like behavior above 80 GPa with the emergence of close-packed ionic structures. The predicted stability of NH4F hydrides shows that NH4F can act as a host to small guest species, albeit in a topologically severely constraint configuration space. Finally, we explore the binary NH3-HF chemical space, where we find candidate structures for several unsolved polyfluoride phases; among them is the chemical analog to H2O2 dihydrate.
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Abstract
7549 Background: Receptor tyrosine kinase-like Orphan Receptor 1 (ROR1) is a type I transmembrane protein is highly expressed on an array of haematological and solid tumours. NVG-111 is a humanised, tandem scFv ROR1xCD3 bispecific antibody previously shown to elicit potent killing of tumour cells in vitro and in vivo by engaging a membrane-proximal epitope in the Wnt5a-binding Frizzled domain of ROR1 and redirecting T cell activity. The in vitro potency and pharmacodynamic responses to NVG-111 were assessed to support progression to a first-in-human study. Methods: The potency of NVG-111 in vitro was determined by evaluating the concentration response for cytotoxicity, T cell activation, and cytokine release in co-cultured Jeko-1 and unstimulated human T cells. Comparative data were generated for the marketed CD19xCD3 bispecific antibody, blinatumomab. Potency data for NVG-111 were used together with allometric scaling from murine PK studies to inform planned clinical doses. Results: NVG-111 demonstrated T cell-dependent cytotoxicity, T cell activation and levels of cytokine release similar in potency to blinatumomab. Cytotoxic responses of both NVG-111 and blinatumomab were more potent than T cell activation and cytokine release. Dose response curves for NVG-111 showed a decrease in activity beyond the concentration of maximal response (ie “hook effect”). We hypothesise this is due to receptor saturation, inhibiting synapse formation. NVG-111 has progressed to a Phase 1/2 first-in-human study in patients with debulked, relapsed/refractory chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL), the drug given as add-on to ≥2nd line therapy with a Bruton’s tyrosine kinase inhibitor, or venetoclax. Phase 1 includes escalating doses of 0.3 to 360 µg/day via continuous infusion over 3 cycles (each 21 days on, 7 days off) to establish safety, PK, pharmacodynamics (PD) and recommended phase 2 dose (RP2D). Predicted exposure at 0.3 µg/day is ̃EC20 for cytotoxicity in vitro and below the lowest EC10 for cytokine release. PD biomarkers in the study include systemic cytokines. Phase 2 will study efficacy and safety of the RP2D in CLL and MCL, with primary endpoint complete response rate; other efficacy endpoints include minimal residual disease and progression free survival. Conclusions: NVG-111 shows potent T-cell mediated lymphoma cell cytotoxicity in vitro at concentrations well below those associated with extensive cytokine release. NVG-111 is in an ongoing Phase 1/2 study and may present a novel option for adoptive immunotherapy in patients with non-Hodgkin lymphoma and potentially other cancers. Clinical trial information: 2020-000820-20. [Table: see text]
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Abstract No. 580 Lower risk of major arterial hemorrhage after percutaneous biliary drainage with primary stent versus primary catheter placement. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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From Hospital to the Community: Redesigning the Human Immunodeficiency Virus (HIV) Clinical Service Model to Respond to an Outbreak of HIV Among People Who Inject Drugs. J Infect Dis 2021; 222:S410-S419. [PMID: 32877546 PMCID: PMC7467274 DOI: 10.1093/infdis/jiaa336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
An outbreak of human immunodeficiency virus (HIV) among people who inject drugs in Glasgow, Scotland started in 2014. We describe 156 cases over 5 years and evaluate the impact of clinical interventions using virological and phylogenetic analysis. We established (1) HIV services within homeless health facilities, including outreach nurses, and (2) antiretroviral therapy (ART) via community pharmacies. Implementation of the new model reduced time to ART initiation from 264 to 23 days and increased community viral load suppression rates to 86%. Phylogenetic analysis demonstrated that 2019 diagnoses were concentrated within a single network. Traditional HIV care models require adaptation for this highly complex population.
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Antiretroviral Adherence, Drug Resistance, and the Impact of Social Determinants of Health in HIV-1 Patients in the US. AIDS Behav 2020; 24:3562-3573. [PMID: 32488554 DOI: 10.1007/s10461-020-02937-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Adherence to antiretroviral therapy (ART) is critical to achieving viral suppression. However, social determinants of health (SDoH) can undermine patient adherence to ART, resulting in drug resistance that compromises future treatment options. We assessed ART adherence and HIV-1 drug resistance at the national and state levels in the US and investigated their associations with SDoH and other HIV-related outcomes. Data were obtained from Symphony Health's Integrated Dataverse (IDV), Monogram/LabCorp Database, as well as national and publicly available databases, including Centers for Disease Control and Prevention (CDC), American Community Survey (ACS), and J. Kaiser Family Foundation (KFF). Inferential analyses were performed to investigate associations using patient-level data, and the results were reported by state and overall within the nation. Correlations between continuous variables were estimated by the Spearman's test, and that between continuous variable and categorical variable were estimated using one-way analysis of variance (ANOVA). State-level rates of poor adherence and resistance ranged from 26 to 55% and 20 to 54%, respectively. Female gender, non-white race, low education, poverty, and unemployment were associated with poor adherence; female gender was associated with drug resistance. Both adherence and resistance were correlated to HIV prevalence rates. Our findings suggest that US patients living with HIV face great challenges associated with poor ART adherence and HIV-1 drug resistance.
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The uncertainty of thyroid dose estimate in chest CT. Biomed Phys Eng Express 2020; 6. [DOI: 10.1088/2057-1976/abb8f3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/16/2020] [Indexed: 11/12/2022]
Abstract
Abstract
Dose to the thyroid from helical chest CT can vary significantly due to the random tube start point, pitch factor, thyroid position relative to the isocenter, and beam width. We used optically stimulated luminescence dosimeters (OSLDs) and an adult anthropomorphic phantom to investigate the uncertainty of thyroid dose estimate. Maximum gap or overlap in the helical beam was estimated using the above factors. Using the maximum gap/overlap over the thyroid, different possible scenarios were simulated and the degree of missed thyroid tissue by the primary beam was estimated. Results showed a variation of >30% in the average thyroid dose, and >50% if a single dosimeter was used to determine dose to the thyroid. Furthermore, measured doses were compared to those calculated by Monte Carlo simulation software, which automatically matches the anatomy of the localizer radiograph with the stylized computational phantom used for dose calculation. The difference was significant: the dose given by the Monte Carlo software was ∼50% lower than the average dose measured with the phantom in all three chest protocols. In addition, the software does not take the effect of the random tube start angle into account.
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67-year-old man • upper extremity pain & edema • recent diagnosis of heart failure • Dx? THE JOURNAL OF FAMILY PRACTICE 2020; 69:466-468. [PMID: 33176344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
► Upper extremity pain ► Upper extremity edema ► Recent diagnosis of heart failure.
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Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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Quantitative sensory testing in feline osteoarthritic pain - a systematic review and meta-analysis. Osteoarthritis Cartilage 2020; 28:885-896. [PMID: 32360738 DOI: 10.1016/j.joca.2020.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 03/31/2020] [Accepted: 04/20/2020] [Indexed: 02/06/2023]
Abstract
UNLABELLED Quantitative sensory testing (QST) is a psychophysical test used to quantify somatosensory sensation under normal or pathological conditions including osteoarthritis (OA). OBJECTIVE This study aimed to conduct a systematic review and meta-analysis of studies using QST in healthy and osteoarthritic cats, registered at Systematic Review Research Facility (#26-06-2017). DESIGN Hierarchical models with random intercepts for each individual study extracted through the systematic review were fit to subject-level data; QST measures were contrasted between healthy and osteoarthritic cats. Four bibliographic databases were searched; quality and risk of bias assessment were performed using pre-established criteria. RESULTS Six articles were included; most were of high quality and low risk of bias. Punctate tactile threshold (n = 70) and mechanical temporal summation (n = 35) were eligible for analysis. Cats with OA have lower punctate tactile threshold [mean difference (95%HDI): -44 (-60; -26) grams] and facilitated temporal summation of pain [hazard ratio (95%HDI): 5.32 (2.19; 14) times] when compared with healthy cats. The effect of sex and body weight on sensory sensitivity remained inconclusive throughout all analyses. Due to the correlation between age and OA status, it remains difficult to assess the effect of OA on sensory sensitivity, independently of age. CONCLUSIONS Clear and transparent reporting using guidelines are warranted. Similar to people, centralized sensitization is a feature of OA in cats. Future studies should try to elucidate the age effect on feline OA. Research with natural OA in cats is promising with potential to benefit feline health and welfare, and improve translatability to clinical research.
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A novel in vivo model using immunotoxin in the absence of p-glycoprotein to achieve ultra selective depletion of target cells: Applications in trogocytosis and beyond. J Immunol Methods 2020; 483:112794. [PMID: 32428450 DOI: 10.1016/j.jim.2020.112794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/05/2020] [Accepted: 05/09/2020] [Indexed: 11/18/2022]
Abstract
A commonly employed method to determine the function of a particular cell population and to assess its contribution to the overall system in vivo is to selectively deplete that population and observe the effects. Using monoclonal antibodies to deliver toxins to target cells can achieve this with a high degree of efficiency. Here, we describe an in vivo model combining the use of immunotoxins and multidrug resistant (MDR) gene deficient mice so that only MDR deficient cells expressing the target molecule would be depleted while target molecule expressing, but MDR sufficient, cells are spared. This allows targeted depletion at a higher degree of specificity than has been previously achieved. We have applied this technique to study trogocytosis, the intercellular transfer of cell surface molecules, but this principle could also be adapted using technology already available for use in other fields of study.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B/deficiency
- ATP Binding Cassette Transporter, Subfamily B/genetics
- ATP Binding Cassette Transporter, Subfamily B, Member 1/metabolism
- ATP Binding Cassette Transporter, Subfamily G, Member 2/deficiency
- ATP Binding Cassette Transporter, Subfamily G, Member 2/genetics
- Animals
- Cytotoxicity, Immunologic/drug effects
- Female
- Genes, MDR/physiology
- Graft Survival/drug effects
- Heart Transplantation
- Histocompatibility Antigens Class II/immunology
- Immunoconjugates/toxicity
- Immunoglobulin Fab Fragments/toxicity
- Immunotoxins/toxicity
- Kidney Transplantation
- Lymphocyte Depletion/methods
- Mice, Inbred C57BL
- Mice, Inbred CBA
- Mice, Knockout
- Ribosome Inactivating Proteins, Type 1/toxicity
- Spleen/drug effects
- Spleen/immunology
- Spleen/pathology
- Transplantation Tolerance/drug effects
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Abstract
Deferoxamine, deferiprone, and deferasirox are used for the treatment of systemic iron overload, although they possess limitations due to lack of oral activity, lower efficacy, and side effects. These limitations led to a search for an orally active iron chelator with an improved therapeutic index. The lower efficacy of deferiprone is due to rapid glucuronidation, leading to the formation of a nonchelating metabolite. Here, we demonstrate that the influence of metabolism can be reduced by introducing a sacrificial site for glucuronidation. A log P-guided investigation of 20 hydroxpyridinones led to the identification of CN128. The Fe(III) affinity and metal selectivity of CN128 are similar to those of deferiprone, the log P value is more lipophilic, and its iron scavenging ability is superior. Overall, CN128 was demonstrated to be safe in a range of toxicity assessments and is now in clinical trials for the treatment of β-thalassemia after regular blood transfusion.
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P218 Disentangling EEG responses to TMS due to cortical and peripheral activations. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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CTXA hip: the effect of partial volume correction on volumetric bone mineral density data for cortical and trabecular bone. Arch Osteoporos 2020; 15:50. [PMID: 32193671 DOI: 10.1007/s11657-020-00721-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 02/25/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study compares the results of computed tomography X-ray absorptiometry (CTXA) hip volumetric BMD (vBMD) analyses of cortical and trabecular bone with and without partial volume correction. For cortical bone in some circumstances, corrected cortical volumes were negative and corrected vBMD was very high. For trabecular bone, the correction effects are smaller. CTXA volumetric data should be interpreted with caution. PURPOSE Previous studies have reported concerns about the reliability of CTXA hip cortical vBMD measurements generated using partial volume (PV) correction (the "default" analysis, with cortical PV correction). To date, no studies have examined the results of the alternative ("new") analysis (with trabecular PV correction). This study presents in vivo and phantom data comparing the corrected and uncorrected data for cortical and trabecular bone respectively. METHODS We used the commercial QCTPro CTXA software to analyze CT scans of 129 elderly Chinese men and women and an anthropomorphic European Proximal Femur phantom (EPFP) and accessed data for two alternative scan analyses using the database dump utility. The CTXA software gives the user two methods of performing the PV correction: (1) a default analysis in which only cortical bone results are corrected; (2) a new analysis in which only trabecular bone results are corrected. Both methods are based on a numerical recalculation of vBMD values without any change in volume of interest (VOI) placement. RESULT In vivo, the results of the two analyses for integral bone were the same while cortical and trabecular results were different. PV correction of cortical bone led to a decrease of cortical volume for all four VOIs: total hip (TH), femoral neck (FN), trochanter (TR), and intertrochanter (IT) volumes were reduced on average by 7.8 cm3, 0.9 cm3, 2.5 cm3, and 4.3 cm3 respectively. For TR, where cortex was thinnest, average corrected cortical volume was negative (- 0.4± 1.3 cm3). Corrected cortical vBMD values were much larger than uncorrected ones for TH, FN, and IT. Scatter plots of corrected cortical vBMD against cortical bone thickness showed that elevated results correlated with thinner cortices. When trabecular bone was corrected for the PV effect, trabecular volumes of TH, FN, TR, and IT were reduced on average by 7.9 cm3, 0.8 cm3, 2.6 cm3, and 4.4 cm3 respectively, while vBMD measurements were increased correspondingly. The trabecular volume and vBMD measurements of the two datasets both had highly positive correlations. For the EPFP, the PV-corrected FN data deviated from the nominal phantom value, but was closer for the TR and IT VOIs. Both corrected and uncorrected data overestimated trabecular vBMD, with the corrected results showing greater deviation from nominal values. CONCLUSION The default and new CTXA analyses for volumetric data generate different results, both for cortical and trabecular bone. For cortical bone, the uncorrected results are subject to partial volume effects but the correction method of the default analysis overcorrects the effect leading to in part unreasonable results for cortical bone volume and BMD. For trabecular bone, the correction effects are smaller. CTXA volumetric data should be interpreted with caution.
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Evaluating temporal patterns of metals concentrations in floodplain lakes of the Athabasca Delta (Canada) relative to pre-industrial baselines. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 704:135309. [PMID: 31896213 DOI: 10.1016/j.scitotenv.2019.135309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/24/2019] [Accepted: 10/29/2019] [Indexed: 06/10/2023]
Abstract
Sediment quality monitoring is widely used to quantify extent of river pollution, but requires knowledge of pre-disturbance conditions in the potentially altered landscape. This has long been identified as a critical aspect to develop for addressing concerns of river pollution in the Alberta Oil Sands Region. Here, we use analyses of sediment cores from eight floodplain lakes spanning a 67 river-km transect across the Athabasca Delta to define pre-1920 (pre-industrial) baseline concentrations for vanadium and five primary pollutants. We then evaluate if sediment metals concentrations have become enriched above baseline since onset of oil sands development and other industrial activities. Results demonstrate no enrichment of metals concentrations (except zinc at one lake) and absence of consistent temporal increases above pre-industrial baselines. Thus, natural processes continue to dominate metal deposition in floodplain lakes of the Athabasca Delta -- an important finding to inform stewardship decisions. The pre-1920 metals concentrations baselines offer a useful tool for ongoing sediment monitoring in aquatic ecosystems of the Athabasca Delta.
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Open retromuscular versus laparoscopic ventral hernia repair for medium-sized defects: where is the value? Hernia 2020; 24:759-770. [PMID: 31930440 DOI: 10.1007/s10029-019-02114-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE There is increasing emphasis on value in health care, defined as quality over cost required to deliver care. We analyzed outcomes and costs of repairing medium-sized ventral hernias to identify whether an open retromuscular or laparoscopic intraperitoneal onlay approach would provide superior value to the patient and healthcare system. METHODS A retrospective analysis of prospectively collected data from the Americas Hernia Society Quality Collaborative was performed for patients undergoing clean, elective repair of ventral hernias between 4 and 8 cm in width at our institution between 4/2013 and 12/2016 for whom at least 1-year follow-up was available. Recurrence rates, wound complications, length of stay, patient-reported outcomes, and perioperative costs were compared. RESULTS One hundred and eighty-six patients met criteria (105 open, 81 laparoscopic) with 93.5% having ≥ 2-year follow-up. Patients undergoing laparoscopic repair had higher BMI, lower ASA classification, slightly lower prevalence of recurrent hernias and less prior mesh utilization, and slightly smaller hernias. Length of stay was shorter in the laparoscopic group (median 1 vs. 3 days, p < 0.001), without increased readmissions. Recurrence rates, wound complications, and patient-reported outcomes were similar. Laparoscopic repair had higher up-front surgical costs, yet equivalent total perioperative costs. CONCLUSION Both laparoscopic and open approaches for elective repair of medium-sized ventral hernias offer similar clinical outcomes, patient-reported outcomes, and total perioperative costs. Laparoscopic repair appears to offer superior value based on a significantly reduced postoperative length of stay.
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The second-hand effects of antibiotics: communicating the public health risks of drug resistance. JAC Antimicrob Resist 2019; 1:dlz059. [PMID: 34222933 DOI: 10.1093/jacamr/dlz059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Antimicrobial resistance (AMR) poses a threat to modern medicine, but there are challenges in communicating its urgency and scope and potential solutions to this growing problem. It is recognized that AMR has a 'language problem' and the way in which healthcare professionals communicate about AMR may not always resonate with patients. Many patients are unaware that antibiotics can have detrimental effects to those beyond the recipient, due to transmission of drug-resistant organisms. The overestimation of benefits and underestimation of risks helps to fuel demand for antibiotic use in situations where they may be of little or no benefit. To better communicate risks, clinicians may borrow the term 'second-hand' from efforts to reduce smoking cessation. We present several examples where antibiotics themselves have second-hand effects beyond the individual recipient in hospitals, long-term care homes and the community. Incorporation of the concept of the second-hand effects of antibiotics into patient counselling, mass messaging and future research may help facilitate a more balanced discussion about the benefits and risks of antibiotic use in order to use these agents more appropriately.
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160 The Development of Exception from Informed Consent and Waiver of Informed Consent Guidelines for Emergency Medicine Researchers. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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P.197Use of the D3-creatine dilution test as a non-invasive and accurate measurement of total body muscle mass in Duchenne muscular dystrophy. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Descriptive analysis of dosing and outcomes for patients with ibrutinib-treated relapsed or refractory chronic lymphocytic leukemia in a Canadian centre. ACTA ACUST UNITED AC 2019; 26:e610-e617. [PMID: 31708654 DOI: 10.3747/co.26.4957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Ibrutinib is an approved treatment for relapsed or refractory chronic lymphocytic leukemia (cll) and small lymphocytic lymphoma (sll). The effect of ibrutinib dose reduction compared with discontinuation in a population-based setting is unclear. Methods To examine the patterns of ibrutinib use in a Canadian population-based setting, we analyzed a retrospective cohort of patients with relapsed or refractory cll or sll treated with ibrutinib. Results The 64 patients diagnosed with cll or sll had a median age of 76.5 years. Most had unmutated ighv (immunoglobulin variable heavy chain). A hematologic response occurred in 39 patients regardless of the ibrutinib dose. The most common toxicities were infection, bruising or bleeding, and musculoskeletal problems, with a median time to first toxicity of 14 days. More than half the cohort experienced a dose reduction, with musculoskeletal problems, cytopenias, and infection being the leading causes; surgery was the most frequent indication for holding treatment. Only 26 of the 64 patients (40.6%) stayed on the recommended maximal dose of ibrutinib. No differences in reported toxicities or hematologic response rates were evident between the patients receiving maximal and submaximal therapy. At the end of the study period, 53 patients from the initial cohort remained on ibrutinib. Conclusions More than half the study patients received ibrutinib therapy at a submaximal dose without evidence of increased frequency of toxicities or disease progression. The rate of ibrutinib discontinuation was lower in our cohort than has been reported in other settings. Submaximal ibrutinib dosing will have to be further systematically evaluated.
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MRI-Guided SABR of Spinal Metastases: A Safety and Quality Comparison of Co-60 and Linac Treatments. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Process Evaluation of the Healthy Campus Environmental Audits. J Acad Nutr Diet 2019. [DOI: 10.1016/j.jand.2019.06.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Effect of clinical signs, endocrinopathies, timing of surgery, hyperlipidemia, and hyperbilirubinemia on outcome in dogs with gallbladder mucocele. Vet J 2019; 251:105350. [PMID: 31492387 DOI: 10.1016/j.tvjl.2019.105350] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 07/27/2019] [Accepted: 07/28/2019] [Indexed: 12/21/2022]
Abstract
Gallbladder mucocele (GBM) is a common extra-hepatic biliary syndrome in dogs with death rates ranging from 7 to 45%. Therefore, the aim of this study was to identify the association of survival with variables that could be utilized to improve clinical decisions. A total of 1194 dogs with a gross and histopathological diagnosis of GBM were included from 41 veterinary referral hospitals in this retrospective study. Dogs with GBM that demonstrated abnormal clinical signs had significantly greater odds of death than subclinical dogs in a univariable analysis (OR, 4.2; 95% CI, 2.14-8.23; P<0.001). The multivariable model indicated that categorical variables including owner recognition of jaundice (OR, 2.12; 95% CI, 1.19-3.77; P=0.011), concurrent hyperadrenocorticism (OR 1.94; 95% CI, 1.08-3.47; P=0.026), and Pomeranian breed (OR, 2.46; 95% CI 1.10-5.50; P=0.029) were associated with increased odds of death, and vomiting was associated with decreased odds of death (OR, 0.48; 95% CI, 0.30-0.72; P=0.001). Continuous variables in the multivariable model, total serum/plasma bilirubin concentration (OR, 1.03; 95% CI, 1.01-1.04; P<0.001) and age (OR, 1.17; 95% CI, 1.08-1.26; P<0.001), were associated with increased odds of death. The clinical utility of total serum/plasma bilirubin concentration as a biomarker to predict death was poor with a sensitivity of 0.61 (95% CI, 0.54-0.69) and a specificity of 0.63 (95% CI, 0.59-0.66). This study identified several prognostic variables in dogs with GBM including total serum/plasma bilirubin concentration, age, clinical signs, concurrent hyperadrenocorticism, and the Pomeranian breed. The presence of hypothyroidism or diabetes mellitus did not impact outcome in this study.
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Prevalence of adverse events and their effect on completion of high speed treadmill exercise tests at a single institution (2000-2015). Equine Vet J 2019; 52:232-237. [PMID: 31228868 DOI: 10.1111/evj.13143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 06/13/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Decline in high speed treadmill (HSTM) exercise testing may be attributed to the rise of over-ground endoscopy and telemetric electrocardiography, in addition to concerns of adverse events during treadmill exercise resulting in injury or inadequate testing. OBJECTIVES To describe adverse events occurring during HSTM exercise tests at a single institution and determine their effect on likelihood of completing diagnostic HSTM exercise testing. STUDY DESIGN Retrospective cohort study. METHODS Pearson's chi-square test was used to determine if a significant difference in frequencies of adverse events existed between complete and incomplete HSTM exercise tests. Two Firth logistic regression models were used to determine likelihood of exercise test completion given the presence of any adverse event, and the likelihood of exercise test completion for each type of adverse event. RESULTS The majority of horses presenting for HSTM evaluation underwent exercise testing (900/1003; 90%). Eight-hundred and seven (90%) exercise tests were completed. Adverse events occurred in 136 (15%) HSTM exercise tests of which 97 (71%) did not impact ability to complete HSTM testing. Adverse events significantly but variably decreased the likelihood of HSTM exercise test completion. Sixty-six percent of incomplete exercise tests were prematurely terminated due to poor performance abnormalities during which diagnosis of poor performance cause(s) was still achieved. MAIN LIMITATIONS Variable personnel recorded data over the study period. Per-test rather than per-horse evaluation does not account for the effect of multiple training and testing episodes performed in the same horse. CONCLUSIONS This study supports the continued usage of HSTM exercise testing for examination of horses with poor performance, with adverse events occurring infrequently. Adverse events reduced the likelihood of completing HSTM exercise testing although not all adverse events affected likelihood of completion similarly. In many cases, a performance limiting problem was identified for horses in which an exercise test was considered incomplete. The Summary is available in Spanish - see Supporting information.
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