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Morgan OJ, Hillstrom HJ, Ellis SJ, Golightly YM, Russell R, Hannan MT, Deland JT, Hillstrom R. Osteoarthritis in England: Incidence Trends From National Health Service Hospital Episode Statistics. ACR Open Rheumatol 2019; 1:493-498. [PMID: 31777830 PMCID: PMC6858070 DOI: 10.1002/acr2.11071] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 07/22/2019] [Indexed: 11/22/2022] Open
Abstract
Objective It is typical in epidemiological research of osteoarthritis (OA) to collect data for the hand, hip, and knee. However, little population‐based data exist for this disease in the foot. Thus, we addressed patterns of OA for the foot compared with the hand, hip, and knee spanning 2000/2001 to 2017/2018 in England. Methods Secondary‐care data from 3 143 928 patients with OA of the foot, hand, hip, and knee were derived from the National Health Service (NHS) Hospital Episode Statistics (HES) database. Distribution, population prevalence, and incidence of joint‐specific OA were stratified by age and sex. Results OA incidence increased significantly at the foot [3.8% (95% confidence interval [CI] 3.0, 4.6)], hand [10.9% (10.1, 11.7)], hip [3.8% (2.9, 4.7)], and knee [2.9% (2.2, 3.6)] per year from 2000/2001 to 2017/2018. A higher proportion of women were diagnosed with OA, whereas greater incidence in men was estimated for the hand and hip. Foot OA presented comparable diagnosis numbers to the hand. More recently during 2012/2013 to 2017/2018, a significant rise in hip OA was estimated among younger adults, whereas knee OA decreased across all age groups. Incidence of OA in the foot and hand were particularly significant among the 75 or older age group, though bimodal age distributions were observed for both sites. Conclusion The significant increase in secondary care records for OA in England underscores the importance of exploring possible causative factors and identifying groups most at risk. Further detailed data may be particularly important for the hip, which represents significant incidence among younger adults. Greater incidence of OA in the foot compared with the knee emphasizes the need for well‐conducted epidemiological research in this area. Monitoring the performance of surgical outcomes at the population‐level for this frequently affected yet understudied site could have substantial potential to reduce the socioeconomic burden it represents to the NHS.
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Affiliation(s)
- O J Morgan
- Anglia Ruskin University, Chelmsford, Essex, UK
| | | | - S J Ellis
- Hospital for Special Surgery, New York, New York
| | | | - R Russell
- Mid-Essex Hospitals Trust, Chelmsford, Essex, UK
| | - M T Hannan
- Marcus Institute for Aging Research, Hebrew SeniorLife, and Harvard Medical School, Boston, Massachusetts
| | - J T Deland
- Hospital for Special Surgery, New York, New York
| | - R Hillstrom
- Anglia Ruskin University, Chelmsford, Essex, UK
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Shepherd TA, Edelstyn NMJ, Longshaw L, Sim J, Watts K, Mayes AR, Murray M, Ellis SJ. Feasibility of a randomized single-blind crossover trial to assess the effects of the second-generation slow-release dopamine agonists pramipexole and ropinirole on cued recall memory in idiopathic mild or moderate Parkinson's disease without cognitive impairment. Pilot Feasibility Stud 2017; 4:11. [PMID: 28694990 PMCID: PMC5501424 DOI: 10.1186/s40814-017-0154-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 06/08/2017] [Indexed: 01/25/2023] Open
Abstract
Background The aim was to assess the feasibility of a single-centre, single-blind, randomized, crossover design to explore the effects of two slow-release dopamine agonists, ropinirole and pramipexole, on cued recall in Parkinson’s disease. As the design required a switch from the prescribed agonist (pramipexole-to-ropinirole, or ropinirole-to-pramipexole), the primary objectives were to (a) examine the efficacy of processes and procedures used to manage symptoms during the washout period and (b) to use cued recall estimates to inform a power calculation for a definitive trial. Secondary objectives were to assess consent and missing data rates, acceptability of clinical support for the OFF sessions, experience of the OFF sessions and of agonist switching, barriers-to-participation for patients and informal caregivers. Methods Patients were randomized in a 1:1 ratio to two treatment arms and stabilized on each agonist for 6 weeks. The arms differed only in the sequence in which the agonists were administered. Cued recall was assessed ON medication and, following a washout period resulting in 93.75% agonist elimination, OFF medication. Results A total of 220 patients were screened: 145 were excluded and 75 invitations to participate were sent to eligible patients. Fifty-three patients declined, 22 consented and 16 completed the study. There were no serious adverse events, and rates of non-serious adverse events were equivalent between the agonists. Using the largest standard deviation (SD) of the ON–OFF difference cued recall score (inflated by ~25% to give a conservative estimate of the SD in a definitive trial) and assuming an effect of at least 10% of the observed range of OFF medication cued recall scores for either agonist to be clinically important, a main trial requires a sample size of just under 150 patients. The consent and missing data rates were 29 and 27% respectively. The washout period and the preparation for the OFF sessions were acceptable, and the sessions were manageable. The experience of switching was also manageable. Barriers to participation included concerns about disease stability, side effects, research process, carer workload and accessibility of the information sheet. Conclusions This study presented challenges to recruitment both in design and execution, and while it was a major aim of the study to assess this, evaluation of these challenges provided the opportunity to explore how they could be overcome for future studies. Trial registration EudraCT 2012-000801-64
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Affiliation(s)
- Thomas A Shepherd
- Research Institute for Primary Care and Health Sciences, Keele University, ST5 5BG Keele, Staffordshire UK
| | | | - Laura Longshaw
- University Hospital of North Midlands, Stoke on Trent, Staffordshire UK.,Keele University, Keele, Staffordshire UK
| | - Julius Sim
- Research Institute for Primary Care and Health Sciences, Keele University, ST5 5BG Keele, Staffordshire UK
| | - Keira Watts
- University Hospital of North Midlands, Stoke on Trent, Staffordshire UK.,Keele University, Keele, Staffordshire UK
| | - Andrew R Mayes
- Psychological Sciences, University of Manchester, Manchester, UK
| | - Michael Murray
- School of Psychology, Keele University, Keele, Staffordshire UK
| | - Simon J Ellis
- University Hospital of North Midlands, Stoke on Trent, Staffordshire UK.,Keele University, Keele, Staffordshire UK
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Edelstyn NMJ, Grange JA, Ellis SJ, Mayes AR. A deficit in familiarity-driven recognition in a right-sided mediodorsal thalamic lesion patient. Neuropsychology 2016; 30:213-24. [PMID: 26192538 DOI: 10.1037/neu0000226] [Citation(s) in RCA: 8] [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: 11/08/2022] Open
Abstract
OBJECTIVE According to a still-controversial view of recognition, projections between the perirhinal cortex and the medial subdivision of the mediodorsal thalamic nucleus (mMDT) support the mnemonic processes underlying familiarity, whereas a separate extended hippocampal system is critical for the recollection of episodic details during recognition. METHOD In this study, we examined item recognition, familiarity, and recollection for faces and words in a patient (OG) with a right-sided lesion centered on the mMDT, which encroached on the central medial midline nucleus and may have resulted in partial disconnection of the mammillothalamic tract. On the basis of OG's neuropathology, the dual-process signal-detection (DPSD) high-threshold theory and the material-specific hypothesis of long-term memory together predicted a material-specific impairment in familiarity for novel facial memoranda, with a lesser decline in recollection of novel faces at short retention intervals. No abnormalities in either familiarity- or recollection-driven recognition of verbal memoranda were expected. RESULTS Comparing the performance of OG and that of a group of 10 age-, sex-, and IQ-matched healthy controls, the remember-know procedure revealed the dissociations predicted by the material-specific and DPSD hypotheses: With recognition of previously novel faces, OG showed a deficit in familiarity-driven recognition that was significantly greater than the insignificant reduction in his recollection. All components of his word recognition were, however, preserved. CONCLUSION A memory profile, marked by a dissociation between familiarity and recollection, fits naturally with the DPSD model and is incompatible with the idea that these kinds of memories reflect different degrees of trace strength.
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Affiliation(s)
| | | | | | - Andrew R Mayes
- School of Psychological Sciences, University of Manchester
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Abstract
Anarchic hand syndrome (AHS) is characterized by goal-directed movements performed without volitional control (agency). Different AHS subtypes have been identified; however, few studies have examined the posterior subtype. We report a case of AHS following right-hemisphere parietal damage, with left-sided somatosensory and proprioceptive impairment. Agency was examined for nonanarchic (volitional) movements performed using the anarchic hand. The patient experienced abnormal agency for movements whether motor intention and visual feedback were congruent or incongruent, but not when intention was absent (passive movement). Findings suggest a general disturbance of veridical motor awareness and agency in this case of parietal AHS.
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Affiliation(s)
- Paul M Jenkinson
- a Department of Psychology , University of Hertfordshire , Hertfordshire , UK
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Edelstyn NMJ, Mayes AR, Ellis SJ. Damage to the dorsomedial thalamic nucleus, central lateral intralaminar thalamic nucleus, and midline thalamic nuclei on the right-side impair executive function and attention under conditions of high demand but not low demand. Neurocase 2014; 20:121-32. [PMID: 23030052 DOI: 10.1080/13554794.2012.713497] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This study reports a patient, OG, with a unilateral right-sided thalamic lesion. High resolution 3T magnetic resonance imaging revealed damage to the parvicellular and magnocellular subdivisions of the dorsomedial thalamus (DMT), the central lateral intralaminar nucleus (also known as the paralamellar DMT), the paraventricular and the central medial midline thalamic nuclei. According to the neuropsychological literature, the DMT, the midline and intralaminar thalamic nuclei influence a wide array of cognitive functions by virtue of their modulatory influences on executive function and attention, and this is particularly indicated under conditions of low arousal or high cognitive demand. We explored this prediction in OG, and compared his performance on a range of low and high demand versions of tests that tapped executive function and attention to a group of 6 age- and IQ-matched controls. OG, without exception, significantly under performed on the high-demand attention and executive function tasks, but performed normally on the low-demand versions. These findings extend and refine current understanding of the effects of thalamic lesion on attention and executive function.
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Affiliation(s)
- N M J Edelstyn
- a School of Psychology , University of Keele , Staffordshire , UK
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Shepherd TA, Edelstyn NMJ, Mayes AR, Ellis SJ. Second-generation dopamine agonists and recollection impairments in Parkinson's disease. J Neuropsychol 2013; 7:284-305. [DOI: 10.1111/jnp.12025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 04/12/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Simon J. Ellis
- University Hospital of North Staffordshire and Keele University; UK
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Edelstyn NMJ, Mayes AR, Denby C, Ellis SJ. Impairment in material-specific long-term memory following unilateral mediodorsal thalamic damage and presumed partial disconnection of the mammillo-thalamic tract. J Neuropsychol 2011; 6:119-40. [DOI: 10.1111/j.1748-6653.2011.02019.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jenkinson PM, Preston C, Ellis SJ. Unawareness after stroke: A review and practical guide to understanding, assessing, and managing anosognosia for hemiplegia. J Clin Exp Neuropsychol 2011; 33:1079-93. [DOI: 10.1080/13803395.2011.596822] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - Catherine Preston
- b School of Social Sciences , Nottingham Trent University , Nottingham, UK
| | - Simon J. Ellis
- c Department of Neurology , University Hospital of North Staffordshire , Newcastle-under-Lyme, UK
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Affiliation(s)
- Paul M Jenkinson
- School of Psychology, University of Hertfordshire, Hatfield, UK.
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Edelstyn NMJ, Mayes AR, Condon L, Tunnicliffe M, Ellis SJ. Recognition, recollection, familiarity and executive function in medicated patients with moderate Parkinson's disease. J Neuropsychol 2010; 1:131-47. [DOI: 10.1348/174866407x182565] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Edelstyn NMJ, Shepherd TA, Mayes AR, Sherman SM, Ellis SJ. Effect of disease severity and dopaminergic medication on recollection and familiarity in patients with idiopathic nondementing Parkinson's. Neuropsychologia 2009; 48:1367-75. [PMID: 20036678 DOI: 10.1016/j.neuropsychologia.2009.12.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 11/24/2009] [Accepted: 12/21/2009] [Indexed: 11/30/2022]
Abstract
The effect of disease severity and dopaminergic medication on the assessment of familiarity and the recollection of episodic details during recognition in nondementing idiopathic Parkinson's is uncertain. Some studies have reported familiarity as deficient in mild Parkinson's yet others have found it intact even in moderate Parkinson's. Recollection has been found to be both preserved and deficient in mild and moderate Parkinson's. The extent to which these conflicting findings are explained by disease severity or dopaminergic medication or a combination of the two is uncertain, as all studies assessed patients in a medicated state, and disease severity has not always been consistently reported. Twelve patients with mild Parkinson's and 11 with moderate Parkinson's (medicated Hoehn and Yahr mean: 2.1 and 3.2, respectively), completed matched versions of a yes/no recognition memory test in a medicated and unmedicated condition (termed ON and OFF, respectively). Twenty-one matched healthy volunteers also completed both memory tasks in 2 separate sessions (termed Blue and Green, respectively). In the ON/Green condition, the moderate Parkinson's recollection performance was significantly poorer than the healthy volunteers and mild Parkinson's. By contrast, recognition memory and familiarity measures in both Parkinson's group were relatively spared. In the OFF/Blue condition, the moderate Parkinson's recollection was impaired, but only in relation to the healthy volunteer set. There were no significant differences in recollection performance between the mild and moderate Parkinson's groups. Again, recognition memory and familiarity measures in both Parkinson's group were relatively spared. Further analyses showed the moderate patients' recollection rates to be significantly poorer ON-medication compared to OFF. These findings are discussed in relation to the staging of disease progression on medial temporal areas which separately support recollection and familiarity, and the putative effects the different classes of dopaminergic drugs may have on these areas.
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Abstract
OBJECTIVE To test the hypothesis that anosognosia for dyskinesias in Parkinson disease (PD) results from a failure to detect discrepancies between intended and actual movement. BACKGROUND PD patients often complain of drug-induced dyskinesias (involuntary movements) less than their carers. This remarkable unawareness is an example of anosognosia (ie, unawareness of deficits associated with an illness). A better understanding of anosognosia for dyskinesias in PD is important to understand the impact of the illness and side effects of treatment. METHODS The ability to detect a discrepancy between intended movement and visual feedback about actual movement was investigated in 6 PD patients with anosognosia for dyskinesias, 11 nonanosognosic PD controls with dyskinesias, and 22 healthy volunteers, using a mirror to reverse the expected visual consequences of an executed movement. RESULTS Nonanosognosic PD patients and healthy volunteers rated mirror-reversed movement as significantly stranger than normal movement (P=0.024 and <0.001, respectively), whereas PD patients with anosognosia for dyskinesias did not (P=0.375). CONCLUSIONS The findings support our proposal, in that PD patients with anosognosia for dyskinesias do not report mirror-reversed movement (in which intentions and visual feedback conflict) as feeling distinct from normal movement.
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Jenkinson PM, Edelstyn NMJ, Drakeford JL, Ellis SJ. Reality monitoring in anosognosia for hemiplegia. Conscious Cogn 2009; 18:458-70. [PMID: 19195910 DOI: 10.1016/j.concog.2008.12.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [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: 08/19/2008] [Revised: 11/18/2008] [Accepted: 12/16/2008] [Indexed: 11/18/2022]
Abstract
Anosognosia for hemiplegia (AHP) is a lack of awareness about paralysis following stroke. Recent explanations use a 'forward model' of movement to suggest that AHP patients fail to register discrepancies between internally- and externally-generated sensory information. We predicted that this failure would impair the ability to recall from memory whether information is internally- or externally-generated (i.e., reality monitor). Two experiments examined this prediction. Experiment 1 demonstrated that AHP patients exhibit a reality monitoring deficit for non-motor information (i.e., perceived vs. imagined drawings), whilst hemiplegic controls without anosognosia (nonAHP) perform like age-matched healthy volunteers (HVs). Experiment 2 explored if this deficit occurs when AHP patients discriminate performed, imagined, or observed movement. Results showed impaired reality monitoring for movements in AHP and nonAHP patients relative to HVs. Findings suggest that reality monitoring processes not directly related to movement, together with a failure to reality monitor movements, contribute to the pathogenesis of AHP.
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Affiliation(s)
- Paul M Jenkinson
- School of Psychology, Research Institute for Life Course Studies, University of Keele, Staffordshire ST5 5BG, UK.
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Jenkinson PM, Edelstyn NM, Ellis SJ. Imagining the impossible: Motor representations in anosognosia for hemiplegia. Neuropsychologia 2009; 47:481-8. [DOI: 10.1016/j.neuropsychologia.2008.10.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Revised: 09/22/2008] [Accepted: 10/02/2008] [Indexed: 11/28/2022]
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Abstract
The somatic marker hypothesis (SMH) proposes that physiological feedback to the brain influences cognitive appraisal and human decisions, however, the strength of evidence in support of the SMH is equivocal. We examined the validity of the SMH by measuring physiological arousal in a population of healthy individuals playing the Iowa Gambling Task (IGT), which is a computerized card game designed to assess real-life decisions. We also examined the influence of reinforcer type on IGT performance and physiological reactivity. Skin conductance level (SCL) reactivity was measured in 41 participants performing the IGT using either facsimile or real money. Participants were categorized as normal (i.e., nonimpaired) or impaired on the basis of their IGT performance, and differences in performance and physiological reactivity between groups were examined. No differences in SCL were found between normal and impaired groups. However, greater SCL rises were borderline significant when anticipating choices from bad decks compared with good decks, and a significantly greater SCL rise followed a reward from a bad deck. The effect of reinforcer type also revealed marginally greater performance when using facsimile money. This was corroborated physiologically by Deck × Reinforcer Type interactions, showing a marginally significant tendency for a greater SCL rise when anticipating a choice from a bad deck using facsimile but not real money, and a significantly greater SCL rise following a reward from a bad deck when using facsimile but not real money. Findings constrain the SMH, suggesting that autonomic activity may discriminate between good and bad decks (i.e., good vs. bad decision-making) by reflecting the magnitude of gains and losses, but is independent of long-term consequences and does not discriminate between overall good and bad performance (i.e., normal vs. impaired decision-makers).
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Affiliation(s)
- Paul M. Jenkinson
- School of Psychology & Research Institute for Life Course Studies, University of Keele, UK
| | - Sarah R. Baker
- School of Clinical Dentistry, University of Sheffield, UK
| | - Nicola M.J. Edelstyn
- School of Psychology & Research Institute for Life Course Studies, University of Keele, UK
| | - Simon J. Ellis
- Department of Neurology, University Hospital of North Staffordshire, UK
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Edelstyn NMJ, Hunter B, Ellis SJ. Bilateral dorsolateral thalamic lesions disrupts conscious recollection. Neuropsychologia 2006; 44:931-8. [PMID: 16253293 DOI: 10.1016/j.neuropsychologia.2005.08.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [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: 05/27/2005] [Revised: 08/23/2005] [Accepted: 08/24/2005] [Indexed: 11/24/2022]
Abstract
In an earlier study we disputed the claim that the mediodorsal thalamic nucleus is critical for familiarity. We reported patient (QX) who showed a severe deficit in conscious recollection, and behavioural problems (disinhibition, emotional lability) with relative sparing of familiarity-aware memory following a left mediodorsal thalamic lesion. More recent MR imaging has revealed that QX's lesions are more extensive than previously reported and involve both dorsolateral thalamic nuclei, and whilst there is evidence of left mediodorsal thalamic damage, it is not the main focus of damage. This paper reports a full analysis of QX's thalamic pathology alongside a more detailed investigation of his recognition memory, using yes/no and forced-choice procedures, and executive function. The results revealed impairments in yes/no recognition and conscious recollection rates of famous, artist and unknown names. In addition to the previously noted behavioural disinhibition and emotional lability, a deficit in spontaneous planning ability was evident on the Zoo Map Test (subtest of the Bahavioural Assessment of the Dysexecutive Syndrome). Forced-choice recognition, familiarity estimates and remote memory showed higher levels of preservation. The findings indicate that the dorsolateral thalamus is part of the extended hippocampal circuit which is causally critical only for recall and conscious recollection of complex associations rather than for the more automatic processes linked with novelty detection.
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Affiliation(s)
- Nicola M J Edelstyn
- School of Psychology, University of Keele, Keele, Newcastle under Lyme, Staffordshire ST5 5BG, UK.
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Edelstyn NMJ, Baker SR, Ellis SJ, Jenkinson P. A cognitive neuropsychological and psychophysiological investigation of a patient who exhibited an acute exacerbated behavioural response during innocuous somatosensory stimulation and movement. Behav Neurol 2004; 15:15-22. [PMID: 15201490 PMCID: PMC5488614 DOI: 10.1155/2004/458327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We report findings from a cognitive neuropsychological and psychophysiological investigation of a patient who displayed an exacerbated acute emotional expression during movement, innocuous, and aversive somatosensory stimulation. The condition developed in the context of non-specific white matter ischaemia along with abnormalities in the cortical white matter of the left anterior parietal lobe, and subcortical white matter of the left Sylvian cortex. Cognitive neuropsychological assessment revealed a pronounced deficiency in executive function, relative to IQ, memory, attention, language and visual processing. Compared to a normal control group, the patient [EQ] displayed a significantly elevated skin conductance level during both innocuous and aversive somatosensory stimulation. His pain tolerance was also significantly reduced. Despite this, EQ remained able to accurately describe the form of stimulation taking place, and to rate the levels of pain intensity and pain affect. These results suggest that EQ’s exaggerated behavioural response and reduced pain tolerance to somatosensory stimulation may be linked to cognitive changes, possibly related to increased apprehension and fear, rather than altered pain intensity or pain affect per se.
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Affiliation(s)
- N M J Edelstyn
- Department of Psychology, University of Keele, Staffordshire, UK.
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Abstract
In order to safeguard patient safety, all new or modified medical devices must be assessed for their safety and performance before they are used routinely in clinical practice. Most devices will carry a CE (Confirmity European) mark to demonstrate their safety, but many devices will require an alternative method of assessment. In this article, we discuss the procedures already in place, the significant gaps that exist in the system and the risk management issues. We consider the impact on research and clinical practice, and describe our comprehensive risk management system for objectively assessing the safety of any medical device.
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Abstract
Outcome prediction of neurological recovery in an unconscious survivor of cardiorespiratory arrest is difficult and uncertain. We describe the case of a 25-yr-old post-arrest survivor who made a remarkable neurological improvement despite a seemingly hopeless prognosis. Conventional clinical and neurophysiological assessments need to be interpreted with care in the presence of uncontrolled seizure activity and sedative medications. The measurement of biochemical markers in the serum and cerebrospinal fluid may be useful in helping the clinician to arrive at a more accurate neurological outcome prediction.
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Affiliation(s)
- W C Goh
- Department of Anaesthesia and Intensive Care, City General, Royal Infirmary, North Staffordshire Hospital, Hartshill, Stoke-on-Trent, UK
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Abstract
This study reports a patient with a unilateral left thalamic lesion which was centred on the dorsomedial thalamic nucleus. Cognitive neuropsychological assessment revealed a severe impairment in verbal memory and symptoms of executive dysfunction, in the presence of relatively intact visual and facial recognition, working memory, praxis, language and IQ. Verbal and visual recognition memory were investigated using the remember-know paradigm. The results indicated a profound impairment in recollection-driven verbal recognition memory. These results are discussed in the context of the role of the dorsomedial thalamic nucleus in recognition memory, and functional models of memory.
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Affiliation(s)
- N M J Edelstyn
- Department of Psychology, University of Keele, Keele, UK.
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Ellis SJ, Velayutham M, Velan SS, Petersen EF, Zweier JL, Kuppusamy P, Spencer RG. EPR oxygen mapping (EPROM) of engineered cartilage grown in a hollow-fiber bioreactor. Magn Reson Med 2001; 46:819-26. [PMID: 11590660 DOI: 10.1002/mrm.1262] [Citation(s) in RCA: 23] [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: 11/11/2022]
Abstract
A novel electron paramagnetic resonance (EPR)-based oxygen mapping procedure (EPROM) is applied to cartilage grown in a single-, hollow-fiber bioreactor (HFBR) system. Chondrocytes harvested from the sterna of 17-day-old chick embryos were inoculated into an HFBR and produced hyaline cartilage over a period of 4 weeks. Tissue oxygen maps were generated according to the EPROM technique (Velan et al., Magn Reson Med 2000;43:804-809) by making use of the line-broadening effects of oxygen on the signal generated from nitroxide spin probes. In addition, the effect on oxygen consumption of the addition of cyanide to the tissue was investigated. Cyanide is a potent inhibitor of oxidative phosphorylation, and accordingly, given the constant provision of oxygen to the tissue, it would be expected to increase oxygen levels within the HFBR. The EPROM measurements showed a significant increase in oxygen concentration in the cartilage after the addition of cyanide. In contrast to other methods for studying oxygen in cartilage, EPROM can provide direct, noninvasive visualization of local concentrations in three dimensions.
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Affiliation(s)
- S J Ellis
- Nuclear Magnetic Resonance Unit, National Institute on Aging, National Institutes of Health, Baltimore, Maryland 21224, USA
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Kalamangalam GP, Ellis SJ. Migrainous brain stem disturbance in Norrie disease: case report. J Neurol Neurosurg Psychiatry 2001; 70:815-6. [PMID: 11430297 PMCID: PMC1737388 DOI: 10.1136/jnnp.70.6.815a] [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: 11/04/2022]
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Ellis SJ. Post-traumatic stress disorder. Logic is flawed. BMJ 2001; 322:1302; author reply 1303-4. [PMID: 11403053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Tomiyama N, Müller NL, Ellis SJ, Cleverley JR, Okumura M, Miyoshi S, Kusumoto M, Johkoh T, Yoshida S, Mihara N, Honda O, Kozuka T, Hamada S, Nakamura H. Invasive and Noninvasive Thymoma: Distinctive CT Features. J Comput Assist Tomogr 2001; 25:388-93. [PMID: 11351188 DOI: 10.1097/00004728-200105000-00010] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [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: 11/27/2022]
Abstract
PURPOSE The purpose of this work was to evaluate the CT features of thymoma and to determine the most helpful findings in differentiating invasive from noninvasive thymoma. METHOD The CT scans from 27 patients with invasive thymoma and 23 with noninvasive thymoma were independently assessed by two observers without knowledge of their invasiveness. The presence and distribution of various CT findings were independently analyzed. RESULTS Invasive thymomas were more likely to have lobulated (16/27, 59%) or irregular (6/27, 22%) contours than noninvasive thymomas (8/23, 35% and 1.5/23, 6%, respectively) (p < 0.05). Invasive thymomas had a higher prevalence of low attenuation areas within the tumor (16/27, 60%) than noninvasive thymomas (5/23, 22%) (p < 0.001) as well as foci of calcification (14.5/27, 54% vs. 6/23, 26%; p < 0.01). CONCLUSION The presence of lobulated or irregular contour, areas of low attenuation, and multifocal calcification is suggestive of invasive thymoma.
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Affiliation(s)
- N Tomiyama
- Department of Radiology, Osaka University Medical School, Japan.
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Ellis SJ. Data protection and patients' consent. GMC is greater threat to research than the act. BMJ 2001; 322:550. [PMID: 11230075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Ellis SJ. The failings of NICE. Doctors treating patients with multiple sclerosis will lose confidence in NICE. BMJ 2001; 322:491. [PMID: 11222442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Tomiyama N, Müller NL, Johkoh T, Cleverley JR, Ellis SJ, Akira M, Ichikado K, Honda O, Mihara N, Kozuka T, Hamada S, Nakamura H. Acute respiratory distress syndrome and acute interstitial pneumonia: comparison of thin-section CT findings. J Comput Assist Tomogr 2001; 25:28-33. [PMID: 11176289 DOI: 10.1097/00004728-200101000-00005] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [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: 11/25/2022]
Abstract
PURPOSE The purpose of this work was to compare the thin-section CT findings of acute respiratory distress syndrome (ARDS) with those of acute interstitial pneumonia (AIP). METHOD The thin-section CT scans from 25 patients with ARDS and 25 with AIP were independently assessed by two observers without knowledge of clinical and pathologic data. The presence, extent, and distribution of various CT findings were independently analyzed. RESULTS Honeycombing was seen more frequently in lobes of patients with AIP (26%) than in lobes with ARDS (8%) (p < 0.001). Compared with patients with ARDS, a greater number of patients with AIP had a predominantly lower lung zone distribution (p < 0.05) and a symmetric distribution (p < 0.05) of the parenchymal abnormalities. CONCLUSION Patients with AIP have a greater prevalence of honeycombing and are more likely to have a symmetric bilateral distribution and a lower lung zone predominance than patients with ARDS. However, significant overlap exists among the CT findings.
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Affiliation(s)
- N Tomiyama
- Department of Radiology, Osaka University Medical School, Suita, Japan.
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Affiliation(s)
- S J Ellis
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 W. 12th Ave., Vancouver, BC, V5Z 1M9, Canada
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Affiliation(s)
- M B Davies
- Department of Neurology, North Staffordshire Royal Infirmary, Stoke-on-Trent, UK
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Ellis SJ. Cost utility of drugs for multiple sclerosis. Analysis goes too far. BMJ 2000; 320:1475-6. [PMID: 10877571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Ellis SJ, Hans R. Using anticoagulation or aspirin to prevent stroke. Research was methodologically flawed. BMJ 2000; 320:1008-9; author reply 1010-1. [PMID: 10753166 PMCID: PMC1117881 DOI: 10.1136/bmj.320.7240.1008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ellis SJ. Why volunteers: a resource money can't buy. Volunt Leader 2000; 40:13-6. [PMID: 10747620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Ellis SJ, Ellis F. Ethical issues surrounding the practice of neuroanaesthesia. Best Pract Res Clin Anaesthesiol 1999. [DOI: 10.1053/bean.1999.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ellis SJ. Some unanswered questions about NICE. J R Soc Med 1999; 92:538-9. [PMID: 10692911 PMCID: PMC1297399 DOI: 10.1177/014107689909201015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- S J Ellis
- Keele University, Stoke-on-Trent, UK.
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Ellis SJ. Rationing. Fidelity and stewardship are incompatible when attempted by same individual. BMJ 1999; 318:941. [PMID: 10232906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Campbell KN, Ellis SJ. Finding your internal volunteer management team. Volunt Leader 1999; 39:5-8. [PMID: 10178123] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Ellis SJ, Ellis PJ, Marshall E, Windridge C, Jones S. Is forced dextrality an explanation for the fall in the prevalence of sinistrality with age? A study in northern England. J Epidemiol Community Health 1998; 52:41-4. [PMID: 9604040 PMCID: PMC1756611 DOI: 10.1136/jech.52.1.41] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The fall in the prevalence of left handedness with age has been attributed to either premature mortality or a cohort effect of forced dextrality. Evidence for forced dextrality was sought to differentiate between these competing theories. DESIGN 6097 Edinburgh handedness inventories were used to calculate laterality quotients (LQ) with and without the questions relating to writing and drawing. These questions might be expected to be most influenced by forced dextrality. SETTING The study was performed in a small industrial town in Lancashire, UK. PARTICIPANTS Using the British family practitioner service where over 95% of the population are registered with a general practitioner a response rate of 82.17% was obtained with respect to the Edinburgh Inventory. RESULTS Questions about writing and drawing on the Edinburgh Inventory contributed to the positivity (right handedness) of the mean LQ, but equally across the ages. When a negative LQ was used to define left handedness the prevalence of left handedness fell from 11.2% at age 15 to 4.4% at age 70. Removal of the questions about writing and drawing caused the prevalence of left handedness to fall from 10.5% at age 15 to 4.95% at age 70. CONCLUSIONS Less than 20% of the fall in the prevalence of left handedness was accounted for by questions relating to writing and drawing. The fall in the prevalence of sinistrals in older age groups is not adequately explained by cohort effects of forced dextrality on the writing hand.
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Affiliation(s)
- S J Ellis
- Department of Neurology, Keele University, North Staffordshire Royal Infirmary
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Abstract
Movement disorders are usually of central origin, but have been reported in association with peripheral trauma. Injuries to the neck of the whiplash type provide a source of both types of injuries. Six cases are reported in which the temporal relation between the injury and the movement disorder make a causal relation likely. This important cause of disability has not previously been appreciated.
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Affiliation(s)
- S J Ellis
- Department of Neurology, Keele University, North Staffordshire Royal Infirmary, UK
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