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Lowe E, Soylu E, Deekonda P, Gajaweera H, Ioannidis D, Walker W, Amonoo-Kuofi K. Principal diagnostic features of paediatric foreign body aspiration. Int J Pediatr Otorhinolaryngol 2024; 177:111846. [PMID: 38176114 DOI: 10.1016/j.ijporl.2023.111846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/27/2023] [Accepted: 12/30/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVES The aim of this study is to identify the most common and important features within the presenting history, clinical examination and chest radiograph that are associated with foreign body (FB) aspiration in the paediatric population, to support rationalised decision making in regards to proceeding with diagnostic bronchoscopy. METHODS A retrospective notes review was conducted of 70 patients over a 12-year period at our tertiary referral centre. Their presenting history, clinical and radiographic signs were documented and univariate logistic regression model used to calculate odds ratios. RESULTS The main features identified within our cohort with a positive FB finding at bronchoscopy were history of a cough (OR 5.1, p = 0.008) and radiographic evidence of hyperinflation or air trapping (OR 7.1, p = 0.016). Zero patients with a FB presented with only a positive history in the absence of other clinical or radiological signs. History of a witnessed choking episode neither increased or decreased the likelihood of as aspirated FB (OR 1, p = 0.967). CONCLUSIONS We have identified two principal features, as described above, which are associated with paediatric FB aspiration. Reliance on a positive clinical history alone, but specifically the history of a witnessed choking episode, did not support the presence of a FB and other associated signs need to be considered in deciding to proceed to bronchoscopy.
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Affiliation(s)
- Emily Lowe
- ENT Department, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, S016 6YD, United Kingdom.
| | - Erdinc Soylu
- ENT Department, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, S016 6YD, United Kingdom.
| | - Praveena Deekonda
- ENT Department, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, S016 6YD, United Kingdom.
| | - Hasitha Gajaweera
- Paediatric Respiratory Department, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, United Kingdom.
| | - Dimitrios Ioannidis
- ENT Department, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, S016 6YD, United Kingdom.
| | - Woolf Walker
- Paediatric Respiratory Department, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, United Kingdom.
| | - Kwamena Amonoo-Kuofi
- ENT Department, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, S016 6YD, United Kingdom.
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Peña M, Martin A, Holland P, Black LE, Peterman J, Montoya-Williams D, Burris H, Ciara N, Wooten J, Christ L, Walker W, Lilley J, Tkacs M, Scott L. Qualitative analysis of black birthing parents’ influences on infant feeding. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00554-2] [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: 01/28/2023]
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3
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Newman L, Chopra J, Dossett C, Shepherd E, Bercusson A, Carroll M, Walker W, Lucas JS, Cheong Y. The impact of primary ciliary dyskinesia on female and male fertility: a narrative review. Hum Reprod Update 2023; 29:347-367. [PMID: 36721921 PMCID: PMC10152180 DOI: 10.1093/humupd/dmad003] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/02/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) is a genetic condition affecting the structure and function of sperm flagellum and motile cilia including those in the male and female reproductive tracts. Infertility is a commonly reported feature of PCD, but there is uncertainty as to how best to counsel patients on their fertility prognosis. OBJECTIVE AND RATIONALE This review aimed to summarize the prevalence of subfertility, possible underlying mechanisms, and the success of ART in men and women with PCD. The efficacy of ART in this patient group is relatively unknown and, hence, the management of infertility in PCD patients remains a challenge. There are no previous published or registered systematic reviews of fertility outcomes in PCD. SEARCH METHODS Systematic literature searches were performed in Medline, Embase, Cochrane Library, and PubMed electronic databases to identify publications between 1964 and 2022 reporting fertility outcomes in men and women with PCD. Publications were excluded if they reported only animal studies, where gender was not specified or where subjects had a medical co-morbidity also known to impact fertility. Quality of evidence was assessed by critical appraisal and application of an appraisal tool for cross-sectional studies. The primary outcomes were natural conception in men and women with PCD, and conception following ART in men and women with PCD. OUTCOMES A total of 1565 publications were identified, and 108 publications were included after screening by two independent researchers. The quality of available evidence was low. The exact prevalence of subfertility in PCD is unclear but appears to be higher in men (up to 83% affected) compared to women (up to 61% affected). Variation in the prevalence of subfertility was observed between geographic populations which may be explained by differences in underlying genotype and cilia function. Limited evidence suggests subfertility in affected individuals is likely caused by abnormal cilia motion in the fallopian tubes, endometrium and efferent ductules, and dysmotile sperm. Some men and women with PCD benefited from ART, which suggests its use should be considered in the management of subfertility in this patient group. Further epidemiological and controlled studies are needed to determine the predictors of fertility and optimal management in this patient group. WIDER IMPLICATIONS It is important that patients with PCD receive evidence-based counselling about the potential impact of their condition on their fertility prognosis and what management options may be available to them if affected. Understanding the pathophysiology and optimal management of subfertility in PCD will increase our understanding of the role of cilia and the impact of wider secondary ciliopathies on reproduction.
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Affiliation(s)
- Lydia Newman
- School of Human Development and Health, University of Southampton, Southampton, UK
| | - Jagrati Chopra
- School of Human Development and Health, University of Southampton, Southampton, UK
| | - Claire Dossett
- Primary Ciliary Dyskinesia Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Elizabeth Shepherd
- Primary Ciliary Dyskinesia Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Amelia Bercusson
- Primary Ciliary Dyskinesia Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Mary Carroll
- Primary Ciliary Dyskinesia Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Woolf Walker
- Primary Ciliary Dyskinesia Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK.,Primary Ciliary Dyskinesia Centre, National Institute for Health Research Southampton Respiratory Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK.,Primary Ciliary Dyskinesia Centre, National Institute for Health Research Southampton Respiratory Biomedical Research Centre, University of Southampton, Southampton, UK.,School of Clinical and Experimental Science, University of Southampton, Southampton, UK
| | - Ying Cheong
- School of Human Development and Health, University of Southampton, Southampton, UK.,Complete Fertility Southampton, Princess Anne Hospital, Southampton, UK
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4
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Beydon N, Ferkol T, Harris AL, Colas M, Davis SD, Haarman E, Hogg C, Kilbride E, Kouis P, Kuehni CE, Latzin P, Marangu D, Marthin J, Nielsen KG, Robinson P, Rumman N, Rutter M, Walker W, Lucas JS. An international survey on nasal nitric oxide measurement practices for the diagnosis of primary ciliary dyskinesia. ERJ Open Res 2022; 8:00708-2021. [PMID: 35386825 PMCID: PMC8977594 DOI: 10.1183/23120541.00708-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/14/2022] [Indexed: 11/05/2022] Open
Abstract
Nasal nitric oxide (nNO) measurements are routinely used in the assessment of patients suspected to have primary ciliary dyskinesia (PCD), but recommendations for performing such measurements have not focused on children and do not include all current practices. To guide the development of a European Respiratory Society-supported technical standard for nNO measurements in children, an international online survey was conducted to better understand current practices for measuring nNO among providers involved in PCD diagnostics.Seventy-eight professionals responded, representing 65 centres across 18 countries, mainly located in Europe and North America. Nearly all centres measured nNO in children and more than half of them performed measurements before 5-years of age. The test was often postponed in children with signs of acute airway infection. In Europe, the electrochemical technique was more frequently used than chemiluminescence. A similar proportion of centres performed measurements during exhalation against a resistance (49/65) or during tidal breathing (50/65) with 15 centres using only exhalation against a resistance and 15 centres using only tidal breathing. The cut-off values used to discriminate PCD was consistent across centres using chemiluminescence analyzers and these centres reported results as an output (nL.min−1). However, cut-off values were highly variable across centres using electrochemical devices, and nNO concentrations were typically reported as ppb.This survey represents the first to determine real-world use of nNO measurements worldwide and revealed remarkable variability in methodology, equipment, and interpretation. These findings will be useful to standardise methods and training.
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5
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Harris A, Phan H, Borca F, Packham S, Friend A, Wilkins H, Glen A, Walker W, Lucas J. Experience of measuring nasal nitric oxide (nNO) in a National Primary Ciliary Dyskinesia (PCD) Centre (2006-20). Epidemiology 2020. [DOI: 10.1183/13993003.congress-2020.2070] [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: 11/05/2022]
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Fassad MR, Patel MP, Shoemark A, Cullup T, Hayward J, Dixon M, Rogers AV, Ollosson S, Jackson C, Goggin P, Hirst RA, Rutman A, Thompson J, Jenkins L, Aurora P, Moya E, Chetcuti P, O'Callaghan C, Morris-Rosendahl DJ, Watson CM, Wilson R, Carr S, Walker W, Pitno A, Lopes S, Morsy H, Shoman W, Pereira L, Constant C, Loebinger MR, Chung EMK, Kenia P, Rumman N, Fasseeh N, Lucas JS, Hogg C, Mitchison HM. Clinical utility of NGS diagnosis and disease stratification in a multiethnic primary ciliary dyskinesia cohort. J Med Genet 2019; 57:322-330. [PMID: 31879361 DOI: 10.1136/jmedgenet-2019-106501] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/23/2019] [Accepted: 11/01/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD), a genetically heterogeneous condition enriched in some consanguineous populations, results from recessive mutations affecting cilia biogenesis and motility. Currently, diagnosis requires multiple expert tests. METHODS The diagnostic utility of multigene panel next-generation sequencing (NGS) was evaluated in 161 unrelated families from multiple population ancestries. RESULTS Most (82%) families had affected individuals with biallelic or hemizygous (75%) or single (7%) pathogenic causal alleles in known PCD genes. Loss-of-function alleles dominate (73% frameshift, stop-gain, splice site), most (58%) being homozygous, even in non-consanguineous families. Although 57% (88) of the total 155 diagnostic disease variants were novel, recurrent mutations and mutated genes were detected. These differed markedly between white European (52% of families carry DNAH5 or DNAH11 mutations), Arab (42% of families carry CCDC39 or CCDC40 mutations) and South Asian (single LRRC6 or CCDC103 mutations carried in 36% of families) patients, revealing a striking genetic stratification according to population of origin in PCD. Genetics facilitated successful diagnosis of 81% of families with normal or inconclusive ultrastructure and 67% missing prior ultrastructure results. CONCLUSIONS This study shows the added value of high-throughput targeted NGS in expediting PCD diagnosis. Therefore, there is potential significant patient benefit in wider and/or earlier implementation of genetic screening.
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Affiliation(s)
- Mahmoud R Fassad
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, UK.,Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Mitali P Patel
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Amelia Shoemark
- PCD Diagnostic Team and Department of Pediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Thomas Cullup
- NE Thames Regional Molecular Genetics Laboratory, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Jane Hayward
- NE Thames Regional Molecular Genetics Laboratory, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Mellisa Dixon
- PCD Diagnostic Team and Department of Pediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Andrew V Rogers
- Host Defence Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Sarah Ollosson
- PCD Diagnostic Team and Department of Pediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Claire Jackson
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust and Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Patricia Goggin
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust and Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Robert A Hirst
- Centre for PCD Diagnosis and Research, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Andrew Rutman
- Centre for PCD Diagnosis and Research, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - James Thompson
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust and Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lucy Jenkins
- NE Thames Regional Molecular Genetics Laboratory, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Paul Aurora
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Department of Respiratory, Critical Care and Anaesthesia Unit, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Eduardo Moya
- Children's Services (Paediatrics), Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Philip Chetcuti
- Department of Respiratory Paediatrics, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Chris O'Callaghan
- Centre for PCD Diagnosis and Research, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK.,Department of Respiratory, Critical Care and Anaesthesia Unit, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Deborah J Morris-Rosendahl
- Clinical Genetics and Genomics Laboratory, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Robert Wilson
- Host Defence Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Siobhan Carr
- PCD Diagnostic Team and Department of Pediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Woolf Walker
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust and Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andreia Pitno
- PCD Diagnostic Team and Department of Pediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Laboratório de Histologia e Patologia Comparada, Instituto de Medicina Molecular, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Susana Lopes
- CEDOC, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Heba Morsy
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Walaa Shoman
- Department of Pediatrics, Faculty of Medicine, Alexandria University Children's Hospital, Alexandria, Egypt
| | - Luisa Pereira
- Paediatric Pulmonology Unit, Department of Pediatrics, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Carolina Constant
- Paediatric Pulmonology Unit, Department of Pediatrics, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | | | - Eddie M K Chung
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Priti Kenia
- Department of Respiratory Paediatrics, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Nisreen Rumman
- Pediatrics Department, Makassed Hospital, East Jerusalem, Israel
| | - Nader Fasseeh
- Department of Pediatrics, Faculty of Medicine, Alexandria University Children's Hospital, Alexandria, Egypt
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust and Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Claire Hogg
- PCD Diagnostic Team and Department of Pediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Hannah M Mitchison
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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Fritz L, Brost B, Laman E, Luxa K, Sweeney K, Thomason J, Tollit D, Walker W, Zeppelin T. A re-examination of the relationship between Steller sea lion (Eumetopias jubatus) diet and population trend using data from the Aleutian Islands. CAN J ZOOL 2019. [DOI: 10.1139/cjz-2018-0329] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Prey diversity and energy density have been linked to each other and to population trends in many studies of bird and mammal diets. We re-examined these relationships in Steller sea lions (Eumetopias jubatus (Schreber, 1776)) using data collected from the Aleutian Islands, where there has been a strong longitudinal gradient in population trend. Diet diversity and energy density metrics were similar in the western Aleutians, where sea lion counts declined consistently, and in the easternmost Aleutian area, where population trends improved significantly. We compared traditional deterministic diet diversity metrics with diversity scores based on an occupancy model that accounts for differences in sample size and uncertainty in prey group detection. This analysis indicated that there was no significant change in diet diversity over the 23-year study period or any significant differences across the Aleutian Islands. These results are consistent with prey abundance data from nine groundfish bottom trawl surveys conducted over the same period. While diet studies detail what Steller sea lions eat and provide an estimate of their energy intake, they provide only limited information on the energy expended to obtain their food or the consequences of their diet and foraging ecology on individual or population fitness.
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Affiliation(s)
- L. Fritz
- NOAA Fisheries, Alaska Fisheries Science Center, 7600 Sand Point Way NE, Seattle, WA 98115, USA
| | - B. Brost
- NOAA Fisheries, Alaska Fisheries Science Center, 7600 Sand Point Way NE, Seattle, WA 98115, USA
| | - E. Laman
- NOAA Fisheries, Alaska Fisheries Science Center, 7600 Sand Point Way NE, Seattle, WA 98115, USA
| | - K. Luxa
- NOAA Fisheries, Alaska Fisheries Science Center, 7600 Sand Point Way NE, Seattle, WA 98115, USA
| | - K. Sweeney
- NOAA Fisheries, Alaska Fisheries Science Center, 7600 Sand Point Way NE, Seattle, WA 98115, USA
| | - J. Thomason
- NOAA Fisheries, Alaska Fisheries Science Center, 7600 Sand Point Way NE, Seattle, WA 98115, USA
| | - D. Tollit
- SMRU Consulting North America, 55 Water Street, Suite 604, Vancouver, BC V6V 1A1, Canada
| | - W. Walker
- NOAA Fisheries, Alaska Fisheries Science Center, 7600 Sand Point Way NE, Seattle, WA 98115, USA
| | - T. Zeppelin
- NOAA Fisheries, Alaska Fisheries Science Center, 7600 Sand Point Way NE, Seattle, WA 98115, USA
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Igboeli P, Walker W, McHugh A, Sultan A, Al-Hendy A. Burden of Uterine Fibroids: An African Perspective, A Call for Action and Opportunity for Intervention. ACTA ACUST UNITED AC 2019; 2:287-294. [PMID: 32647835 PMCID: PMC7344264 DOI: 10.18314/cogo.v2i1.1701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Black women carry the burden of uterine fibroids, (AKA uterine leiomyomas), at a much higher rate than their racial counterparts. Thus, increasing awareness and discovering a solution to an endemic problem that plagues Sub-Saharan Africa is of critical importance, not only for the region itself, but also for the medical community globally. A collaborative, patient oriented, cost effective, and culturally sensitive approach must be at the forefront of this endeavor. While the exact pathogenesis of uterine fibroid development remains elusive, the racial disparity is well documented. Moreover, in the developed world, women are able to seek treatment through surgical and non-surgical means; however, sub-Saharan regions face their own challenges that, if not addressed, can ultimately extinguish the lives of many suffering women. Unfortunately, the literature is scarce on how to prevent fibroid development, which may be critical for women who do not have access to effective interventions. Recent research from our group and others has shown that vitamin D deficiency plays an important role in fibroid development and may be a preventable risk factor. Daily vitamin D supplementation is a low cost, effective intervention that could be implemented throughout the Sub-Saharan region. Similarly, education and increased awareness as to the nature and symptoms of uterine fibroids could improve the quality of life, remove negative social stigma, and reduce morbidity and mortality rates in women who seek medical care with advanced uterine fibroids.
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Affiliation(s)
- P Igboeli
- University of Nigeria Teaching Hospital, Department of Obstetrics and Gynaecology, Enugu, Nigeria.,Department of Obstetrics and Gynecology, Augusta University, Augusta, GA 30912, USA.,Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA
| | - W Walker
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA 30912, USA
| | - A McHugh
- Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA
| | - A Sultan
- Xavier University School of Medicine, Oranjestad, Aruba
| | - A Al-Hendy
- Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA
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9
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Seccombe EL, Ardern‐Jones M, Walker W, Austin S, Taibjee S, Williams S, Hossain P, Shenoy D, Fityan A. Bronchiolitis obliterans as a long‐term sequela of Stevens–Johnson syndrome and toxic epidermal necrolysis in children. Clin Exp Dermatol 2019; 44:897-902. [DOI: 10.1111/ced.13969] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2019] [Indexed: 01/10/2023]
Affiliation(s)
- E. L. Seccombe
- Department of Dermatology University Hospital Southampton NHS Foundation Trust Southampton Hampshire UK
| | - M. Ardern‐Jones
- Department of Dermatology University Hospital Southampton NHS Foundation Trust Southampton Hampshire UK
| | - W. Walker
- Paediatric Respiratory Department University Hospital Southampton NHS Foundation Trust Southampton Hampshire UK
| | - S. Austin
- Department of Dermatology Dorset County Hospital NHS Foundation Trust Dorchester Dorset UK
| | - S. Taibjee
- Department of Dermatology Dorset County Hospital NHS Foundation Trust Dorchester Dorset UK
| | - S. Williams
- Department of Paediatrics University Hospital Southampton NHS Foundation Trust Southampton Hampshire UK
| | - P. Hossain
- Department of Ophthalmology University Hospital Southampton NHS Foundation Trust Southampton Hampshire UK
| | - D. Shenoy
- Department of Paediatrics University Hospital Southampton NHS Foundation Trust Southampton Hampshire UK
| | - A. Fityan
- Department of Dermatology University Hospital Southampton NHS Foundation Trust Southampton Hampshire UK
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10
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Kentish-Barnes N, Siminoff LA, Walker W, Urbanski M, Charpentier J, Thuong M, Sarti A, Shemie SD, Azoulay E. A narrative review of family members’ experience of organ donation request after brain death in the critical care setting. Intensive Care Med 2019; 45:331-342. [DOI: 10.1007/s00134-019-05575-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/19/2019] [Indexed: 11/27/2022]
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11
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Baccini A, Walker W, Carvalho L, Farina M, Houghton RA. Response to Comment on "Tropical forests are a net carbon source based on aboveground measurements of gain and loss". Science 2019; 363:363/6423/eaat1205. [PMID: 30630897 DOI: 10.1126/science.aat1205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 11/08/2018] [Indexed: 11/02/2022]
Abstract
The Hansen et al critique centers on the lack of spatial agreement between two very different datasets. Nonetheless, properly constructed comparisons designed to reconcile the two datasets yield up to 90% agreement (e.g., in South America).
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Affiliation(s)
- A Baccini
- Woods Hole Research Center, Falmouth, MA 04523, USA.
| | - W Walker
- Woods Hole Research Center, Falmouth, MA 04523, USA
| | - L Carvalho
- Department of Mathematics and Statistics, Boston University, Boston, MA, USA
| | - M Farina
- Woods Hole Research Center, Falmouth, MA 04523, USA
| | - R A Houghton
- Woods Hole Research Center, Falmouth, MA 04523, USA
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12
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Robinson C, Miller D, Will M, Dhaun N, Walker W. Hughes-Stovin syndrome: the diagnostic and therapeutic challenges of peripheral pulmonary artery aneurysms. QJM 2018; 111:729-730. [PMID: 29860510 DOI: 10.1093/qjmed/hcy110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Robinson
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - D Miller
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - M Will
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - N Dhaun
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - W Walker
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
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Rizza CR, Shepherd DM, Walker W. Haemoglobinaemia and Haemoglobinuria Following the Administration of Neodymium 3-Sulpho-Isonicotinate (Thrombodym). Thromb Haemost 2018. [DOI: 10.1055/s-0038-1656219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
SummaryNine of thirteen patients receiving daily intravenous injections of 375 mg. 3-sulpho-isonicotinate for four to eight days developed haemoglobinaemia, accompanied in one case by haemoglobinuria and methaemalbuminaemia. In addition to haemoglobinaemia, a rise in blood cholesterol was observed in rabbits given larger doses.
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Baccini A, Walker W, Carvalho L, Farina M, Sulla-Menashe D, Houghton RA. Tropical forests are a net carbon source based on aboveground measurements of gain and loss. Science 2017; 358:230-234. [DOI: 10.1126/science.aam5962] [Citation(s) in RCA: 421] [Impact Index Per Article: 60.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 09/08/2017] [Indexed: 01/30/2023]
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15
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Shoemark A, Moya E, Hirst RA, Patel MP, Robson EA, Hayward J, Scully J, Fassad MR, Lamb W, Schmidts M, Dixon M, Patel-King RS, Rogers AV, Rutman A, Jackson CL, Goggin P, Rubbo B, Ollosson S, Carr S, Walker W, Adler B, Loebinger MR, Wilson R, Bush A, Williams H, Boustred C, Jenkins L, Sheridan E, Chung EMK, Watson CM, Cullup T, Lucas JS, Kenia P, O'Callaghan C, King SM, Hogg C, Mitchison HM. High prevalence of CCDC103 p.His154Pro mutation causing primary ciliary dyskinesia disrupts protein oligomerisation and is associated with normal diagnostic investigations. Thorax 2017; 73:157-166. [PMID: 28790179 DOI: 10.1136/thoraxjnl-2017-209999] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/07/2017] [Accepted: 07/03/2017] [Indexed: 11/03/2022]
Abstract
RATIONALE Primary ciliary dyskinesia is a genetically heterogeneous inherited condition characterised by progressive lung disease arising from abnormal cilia function. Approximately half of patients have situs inversus. The estimated prevalence of primary ciliary dyskinesia in the UK South Asian population is 1:2265. Early, accurate diagnosis is key to implementing appropriate management but clinical diagnostic tests can be equivocal. OBJECTIVES To determine the importance of genetic screening for primary ciliary dyskinesia in a UK South Asian population with a typical clinical phenotype, where standard testing is inconclusive. METHODS Next-generation sequencing was used to screen 86 South Asian patients who had a clinical history consistent with primary ciliary dyskinesia. The effect of a CCDC103 p.His154Pro missense variant compared with other dynein arm-associated gene mutations on diagnostic/phenotypic variability was tested. CCDC103 p.His154Pro variant pathogenicity was assessed by oligomerisation assay. RESULTS Sixteen of 86 (19%) patients carried a homozygous CCDC103 p.His154Pro mutation which was found to disrupt protein oligomerisation. Variable diagnostic test results were obtained including normal nasal nitric oxide levels, normal ciliary beat pattern and frequency and a spectrum of partial and normal dynein arm retention. Fifteen (94%) patients or their sibling(s) had situs inversus suggesting CCDC103 p.His154Pro patients without situs inversus are missed. CONCLUSIONS The CCDC103 p.His154Pro mutation is more prevalent than previously thought in the South Asian community and causes primary ciliary dyskinesia that can be difficult to diagnose using pathology-based clinical tests. Genetic testing is critical when there is a strong clinical phenotype with inconclusive standard diagnostic tests.
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Affiliation(s)
- Amelia Shoemark
- Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Trust, National Heart and Lung Institute, London, UK
| | - Eduardo Moya
- Division of Services for Women and Children, Women's and Newborn Unit Bradford Royal Infirmary, University of Bradford, Bradford, UK
| | - Robert A Hirst
- Department of Infection, Centre for PCD Diagnosis and Research, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Mitali P Patel
- Genetics and Genomic Medicine, University College London, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Evelyn A Robson
- Division of Services for Women and Children, Women's and Newborn Unit Bradford Royal Infirmary, University of Bradford, Bradford, UK
| | - Jane Hayward
- Genetics and Genomic Medicine, University College London, UCL Great Ormond Street Institute of Child Health, London, UK.,North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children, London, UK
| | - Juliet Scully
- Genetics and Genomic Medicine, University College London, UCL Great Ormond Street Institute of Child Health, London, UK.,Neuroscience and Mental Health Research Institute, School of Medicine and School of Bioscience, Cardiff University, London, UK
| | - Mahmoud R Fassad
- Genetics and Genomic Medicine, University College London, UCL Great Ormond Street Institute of Child Health, London, UK.,Human Genetics Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - William Lamb
- Genetics and Genomic Medicine, University College London, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Miriam Schmidts
- Genome Research Division, Human Genetics Department, Radboud University Medical Center and Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.,Pediatric Genetics Division, Center for Pediatrics and Adolescent Medicine, University of Freiburg Medical Center, Freiburg, Germany
| | - Mellisa Dixon
- Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Trust, National Heart and Lung Institute, London, UK
| | - Ramila S Patel-King
- Department of Molecular Biology and Biophysics, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Andrew V Rogers
- Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Trust, National Heart and Lung Institute, London, UK.,Department of Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, UK
| | - Andrew Rutman
- Department of Infection, Centre for PCD Diagnosis and Research, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Claire L Jackson
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust and Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK.,NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Patricia Goggin
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust and Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK.,NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Bruna Rubbo
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust and Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK.,NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Ollosson
- Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Trust, National Heart and Lung Institute, London, UK
| | - Siobhán Carr
- Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Trust, National Heart and Lung Institute, London, UK
| | - Woolf Walker
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust and Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK.,NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Beryl Adler
- Department of Paediatrics, Luton and Dunstable Hospital NHS Trust, Luton, UK
| | - Michael R Loebinger
- Department of Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, UK
| | - Robert Wilson
- Department of Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, UK
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Trust, National Heart and Lung Institute, London, UK.,Department of Paediatric Respiratory Medicine, National Heart and Lung Institute, Imperial College, London, UK
| | - Hywel Williams
- Centre for Translational Omics-GOSgene, Genetics and Genomic Medicine, University College London, Institute of Child Health, London, UK
| | - Christopher Boustred
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children, London, UK
| | - Lucy Jenkins
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children, London, UK
| | - Eamonn Sheridan
- Yorkshire Regional Genetics Service and School of Medicine, University of Leeds, St. James's University Hospital, Leeds, UK
| | - Eddie M K Chung
- Population, Policy and Practice Programme, University College London, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Christopher M Watson
- Yorkshire Regional Genetics Service and School of Medicine, University of Leeds, St. James's University Hospital, Leeds, UK
| | - Thomas Cullup
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children, London, UK
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust and Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK.,NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Priti Kenia
- Department of Respiratory Paediatrics, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Christopher O'Callaghan
- Department of Infection, Centre for PCD Diagnosis and Research, Immunity and Inflammation, University of Leicester, Leicester, UK.,Infection, Immunity, Inflammation and Physiological Medicine, University College London, Institute of Child Health, London, UK
| | - Stephen M King
- Department of Molecular Biology and Biophysics, University of Connecticut Health Center, Farmington, Connecticut, USA.,Institute for Systems Genomics, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Claire Hogg
- Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Trust, National Heart and Lung Institute, London, UK
| | - Hannah M Mitchison
- Genetics and Genomic Medicine, University College London, UCL Great Ormond Street Institute of Child Health, London, UK
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Gutiérrez-Cardona N, Sands P, Roberts G, Lucas JS, Walker W, Salib R, Burgess A, Ismail-Koch H. The acceptability and tolerability of nasal douching in children with allergic rhinitis: A systematic review. Int J Pediatr Otorhinolaryngol 2017; 98:126-135. [PMID: 28583489 DOI: 10.1016/j.ijporl.2017.04.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 04/25/2017] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Allergic rhinitis (AR) is a significant issue in children. Treatment options include allergen avoidance, pharmacotherapy and immunotherapy. The use of nasal saline douching (NSD) in children has recently gained acceptability. However, there is limited data regarding the acceptability and tolerability of NSD in children with AR. METHODS A search was conducted using Medline and Embase databases from January 1946 until June 2015 on the use of NSD in children aged 4-12 years with AR. All publications identified that assessed the beneficial effects, acceptability and tolerability were included. RESULTS 40 studies were analyzed. Data varied considerably in terms of saline solutions used, modality of application, participant numbers, study design, follow up and outcomes. Factors that appear to influence the acceptability and tolerability of NSD include parental and health professionals' preconceptions, and characteristics of the solution. CONCLUSIONS Nasal saline douching appears to be effective, being accepted and tolerated in the majority of children (78-100%). NSD has a significant positive impact on the quality of life in children with allergic rhinitis. When used as an adjunctive treatment having mainly a cleansing property, NSD potentiates the effects and may reduce the dose required of AR medications. Among the principal factors that influence the acceptability and tolerability of NSD are the child's age, delivery system and method, and tonicity. Nasal saline douching provides an accessible, low cost, low morbidity, easy to use treatment in children with allergic rhinitis.
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Affiliation(s)
- Nelson Gutiérrez-Cardona
- Faculty of Medicine, University of Southampton, Building 85, Life Sciences Building, Highfield Campus, Southampton, SO171BJ, United Kingdom.
| | - Paula Sands
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road Southampton Hampshire, Southampton, SO16 6YD, United Kingdom.
| | - Graham Roberts
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road Southampton Hampshire, Southampton, SO16 6YD, United Kingdom.
| | - Jane S Lucas
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road Southampton Hampshire, Southampton, SO16 6YD, United Kingdom.
| | - Woolf Walker
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road Southampton Hampshire, Southampton, SO16 6YD, United Kingdom.
| | - Rami Salib
- Faculty of Medicine, University of Southampton, Building 85, Life Sciences Building, Highfield Campus, Southampton, SO171BJ, United Kingdom; Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road Southampton Hampshire, Southampton, SO16 6YD, United Kingdom.
| | - Andrea Burgess
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road Southampton Hampshire, Southampton, SO16 6YD, United Kingdom.
| | - Hasnaa Ismail-Koch
- Faculty of Medicine, University of Southampton, Building 85, Life Sciences Building, Highfield Campus, Southampton, SO171BJ, United Kingdom; Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road Southampton Hampshire, Southampton, SO16 6YD, United Kingdom.
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Walker W. Book Review: Clinical Pharmacy and Hospital Drug Management. Scott Med J 2016. [DOI: 10.1177/003693308202700437] [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: 11/15/2022]
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18
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Miller D, Will M, Walker W. VATS Pneumonectomy: The Posterior Approach. J Cardiothorac Surg 2015. [PMCID: PMC4695835 DOI: 10.1186/1749-8090-10-s1-a350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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19
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Ramaswamy B, Graziano M, Jones D, Lindop F, Lowe R, Walker W. An APPDE knowledge translation project to promote global professional physiotherapy management in Parkinson's disease. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Walker W. The problem of stillbirth in H.D.N. Bibl Haematol 2015; 23:907-8. [PMID: 5879454 DOI: 10.1159/000384391] [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] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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21
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Collins SA, Gove K, Walker W, Lucas JS. Nasal nitric oxide screening for primary ciliary dyskinesia: systematic review and meta-analysis. Eur Respir J 2014; 44:1589-99. [DOI: 10.1183/09031936.00088614] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Nasal nitric oxide (nNO) concentrations are low in patients with primary ciliary dyskinesia (PCD) providing a noninvasive screening test.We conducted a systematic review of the literature to examine the utility of nNO in screening for PCD, in particular 1) different respiratory manoeuvres during sampling (velum closure, tidal breathing, etc.), 2) accuracy in screening young/uncooperative children, 3) stationary versus portable analysers, and 4) nNO in “atypical” PCD.96 papers were assessed according to modified PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria and 22 were included in this review.Meta-analysis of 11 studies comparing nNO during a velum closure breath hold gave a mean±sd nNO of 19.4±18.6 nL·min-1 in PCD (n = 478) and 265.0±118.9 nL·min-1 in healthy controls (n = 338). Weighted mean difference for PCD versus healthy controls was 231.1 nL·min-1 (95% CI 193.3–268.9; n = 338) and 114.1 nL·min-1 (95% CI 101.5–126.8; n = 415) for PCD versus cystic fibrosis. Five studies of nNO measurement during tidal breathing demonstrated that this is an acceptable manoeuvre in young children where velum closure is not possible, but the discriminatory value was reduced. Four small studies of portable NO analysers suggest these are reliable tools for screening for PCD. However, nNO must be interpreted alongside clinical suspicion. Future studies should focus on standardising sampling techniques and reporting.
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Hopkinson N, Wallis C, Higgins B, Gaduzo S, Sherrington R, Keilty S, Stern M, Britton J, Bush A, Moxham J, Sylvester K, Griffiths V, Sutherland T, Crossingham I, Raju R, Spencer C, Safavi S, Deegan P, Seymour J, Hickman K, Hughes J, Wieboldt J, Shaheen F, Peedell C, Mackenzie N, Nicholl D, Jolley C, Crooks G, Crooks G, Dow C, Deveson P, Bintcliffe O, Gray B, Kumar S, Haney S, Docherty M, Thomas A, Chua F, Dwarakanath A, Summers G, Prowse K, Lytton S, Ong YE, Graves J, Banerjee T, English P, Leonard A, Brunet M, Chaudhry N, Ketchell RI, Cummings N, Lebus J, Sharp C, Meadows C, Harle A, Stewart T, Parry D, Templeton-Wright S, Moore-Gillon J, Stratford- Martin J, Saini S, Matusiewicz S, Merritt S, Dowson L, Satkunam K, Hodgson L, Suh ES, Durrington H, Browne E, Walters N, Steier J, Barry S, Griffiths M, Hart N, Nikolic M, Berry M, Thomas A, Miller J, McNicholl D, Marsden P, Warwick G, Barr L, Adeboyeku D, Mohd Noh MS, Griffiths P, Davies L, Quint J, Lyall R, Shribman J, Collins A, Goldman J, Bloch S, Gill A, Man W, Christopher A, Yasso R, Rajhan A, Shrikrishna D, Moore C, Absalom G, Booton R, Fowler RW, Mackinlay C, Sapey E, Lock S, Walker P, Jha A, Satia I, Bradley B, Mustfa N, Haqqee R, Thomas M, Patel A, Redington A, Pillai A, Keaney N, Fowler S, Lowe L, Brennan A, Morrison D, Murray C, Hankinson J, Dutta P, Maddocks M, Pengo M, Curtis K, Rafferty G, Hutchinson J, Whitfield R, Turner S, Breen R, Naveed SUN, Goode C, Esterbrook G, Ahmed L, Walker W, Ford D, Connett G, Davidson P, Elston W, Stanton A, Morgan D, Myerson J, Maxwell D, Harrris A, Parmar S, Houghton C, Winter R, Puthucheary Z, Thomson F, Sturney S, Harvey J, Haslam PL, Patel I, Jennings D, Range S, Mallia-Milanes B, Collett A, Tate P, Russell R, Feary J, O'Driscoll R, Eaden J, Round J, Sharkey E, Montgomery M, Vaughan S, Scheele K, Lithgow A, Partridge S, Chavasse R, Restrick L, Agrawal S, Abdallah S, Lacy-Colson A, Adams N, Mitchell S, Haja Mydin H, Ward A, Denniston S, Steel M, Ghosh D, Connellan S, Rigge L, Williams R, Grove A, Anwar S, Dobson L, Hosker H, Stableforth D, Greening N, Howell T, Casswell G, Davies S, Tunnicliffe G, Mitchelmore P, Phitidis E, Robinson L, Prowse K, Bafadhel M, Robinson G, Boland A, Lipman M, Bourke S, Kaul S, Cowie C, Forrest I, Starren E, Burke H, Furness J, Bhowmik A, Everett C, Seaton D, Holmes S, Doe S, Parker S, Graham A, Paterson I, Maqsood U, Ohri C, Iles P, Kemp S, Iftikhar A, Carlin C, Fletcher T, Emerson P, Beasley V, Ramsay M, Buttery R, Mungall S, Crooks S, Ridyard J, Ross D, Guadagno A, Holden E, Coutts I, Cullen K, O'Connor S, Barker J, Sloper K, Watson J, Smith P, Anderson P, Brown L, Nyman C, Milburn H, Clive A, Serlin M, Bolton C, Fuld J, Powell H, Dayer M, Woolhouse I, Georgiadi A, Leonard H, Dodd J, Campbell I, Ruiz G, Zurek A, Paton JY, Malin A, Wood F, Hynes G, Connell D, Spencer D, Brown S, Smith D, Cooper D, O'Kane C, Hicks A, Creagh-Brown B, Lordan J, Nickol A, Primhak R, Fleming L, Powrie D, Brown J, Zoumot Z, Elkin S, Szram J, Scaffardi A, Marshall R, Macdonald I, Lightbody D, Farmer R, Wheatley I, Radnan P, Lane I, Booth A, Tilbrook S, Capstick T, Hewitt L, McHugh M, Nelson C, Wilson P, Padmanaban V, White J, Davison J, O'Callaghan U, Hodson M, Edwards J, Campbell C, Ward S, Wooler E, Ringrose E, Bridges D, Long A, Parkes M, Clarke S, Allen B, Connelly C, Forster G, Hoadley J, Martin K, Barnham K, Khan K, Munday M, Edwards C, O'Hara D, Turner S, Pieri-Davies S, Ford K, Daniels T, Wright J, Towns R, Fern K, Butcher J, Burgin K, Winter B, Freeman D, Olive S, Gray L, Pye K, Roots D, Cox N, Davies CA, Wicker J, Hilton K, Lloyd J, MacBean V, Wood M, Kowal J, Downs J, Ryan H, Guyatt F, Nicoll D, Lyons E, Narasimhan D, Rodman A, Walmsley S, Newey A, Buxton M, Dewar M, Cooper A, Reilly J, Lloyd J, Macmillan AB, Roots D, Olley A, Voase N, Martin S, McCarvill I, Christensen A, Agate R, Heslop K, Timlett A, Hailes K, Davey C, Pawulska B, Lane A, Ioakim S, Hough A, Treharne J, Jones H, Winter-Burke A, Miller L, Connolly B, Bingham L, Fraser U, Bott J, Johnston C, Graham A, Curry D, Sumner H, Costello CA, Bartoszewicz C, Badman R, Williamson K, Taylor A, Purcell H, Barnett E, Molloy A, Crawfurd L, Collins N, Monaghan V, Mir M, Lord V, Stocks J, Edwards A, Greenhalgh T, Lenney W, McKee M, McAuley D, Majeed A, Cookson J, Baker E, Janes S, Wedzicha W, Lomas Dean D, Harrison B, Davison T, Calverley P, Wilson R, Stockley R, Ayres J, Gibson J, Simpson J, Burge S, Warner J, Lenney W, Thomson N, Davies P, Woodcock A, Woodhead M, Spiro S, Ormerod L, Bothamley G, Partridge M, Shields M, Montgomery H, Simonds A, Barnes P, Durham S, Malone S, Arabnia G, Olivier S, Gardiner K, Edwards S. Children must be protected from the tobacco industry's marketing tactics. BMJ 2013; 347:f7358. [PMID: 24324220 DOI: 10.1136/bmj.f7358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Nicholas Hopkinson
- British Thoracic Society Chronic Obstructive Pulmonary Disease Specialist Advisory Group, National Heart and Lung Institute, Imperial College, London SW3 6NP, UK
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Yan TD, Cao C, D'Amico TA, Demmy TL, He J, Hansen H, Swanson SJ, Walker WS, Casali G, Dunning J, Shackcloth M, Shah R, Stamenkovic S, Routledge T, Walker W, Woo E, Woolley S, Baste JM, Gossot D, Roviaro G, Solaini L, Loscertales J, Gonzalez-Rivas D, Decaluwe H, Decker G, Ryck FD, Sokolow Y, Oosterhuis JW, Siebenga J, Schmid T, Bodner J, Dienemann H, Leschber G, Schneiter D, Hansen H, Licht P, Petersen RH, Piwkowski C, D'Amico T, Demmy T, Deschamps C, Howington J, Liptay M, McKenna R, Mitchell J, Meyers B, Park B, Swanson S, Lee HS, He J, Li Y, Liu Z, Wu N, Yim A, Yu W, Kohno T, Wright G, Yan TD. Video-assisted thoracoscopic surgery lobectomy at 20 years: a consensus statement. Eur J Cardiothorac Surg 2013; 45:633-9. [DOI: 10.1093/ejcts/ezt463] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sathiya M, Rousse G, Ramesha K, Laisa CP, Vezin H, Sougrati MT, Doublet ML, Foix D, Gonbeau D, Walker W, Prakash AS, Ben Hassine M, Dupont L, Tarascon JM. Reversible anionic redox chemistry in high-capacity layered-oxide electrodes. Nat Mater 2013; 12:827-35. [PMID: 23852398 DOI: 10.1038/nmat3699] [Citation(s) in RCA: 485] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/24/2013] [Indexed: 05/24/2023]
Abstract
Li-ion batteries have contributed to the commercial success of portable electronics and may soon dominate the electric transportation market provided that major scientific advances including new materials and concepts are developed. Classical positive electrodes for Li-ion technology operate mainly through an insertion-deinsertion redox process involving cationic species. However, this mechanism is insufficient to account for the high capacities exhibited by the new generation of Li-rich (Li(1+x)Ni(y)Co(z)Mn(1-x-y-z)O₂) layered oxides that present unusual Li reactivity. In an attempt to overcome both the inherent composition and the structural complexity of this class of oxides, we have designed structurally related Li₂Ru(1-y)Sn(y)O₃ materials that have a single redox cation and exhibit sustainable reversible capacities as high as 230 mA h g(-1). Moreover, they present good cycling behaviour with no signs of voltage decay and a small irreversible capacity. We also unambiguously show, on the basis of an arsenal of characterization techniques, that the reactivity of these high-capacity materials towards Li entails cumulative cationic (M(n+)→M((n+1)+)) and anionic (O(2-)→O₂(2-)) reversible redox processes, owing to the d-sp hybridization associated with a reductive coupling mechanism. Because Li₂MO₃ is a large family of compounds, this study opens the door to the exploration of a vast number of high-capacity materials.
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Affiliation(s)
- M Sathiya
- 1] LRCS, CNRS UMR 7314, Université de Picardie Jules Verne, 80039 Amiens, France [2] ALISTORE-European Research Institute, FR CNRS 3104, France
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Goodman J, Walker W, Wright J, Danjoux G, Howell S, Martin D, Bonner S. Project PIX (Post Intensive care eXercise): impact on physical fitness and focus group analysis of quality of life following exercise rehabilitation. Crit Care 2013. [PMCID: PMC3643082 DOI: 10.1186/cc12472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Walker W, Liew A, Harris A, Lucas JS. Bronchial and alveolar airway nitric oxide levels in primary ciliary dyskinesia and other respiratory diseases. Cilia 2012. [PMCID: PMC3555777 DOI: 10.1186/2046-2530-1-s1-p10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
One hundred different drug advertisements from each of seven leading medical journals have been assessed. Information about drug interactions, adverse reactions, mode of action, absorption, distribution, metabolism, excretion and cost was seldom provided in UK journals. A requirement should exist that drug advertisements include such clinically important information. Only a few pharmaceutical companies are attempting to educate doctors through their marketing and promotional material in advertisements in medical journals.
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Affiliation(s)
- A H Morgan
- Department of Therapeutics and Clinical Pharmacology, University of Aberdeen, Foresterhill, Aberdeen AB9 2ZD
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Lehnert MP, Pereira RM, Koehler PG, Walker W, Lehnert MS. Control of Cimex lectularius using heat combined with dichlorvos resin strips. Med Vet Entomol 2011; 25:460-464. [PMID: 21332764 DOI: 10.1111/j.1365-2915.2011.00944.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Successful management of the bed bug, Cimex lectularius L. (Hemiptera: Cimicidae), is difficult because of its pesticide resistance, which can allow a reduction in population, but not elimination. We evaluated the effect of heat and/or air circulation on the efficacy of dichlorvos resin strips in the control of bed bugs. Treatments were performed in unoccupied dormitory rooms and consisted of dichlorvos resin strips containing 18.6% active ingredient, the same strips + fan, and strips + fan + heat. The mortality of recently fed bed bugs and weight loss of the dichlorvos strips were evaluated over 7 days. Dichlorvos resin strips killed bed bugs and eggs in just over 7 days. The addition of a fan or a fan + heat decreased time to 100% mortality to 3 days and 36 h, respectively. Eggs located in treated rooms did not hatch. Resin strips in the strips + fan treatment and the strips + fan + heat treatment volatilized 10 and 70 times, respectively, faster than strips in the strips-only treatment. The addition of heat in treatments with dichlorvos resin strips enhances the overall efficacy of the volatile insecticide and reduces the time required to eliminate live bed bugs and eggs.
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Affiliation(s)
- M P Lehnert
- Department of Entomology, University of Florida, Gainesville, U.S.A.
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de Whalley P, Walker W, Snape MD, Oeser C, Casey M, Moulsdale P, Harrill C, Andrews N, Hoschler K, Thompson B, Jones C, Chalk J, Kerridge S, Tomlinson R, Heath PT, Finn A, Faust S, Miller E, Pollard AJ. A 1-year follow-on study from a randomised, head-to-head, multicentre, open-label study of two pandemic influenza vaccines in children. Health Technol Assess 2011; 15:v-vi, xi-xiii, 1-128. [DOI: 10.3310/hta15450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- P de Whalley
- Department of Paediatrics, University of Oxford, Oxford, UK
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Abstract
Despite being recognised for over two millennia and having an increasing incidence in many countries, the management of childhood empyema remains controversial. This review examines the recent literature on its causes and investigation then focuses on its treatment. Following a trial of appropriate intravenous antibiotics, the evidence would currently support the use of chest drain insertion with urokinase instillation as first line treatment with video-assisted thoracoscopic surgery to be used for failure of medical management. A treatment algorithm is proposed to guide clinical practice.
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Affiliation(s)
- Woolf Walker
- Regional Paediatric Respiratory Unit, Southampton University Hospitals NHS Trust, Southampton General Hospital, Tremona Road, Southampton, UK
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Walker W, Pierce D, Davidson S, Walker J. Evaluation of a health promotion program for reducing depression, anxiety and stress in community-dwelling older adults. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)72408-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AimHealth education programs that address risk factors for depression and promote positive mental health are approaches that can improve mental wellbeing. We investigated the effectiveness of a health promotion program for reducing levels of depression, anxiety and stress and for promoting appropriate help-seeking behaviour.MethodsFifty-five adults 55+years (43 female, 12 male) self-selected to attend the Healthy & Wise program - a group-based, 8 × 2hr session health-literacy program for promoting positive physical, mental and social functioning in a rural setting. A questionnaire was administered at base-line and post-intervention which included the DASS-21 to measure depression, anxiety and stress levels.ResultsNo significant change in depression scores (mean = 3.60pre-3.51post). Anxiety scores increased (mean 2.92pre-3.51post) (p = .036) correlating with age (p = .029) and change in physical health status (p = .002).Stress scores increased (mean 4.81pre-5.59post) (p = .05) correlating with age (p = .033) and change in physical health status (p = .016).Most participants (pre = 96.36%, post = 98%) indicated they would be likely to seek help from a GP if depressed. Men who mainly rely on their spouse for support were more likely to seek help from a psychologist or psychiatrist (p = .038).ConclusionsThere was no significant change in DASS-21 scores for depression. There was an increase in anxiety and stress levels which may be attributable to older participants experiencing a decline in physical health during the program. Participants remained firm in their preference for seeking help from their GP for depression. Further evaluation is needed to determine whether: at-risk-populations need to be targeted; the intervention has an impact at 12-month follow-up.
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Arias-Pardilla J, Walker W, Wudl F, Otero TF. Reduction and Oxidation Doping Kinetics of an Electropolymerized Donor−Acceptor Low-Bandgap Conjugated Copolymer. J Phys Chem B 2010; 114:12777-84. [DOI: 10.1021/jp1038865] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J. Arias-Pardilla
- Group of Electrochemistry, Intelligent Materials and Devices (GEMDI), Universidad Politécnica de Cartagena, ETSII, E- 30203, Cartagena, Spain, and Center for Polymers and Organic Solids, University of California, Santa Barbara, California 93106
| | - W. Walker
- Group of Electrochemistry, Intelligent Materials and Devices (GEMDI), Universidad Politécnica de Cartagena, ETSII, E- 30203, Cartagena, Spain, and Center for Polymers and Organic Solids, University of California, Santa Barbara, California 93106
| | - F. Wudl
- Group of Electrochemistry, Intelligent Materials and Devices (GEMDI), Universidad Politécnica de Cartagena, ETSII, E- 30203, Cartagena, Spain, and Center for Polymers and Organic Solids, University of California, Santa Barbara, California 93106
| | - T. F. Otero
- Group of Electrochemistry, Intelligent Materials and Devices (GEMDI), Universidad Politécnica de Cartagena, ETSII, E- 30203, Cartagena, Spain, and Center for Polymers and Organic Solids, University of California, Santa Barbara, California 93106
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Walker W, Connett G. Manifesting carriage of a Duchenne muscular dystrophy mutation: an unusual cause of impaired lung function in CF. Med Chir Trans 2010; 103 Suppl 1:S27-9. [DOI: 10.1258/jrsm.2010.s11007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Woolf Walker
- Regional Cystic Fibrosis Unit, Southampton Hospitals NHS Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - Gary Connett
- Regional Cystic Fibrosis Unit, Southampton Hospitals NHS Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
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Recham N, Chotard JN, Dupont L, Delacourt C, Walker W, Armand M, Tarascon JM. A 3.6 V lithium-based fluorosulphate insertion positive electrode for lithium-ion batteries. Nat Mater 2010; 9:68-74. [PMID: 19946280 DOI: 10.1038/nmat2590] [Citation(s) in RCA: 194] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 11/02/2009] [Indexed: 05/24/2023]
Abstract
Li-ion batteries have contributed to the commercial success of portable electronics, and are now in a position to influence higher-volume applications such as plug-in hybrid electric vehicles. Most commercial Li-ion batteries use positive electrodes based on lithium cobalt oxides. Despite showing a lower voltage than cobalt-based systems (3.45 V versus 4 V) and a lower energy density, LiFePO(4) has emerged as a promising contender owing to the cost sensitivity of higher-volume markets. LiFePO(4) also shows intrinsically low ionic and electronic transport, necessitating nanosizing and/or carbon coating. Clearly, there is a need for inexpensive materials with higher energy densities. Although this could in principle be achieved by introducing fluorine and by replacing phosphate groups with more electron-withdrawing sulphate groups, this avenue has remained unexplored. Herein, we synthesize and show promising electrode performance for LiFeSO(4)F. This material shows a slightly higher voltage (3.6 V versus Li) than LiFePO(4) and suppresses the need for nanosizing or carbon coating while sharing the same cost advantage. This work not only provides a positive-electrode contender to rival LiFePO(4), but also suggests that broad classes of fluoro-oxyanion materials could be discovered.
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Affiliation(s)
- N Recham
- LRCS-UMR 6007-Université de Picardie Jules Verne, 80039 Amiens, France
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Abstract
PRIMARY OBJECTIVE To evaluate the effects of administering Donepezil during inpatient rehabilitation for individuals with TBI. RESEARCH DESIGN Retrospective, age and injury severity matched, mixed between-within subjects analysis. METHODS AND PROCEDURES Thirty-six patients with moderate-to-severe TBI admitted to acute rehabilitation within 90 days of injury. Main outcome measures included FIM cognitive total scores and rehabilitation lengths of stay. INTERVENTION Initiation of Donepezil administration beginning at 5 mg daily. Dose titration and continuation based on perceived clinical response. MAIN OUTCOMES AND RESULTS No differences in cognitive improvement were observed between the Donepezil treatment group and the matched control group. Sub-set analyses suggested that administration of Donepezil early in the rehabilitation stay was significantly related to higher rates of cognitive improvement. CONCLUSIONS Preliminary evidence suggests that Donepezil administration early in the rehabilitation stay may have advantageous treatment effects. A prospective, randomized, placebo-controlled clinical trial with standard timing, dosage and treatment duration is recommended to further evaluate treatment efficacy.
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Affiliation(s)
- W Walker
- Defense and Veterans Brain Injury Center, McGuire Veterans Administration Medical Center, Richmond, VA 23249, USA
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Adkison JB, Khuntia D, Bentzen SM, Cannon GM, Tome WA, Jaradat H, Walker W, Traynor AM, Weigel T, Mehta MP. Dose escalated, hypofractionated radiotherapy using helical tomotherapy for inoperable non-small cell lung cancer: preliminary results of a risk-stratified phase I dose escalation study. Technol Cancer Res Treat 2009; 7:441-7. [PMID: 19044323 DOI: 10.1177/153303460800700605] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
To improve local control for inoperable non-small cell lung cancer (NSCLC), a phase I dose escalation study for locally advanced and medically inoperable patients was devised to escalate tumor dose while limiting the dose to organs at risk including the esophagus, spinal cord, and residual lung. Helical tomotherapy provided image-guided IMRT, delivered in a 5-week hypofractionated schedule to minimize the effect of accelerated repopulation. Forty-six patients judged not to be surgical candidates with Stage I-IV NSCLC were treated. Concurrent chemotherapy was not allowed. Radiotherapy was delivered via helical tomotherapy and limited to the primary site and clinically proven or suspicious nodal regions without elective nodal irradiation. Patients were placed in 1 of 5 dose bins, all treated for 25 fractions, with dose per fraction ranging from 2.28 to 3.22 Gy. The bin doses of 57 to 80.5 Gy result in 2 Gy/fraction normalized tissue dose (NTD) equivalents of 60 to 100 Gy. In each bin, the starting dose was determined by the relative normalized tissue mean dose modeled to cause < 20% Grade 2 pneumonitis. Dose constraints included spinal cord maximum NTD of 50 Gy, esophageal maximum NTD < 64 Gy to < or = 0.5 cc volume, and esophageal effective volume of 30%. No grade 3 RTOG acute pneumonitis (NCI-CTC v.3) or esophageal toxicities (CTCAE v.3.0 and RTOG) were observed at median follow-up of 8.1 months. Pneumonitis rates were 70% grade 1 and 13% grade 2. Multivariate analysis identified lung NTD(mean) (p=0.012) and administration of adjuvant chemotherapy following radiotherapy (p=0.015) to be independent risk factors for grade 2 pneumonitis. Only seven patients (15%) required narcotic analgesics (RTOG grade 2 toxicity) for esophagitis, with only 2.3% average weight loss during treatment. Best in-field gross response rates were 17% complete response, 43% partial response, 26% stable disease, and 6.5% in-field thoracic progression. The out-of-field thoracic failure rate was 13%, and distal failure rate was 28%. The median survival was 18 months with 2-year overall survival of 46.8% +/- 9.7% for this cohort, 50% of whom were stage IIIB and 30% stage IIIA. Dose escalation can be safely achieved in NSCLC with lower than expected rates of pneumonitis and esophagitis using hypofractionated image-guided IMRT. The maximum tolerated dose has yet to be reached.
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Affiliation(s)
- J B Adkison
- Department of Human Oncology, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53792, USA
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Wolford DC, Jost CM, Madu EC, Walker W, Ramanatian KB. Role of transesophageal echocardiography in the clinical management of a patients with a giant coronary artery aneurysm. Clin Cardiol 2009; 20:573-5. [PMID: 9181270 PMCID: PMC6655963 DOI: 10.1002/clc.4960200612] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Transthoracic echocardiography (TTE) has substantial limitations for the study of abnormalities of the coronary tree. Transesophageal echocardiography (TEE) allows a more complete examination of the coronary arteries, particularly the proximal segments. This report describes the use of TEE after cardiac catheterization in the clinical management of a patient with unstable angina. While angiography first showed the giant aneurysm of the left circumflex coronary artery. TEE, by revealing an active thrombus of the lumen, prompted an immediate surgical resolution.
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Affiliation(s)
- D C Wolford
- Department of Medicine, University of Tennessee, Memphis 38163, USA
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Adkison J, Cannon G, Khuntia D, Jaradat H, Tome W, Walker W, Huang B, Mehta M. Image-Guided, Intensity-Modulated Hypofractionated Radiotherapy for Inoperable Non-Small Cell Lung Cancer: Preliminary Results of a Phase I Dose Escalation Study. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wong B, Gilbert D, Walker W, Liao I, Xu H, Gregg J, Apperson M, Sharp F. G.P.12.10 Gene expression profiling of blood in subjects with Duchenne muscular dystrophy and related disorders. Neuromuscul Disord 2007. [DOI: 10.1016/j.nmd.2007.06.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Krolewski AS, Poznik GD, Placha G, Canani L, Dunn J, Walker W, Smiles A, Krolewski B, Fogarty DG, Moczulski D, Araki S, Makita Y, Ng DPK, Rogus J, Duggirala R, Rich SS, Warram JH. A genome-wide linkage scan for genes controlling variation in urinary albumin excretion in type II diabetes. Kidney Int 2006; 69:129-36. [PMID: 16374433 DOI: 10.1038/sj.ki.5000023] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The main hallmark of diabetic nephropathy is elevation in urinary albumin excretion. We performed a genome-wide linkage scan in 63 extended families with multiple members with type II diabetes. Urinary albumin excretion, measured as the albumin-to-creatinine ratio (ACR), was determined in 426 diabetic and 431 nondiabetic relatives who were genotyped for 383 markers. The data were analyzed using variance components linkage analysis. Heritability (h2) of ACR was significant in diabetic (h2=0.23, P=0.0007), and nondiabetic (h2=0.39, P=0.0001) relatives. There was no significant difference in genetic variance of ACR between diabetic and nondiabetic relatives (P=0.16), and the genetic correlation (rG=0.64) for ACR between these two groups was not different from 1 (P=0.12). These results suggested that similar genes contribute to variation in ACR in diabetic and nondiabetic relatives. This hypothesis was supported further by the linkage results. Support for linkage to ACR was suggestive in diabetic relatives and became significant in all relatives for chromosome 22q (logarithm of odds, LOD=3.7) and chromosome 7q (LOD=3.1). When analyses were restricted to 59 Caucasian families, support for linkage in all relatives increased and became significant for 5q (LOD=3.4). In conclusion, genes on chromosomes 22q, 5q and 7q may contribute to variation in urinary albumin excretion in diabetic and nondiabetic individuals.
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Affiliation(s)
- A S Krolewski
- Research Division, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
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Shurtleff DB, Duguay S, Cardenas D, Walker W. Obesity and BMI in myelomeningocele. Cerebrospinal Fluid Res 2005. [DOI: 10.1186/1743-8454-2-s1-s38] [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: 11/10/2022] Open
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Traynor A, Richards G, Khuntia D, Churas K, Walker W, Wiederholt P, Bentzen S, Harari P. Combining H&N IMRT with Weekly Cisplatin Chemotherapy: Early Toxicity and Outcome. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Howard GCW, Conkey DS, Peoples S, McLaren DB, Hargreave TB, Tulloch DN, Walker W, Kerr GR. The management and outcome of patients with germ-cell tumours treated in the Edinburgh Cancer Centre between 1988 and 2002. Clin Oncol (R Coll Radiol) 2005; 17:435-40. [PMID: 16149287 DOI: 10.1016/j.clon.2005.03.011] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS The aim of this retrospective analysis was to review the outcome of patients with germ-cell tumours treated in the Edinburgh Cancer Centre over the past 15 years, and to see whether there had been any changes over three 5-year cohorts. MATERIALS AND METHODS Patients referred with gonadal and extra-gonadal primary germ-cell tumours, between 1988 and 2002, were identified from the departmental database, and survival by stage and prognostic group was analysed. RESULTS AND CONCLUSIONS The proportion of patients with stage I seminoma has significantly increased. The good prognosis of patients with early stage disease is confirmed, with the outcome for some groups of patients being better than expected. There is a non-significant trend to improved results over the three 5-year cohorts. The outcome for patients with stage IV seminoma is worse than would be expected, but numbers are small. The poor prognosis of patients with non-seminomatous germ-cell tumours who fall into the International Germ Cell Consensus Classification (IGCCC) poor-prognostic group is confirmed. Failure of patients with metastatic non-seminomatous germ-cell tumours to achieve a complete response to initial therapy is shown to be a poor prognostic indicator.
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Affiliation(s)
- G C W Howard
- Urological Oncology Section, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh, UK.
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Henschler R, Rüster B, Steimle A, Hansmann HL, Walker W, Montag T, Seifried E. Analysis of leukocyte binding to depletion filters: role of passive binding, interaction with platelets, and plasma components. Ann Hematol 2005; 84:538-44. [PMID: 15703928 DOI: 10.1007/s00277-004-0994-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2003] [Accepted: 12/12/2004] [Indexed: 10/25/2022]
Abstract
Since limited knowledge exists on the mechanisms which regulate cell binding to leukocyte removal filter surfaces, we investigated the binding patterns of leukocytes to individual layers of leukocyte depletion filters. After passage of 1 unit of whole blood, blotting of isolated filter layers on glass slides or elution of cells from filter layers revealed that most leukocytes were located within the first 10 of a total of 28 filter layers, peaking at layers 6 to 8, with granulocytes binding on average to earlier filter layers than lymphocytes. Leukocytes preincubated with inhibitors of actin activation showed unchanged distribution between filter layers, suggesting that cytoskeletal activation does not significantly contribute to their binding. When leukocytes were directly incubated with single filter layers, binding of up to 30% of input cells was recorded in the absence of Ca(2+). Immunohistological analyses showed colocalization of platelets and leukocytes, with co-clustering of platelets and leukocytes. Monocytes and to some degree lymphocytes but not granulocytes competed with platelets for filter binding. Precoating of filter layers with individual plasma components showed that hyaluronic acid, plasma type fibronectin, and fibrinogen all increased the binding of leukocytes compared with albumin coating. In conclusion, leukocytes can bind passively to filters in a process which does not require Ca(2+), which is independent of cytoskeletal activation and which may depend on individual plasma components. These results are of importance when new selective cell enrichment or depletion strategies through specific filters are envisaged.
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Affiliation(s)
- R Henschler
- Institute of Transfusion Medicine and Immune Hematology, Blutspendedienst Baden-Württemberg-Hessen, Sandhofstrasse 1, 60528, Frankfurt, Germany.
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Gao PS, Heller NM, Walker W, Chen CH, Moller M, Plunkett B, Roberts MH, Schleimer RP, Hopkin JM, Huang SK. Variation in dinucleotide (GT) repeat sequence in the first exon of the STAT6 gene is associated with atopic asthma and differentially regulates the promoter activity in vitro. J Med Genet 2004; 41:535-9. [PMID: 15235025 PMCID: PMC1447608 DOI: 10.1136/jmg.2003.015842] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Intensive and high-dependency care is currently receiving considerable attention, not least since the Department of Health review of adult critical care nursing and subsequent proposals for the development of a consistent and comprehensive critical care service (DoH 2000). The report highlights the need for policy changes at all levels and across all disciplines and makes several recommendations that are deemed essential for the future organization and delivery of critical care. Central to the proposed reforms is the availability of a skilled workforce, adequately prepared and appropriately trained to provide specialist care in a variety of settings where acutely ill patients are found. This paper considers the implications of 'comprehensive critical care' for pre- and post-registration nurse education and offers insight into programmes of learning that are tailored to meet the needs of the service and individuals. The paper draws upon three influential and timely publications, namely the Audit Commission report into critical care services, the English National Board (ENB) review of adult intensive/critical and high-dependency care programmes and the United Kingdom Central Council (UKCC) Commission for Education recommendations regarding 'fitness for practice'.
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Affiliation(s)
- W Walker
- Staffordshire University, School of Health, Stafford, UK
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Abstract
Numerous epidemiological and clinical studies have noted differences in the incidence and severity of parasitic diseases between males and females. Although in some instances this may be due to gender-associated differences in behavior, there is overwhelming evidence that sex-associated hormones can also modulate immune responses and consequently directly influence the outcome of parasitic infection. Animal models of disease can often recreate the gender-dependent differences observed in humans, and the role of sex-associated hormones can be confirmed by experimentally altering their levels. Under normal circumstances, levels of sex hormones not only differ between males and females but vary according to age. Furthermore, not only are females of reproductive age subject to the regular hormonal cycles which control ovulation, they are also exposed to dramatically altered levels during pregnancy. It is thus not surprising that the severity of many diseases, including those caused by parasites, has been shown to be affected by one or more of these circumstances. In addition, infection with many pathogens has been shown to have an adverse influence on pregnancy. In this article we review the impact of sex-associated hormones on the immune system and the development and maintenance of immunity to the intracellular protozoan parasites Toxoplasma gondii, Plasmodium spp., and Leishmania spp.
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Affiliation(s)
- C W Roberts
- Department of Immunology, Strathclyde Institute of Biomedical Sciences, University of Strathclyde, 27 Taylor St., Glasgow G4 ONR, Scotland, United Kingdom.
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