Author: "S. Walton" / Topic: medicine - Searchworks@Jio Institute Digital Library Search Results

357 results on '"S. Walton"'

1. MYB insufficiency disrupts proteostasis in hematopoietic stem cells leading to age-related neoplasia

Author: Roza Berhanu Lemma, Giacomo Volpe, Boris Noyvert, Odd S. Gabrielsen, Jon Frampton, Mary L. Clarke, and David S. Walton
Subjects: Regulation of gene expression, Immunology, Hematopoietic stem cell, Cell Biology, Hematology, Biology, medicine.disease, Biochemistry, Leukemia, Haematopoiesis, medicine.anatomical_structure, Proteostasis, Cancer research, medicine, MYB, Stem cell, Transcription factor
Abstract: MYB plays a key role in gene regulation throughout the hematopoietic hierarchy and is critical for the maintenance of normal hematopoietic stem cells (HSC). Acquired genetic dysregulation of MYB is involved in the etiology of a number of leukemias, although inherited noncoding variants of the MYB gene are a susceptibility factor for many hematological conditions, including myeloproliferative neoplasms (MPN). The mechanisms that connect variations in MYB levels to disease predisposition, especially concerning age dependency in disease initiation, are completely unknown. Here, we describe a model of Myb insufficiency in mice that leads to MPN, myelodysplasia, and leukemia in later life, mirroring the age profile of equivalent human diseases. We show that this age dependency is intrinsic to HSC, involving a combination of an initial defective cellular state resulting from small effects on the expression of multiple genes and a progressive accumulation of further subtle changes. Similar to previous studies showing the importance of proteostasis in HSC maintenance, we observed altered proteasomal activity and elevated proliferation indicators, followed by elevated ribosome activity in young Myb-insufficient mice. We propose that these alterations combine to cause an imbalance in proteostasis, potentially creating a cellular milieu favoring disease initiation.
Published: 2022

2. Rehabilitating Paraphilic Disorder in Prisons

Author: Jamie S. Walton
Subjects: medicine.medical_specialty, media_common.quotation_subject, Psychological intervention, medicine, Shame, Psychiatry, Psychology, media_common
Published: 2021
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3. Contemporary Programs Designed for the Tertiary Prevention of Recidivism by People Convicted of a Sexual Offense

Author: Jamie S. Walton, Adam J. Carter, and Laura Ramsay
Subjects: Sexual offense, Cognitive behavioral therapy, medicine.medical_specialty, Recidivism, medicine.medical_treatment, medicine, Psychology, Psychiatry, Tertiary Prevention
Published: 2020
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4. Glaucoma following Infant Lensectomy: 2021 Update

Author: David S. Walton and Helen H Yeung
Subjects: Aphakic glaucoma, medicine.medical_specialty, business.industry, Glaucoma, Infant, Aphakia, Postcataract, Cataract Extraction, medicine.disease, Cataract, Ophthalmology, Lens cell, Clinical evidence, medicine, Anterior chamber fibrosis, Humans, business, Intraocular Pressure, Retrospective Studies
Abstract: To review information pertaining to glaucoma following infant lensectomy surgery and to provide evidence to support the responsible mechanism of this condition.Described risk factors and proposed mechanisms for infantile aphakic glaucoma were assessed. The clinical evidence observed in affected glaucoma patients was analyzed, and evidence of postoperative anterior chamber fibrosis was reviewed and interpreted.The review and assessment of laboratory and clinical evidence support the proposal that infantile aphakic glaucoma is caused, in part, by postoperative anterior chamber fibroization related to lens cell dispersion and active epithelial-mesenchymal transition with resultant filtration angle tissue injury and loss of function.ZIEL: Ziel dieser Studie war es, Informationen über das Auftreten eines Glaukoms nach einer im frühkindlichen Alter durchgeführten Lensektomie zu überprüfen und Beweise für den dafür verantwortlichen Mechanismus zu liefern. METHODEN UND ERGEBNISSE: Beschriebene Risikofaktoren und vermutete Mechanismen des infantilen aphakischen Glaukoms wurden evaluiert. Es wurden die in Glaukompatienten beobachteten klinischen Befunde analysiert, und die Hinweise auf eine postoperative Fibrose der vorderen Augenkammer wurden überprüft und interpretiert. SCHLUSSFOLGERUNG: Die Überprüfung und Evaluierung von Laborwerten und klinischen Beweisen stützen die Hypothese, dass das infantile aphakische Glaukom zum Teil durch eine postoperative Fibrosierung der vorderen Augenkammer verursacht wird, die im Zusammenhang mit der Dispersion der Linsenzellen und der aktiven epithelial-mesenchymalen Transition steht, die zu einer Schädigung des Filtrationswinkels mit Funktionsverlust führt.
Published: 2021

5. Pathways linking biodiversity to human health: A conceptual framework

Author: Roland Kraemer, Max Hofmann, Jutta Stadler, Terry Hartig, Sonja Knapp, Aletta Bonn, Franziska Kolek, Ruth Müller, Matthias Braubach, Sjerp de Vries, Siân de Bell, Dörte Martens, Mark J. Nieuwenhuijsen, Nadja Kabisch, Jacqueline M. Potts, Daniel T. C. Cox, Margarita Triguero-Mas, Katherine N. Irvine, S Walton, Iana Markevych, Penny A. Cook, Anna Heintz-Buschart, Sara L. Warber, Katrin Böhning-Gaese, Sarah Lindley, and Melissa R. Marselle
Subjects: Conservation of Natural Resources, medicine.medical_specialty, 010504 meteorology & atmospheric sciences, media_common.quotation_subject, Wildlife, Biodiversity, WASS, Regional Development and Spatial Use, 010501 environmental sciences, 01 natural sciences, Ecosystem services, Promotion (rank), Ecosystem Services, Human Well-being, Mediation, Nature, Public Health, Zoonoses, medicine, Animals, Humans, ddc:610, Exercise, Environmental planning, Ecosystem, lcsh:Environmental sciences, 0105 earth and related environmental sciences, General Environmental Science, media_common, lcsh:GE1-350, Public health, Public Health, Global Health, Social Medicine and Epidemiology, Regionale Ontwikkeling en Ruimtegebruik, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Harm, Conceptual framework, Human well-being, Business
Abstract: Biodiversity is a cornerstone of human health and well-being. However, while evidence of the contributions of nature to human health is rapidly building, research into how biodiversity relates to human health remains limited in important respects. In particular, a better mechanistic understanding of the range of pathways through which biodiversity can influence human health is needed. These pathways relate to both psychological and social processes as well as biophysical processes. Building on evidence from across the natural, social and health sciences, we present a conceptual framework organizing the pathways linking biodiversity to human health. Four domains of pathways - both beneficial as well as harmful - link biodiversity with human health: (i) reducing harm (e.g. provision of medicines, decreasing exposure to air and noise pollution); (ii) restoring capacities (e.g. attention restoration, stress reduction); (iii) building capacities (e.g. promoting physical activity, transcendent experiences); and (iv) causing harm (e.g. dangerous wildlife, zoonotic diseases, allergens). We discuss how to test components of the biodiversity-health framework with available analytical approaches and existing datasets. In a world with accelerating declines in biodiversity, profound land-use change, and an increase in non-communicable and zoonotic diseases globally, greater understanding of these pathways can reinforce biodiversity conservation as a strategy for the promotion of health for both people and nature. We conclude by identifying research avenues and recommendations for policy and practice to foster biodiversity-focused public health actions.
Published: 2021
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6. Compassion and acceptance as interventions for paraphilic disorders and sexual offending behaviour

Author: Kerensa Hocken and Jamie S. Walton
Subjects: Mindfulness, Psychotherapist, media_common.quotation_subject, Sexual arousal, Psychological intervention, Timeline, Compassion, medicine.disease, Constructive, Ethos, medicine, Paraphilia, Psychology, media_common
Abstract: In this chapter the role of trauma and adverse experiences triggering offence paralleling behaviour is explored in relation to the assessment and management of sexual arousal. A model of the impact of trauma on different evolved psychological systems and processes is explored. Links between different trauma related processes and offending processes are suggested. Monitoring offence paralleling behaviour is suggested as a method for establishing whether trauma related offending processes are in play and as a way of identifying relevant treatment targets or establishing if there has been change in a particular risk process for an individual case. In this chapter we track the generations of therapeutic interventions for people with paraphilic interests convicted of sexual offending, providing a timeline of changing practice over several decades. These shifts reflect fundamental paradigm movements in general psychotherapy. We also discuss two emerging therapy models underpinned by compassion science, mindfulness, acceptance techniques and values work, and consider how they could support people with paraphilia convicted of sexual offending lead more constructive, crime-free lives. Our intention is to highlight contemporary therapies that humanize human harming and suffering, and which not only dovetail with the ethos of a good-lives approach but also deepen agendas for working in strengths-based ways.
Published: 2020
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7. Severe Liver Disease

Author: Ronald S. Walton
Subjects: Liver disease, medicine.medical_specialty, business.industry, Internal medicine, Medicine, business, medicine.disease, Gastroenterology
Published: 2020
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8. Ablation of MYB-dependent leukaemia phenotype in MLL-driven AML correlates with increased expression of MAFB

Author: David S. Walton, Florian Grebien, Daniel Blakemore, Mary L. Clarke, Jon Frampton, Giacomo Volpe, Paloma Garcia, Pierre Cauchy, and Carl Ward
Subjects: Mutation, Myeloid, Biology, medicine.disease_cause, Phenotype, Transcriptome, Haematopoiesis, medicine.anatomical_structure, MAFB, hemic and lymphatic diseases, medicine, Cancer research, MYB, Transcription factor
Abstract: The transcription factor MYB plays a pivotal role in haematopoietic homeostasis and its aberrant expression is involved in the genesis and maintenance of acute myeloid leukaemia (AML). Our previous work has demonstrated that not all AML types display the same dependency on MYB expression and that MYB dependence is dictated by the nature of the driver mutation. However, whether this difference in MYB dependency is a general trend in AML still remains to be further elucidated. In this study, we investigate the importance of MYB in human leukaemia by performing siRNA-mediated knock-down in cell line models of AML with different driver lesions. We show that the characteristic reduction in proliferation and the concomitant induction of myeloid differentiation that is observed in MLL-fusion-driven leukaemia upon MYB suppression is not seen in AML cells with a complex karyotype. By performing transcriptome analysis, we demonstrate that a strong activation of MAFB expression driven by MYB ablation is restricted to MYB-dependent cells. In line with these observations, stratification of publicly available patient data reveals a reciprocal relationship between the expression of MYB and MAFB, highlighting a novel connection between those two factors in AML.
Published: 2020
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9. Failure of Goniosurgery for Glaucoma Associated With Sturge-Weber Syndrome

Author: Namratha Turlapati, David S. Walton, Steven A. Kane, Jane Song Nzuna, and Helen H Yeung
Subjects: Male, Intraocular pressure, medicine.medical_specialty, Time Factors, genetic structures, Adolescent, medicine.medical_treatment, Sturge–Weber syndrome, Gonioscopy, Visual Acuity, Glaucoma, Scleral spur, Trabeculectomy, 03 medical and health sciences, Tonometry, Ocular, Young Adult, 0302 clinical medicine, Sturge-Weber Syndrome, Trabecular Meshwork, 030225 pediatrics, Ophthalmology, Glaucoma surgery, Medicine, Humans, Strabismus, Child, Intraocular Pressure, Retrospective Studies, medicine.diagnostic_test, business.industry, Infant, Newborn, Infant, General Medicine, medicine.disease, Trabeculotomy, eye diseases, medicine.anatomical_structure, Treatment Outcome, Child, Preschool, Pediatrics, Perinatology and Child Health, 030221 ophthalmology & optometry, Female, sense organs, business, Follow-Up Studies
Abstract: Purpose: To report the surgical results of goniosurgery for children with glaucoma associated with Sturge-Weber syndrome. Methods: Retrospective review of medical records of patients who had initial goniosurgery for glaucoma associated with Sturge-Weber syndrome. Results: A total of 46 eyes of 42 patients who had glaucoma associated with Sturge-Weber syndrome and were treated with initial goniosurgery were identified to determine the efficacy of therapeutic goniotomy and trabeculotomy (goniosurgery). The average age at the time of goniosurgery was 1.5 years (range: 1 month to 23 years). Office intraocular pressure (IOP) measurements before goniosurgery were recorded in 76% of patients (32 of 42 patients) with an average measurement of 35 mm Hg (range: 25 to 50 mm Hg). The average interval to failure was 4 months (range: 1 to 48 months). Forty-six eyes underwent goniosurgery with a rate of failure of 98% (45 of 46 eyes) and a qualified success rate of 2% (1 of 46 eyes). Fifty-one goniotomy and 11 trabeculotomy procedures were performed. On gonioscopy, the filtration angles were all abnormal with variable width and visibility of the ciliary body band and less visible scleral spur. The trabecular meshwork was seen preoperatively in 100% of eyes (41 of 41 eyes) examined, all of which underwent goniosurgery. Five eyes underwent goniosurgery without documented gonioscopy. The ciliary body band was seen in 39% of eyes (16 of 41 eyes) and the scleral spur was visible in 10% of eyes (4 of 41 eyes). Conclusions: Goniosurgery is not an effective initial glaucoma surgery for glaucoma associated with Sturge-Weber syndrome. It can be used to temporize the IOP, but ultimately other forms of glaucoma surgery must be considered when indicated. [ J Pediatr Ophthalmol Strabismus . 2020;57(6):384–387.]
Published: 2020

10. Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry

Author: Jitendra PS. Sawhney, Veerappa A. Kothiwale, Vikas Bisne, Rajashekhar Durgaprasad, Praveen Jadhav, Manoj Chopda, Velam Vanajakshamma, Ramdhan Meena, Govindan Vijayaraghavan, Kamaldeep Chawla, Jagan Allu, Karen S. Pieper, A. John Camm, Ajay K. Kakkar, Jean-Pierre Bassand, David A. Fitzmaurice, Samuel Z. Goldhaber, Shinya Goto, Sylvia Haas, Werner Hacke, Lorenzo G. Mantovani, Frank Misselwitz, Alexander G.G. Turpie, Martin van Eickels, Freek W.A. Verheugt, Gloria Kayani, Keith A.A. Fox, Bernard J. Gersh, Hector Lucas Luciardi, Harry Gibbs, Marianne Brodmann, Frank Cools, Antonio Carlos Pereira Barretto, Stuart J. Connolly, Alex Spyropoulos, John Eikelboom, Ramon Corbalan, Dayi Hu, Petr Jansky, Jørn Dalsgaard Nielsen, Hany Ragy, Pekka Raatikainen, Jean-Yves Le Heuzey, Harald Darius, Matyas Keltai, Sanjay Kakkar, Jitendra Pal Singh Sawhney, Giancarlo Agnelli, Giuseppe Ambrosio, Yukihiro Koretsune, Carlos Jerjes Sánchez Díaz, Hugo Ten Cate, Dan Atar, Janina Stepinska, Elizaveta Panchenko, Toon Wei Lim, Barry Jacobson, Seil Oh, Xavier Viñolas, Marten Rosenqvist, Jan Steffel, Pantep Angchaisuksiri, Ali Oto, Alex Parkhomenko, Wael Al Mahmeed, David Fitzmaurice, D.Y. Hu, K.N. Chen, Y.S. Zhao, H.Q. Zhang, J.Z. Chen, S.P. Cao, D.W. Wang, Y.J. Yang, W.H. Li, Y.H. Yin, G.Z. Tao, P. Yang, Y.M. Chen, S.H. He, Ying Wang, Yong Wang, G.S. Fu, X. Li, T.G. Wu, X.S. Cheng, X.W. Yan, R.P. Zhao, M.S. Chen, L.G. Xiong, P. Chen, Y. Jiao, Y. Guo, L. Xue, F.Z. Wang, H. Li, Z.M. Yang, C.L. Bai, J. Chen, J.Y. Chen, X. Chen, S. Feng, Q.H. Fu, X.J. Gao, W.N. Guo, R.H. He, X.A. He, X.S. Hu, X.F. Huang, B. Li, J. Li, L. Li, Y.H. Li, T.T. Liu, W.L. Liu, Y.Y. Liu, Z.C. Lu, X.L. Luo, T.Y. Ma, J.Q. Peng, X. Sheng, X.J. Shi, Y.H. Sun, G. Tian, K. Wang, L. Wang, R.N. Wu, Q. Xie, R.Y. Xu, J.S. Yang, L.L. Yang, Q. Yang, Y. Ye, H.Y. Yu, J.H. Yu, T. Yu, H. Zhai, Q. Zhan, G.S. Zhang, Q. Zhang, R. Zhang, Y. Zhang, W.Y. Zheng, B. Zhou, Z.H. Zhou, X.Y. Zhu, S. Kakkar, J.P.S. Sawhney, P. Jadhav, R. Durgaprasad, A.G. Ravi Shankar, R.K. Rajput, K. Bhargava, R. Sarma, A. Srinivas, D. Roy, U.M. Nagamalesh, M. Chopda, R. Kishore, G. Kulkarni, P. Chandwani, R.A. Pothiwala, M. Padinhare Purayil, S. Shah, K. Chawla, V.A. Kothiwale, B. Raghuraman, G. Vijayaraghavan, V.M. Vijan, G. Bantwal, V. Bisne, A. Khan, J.B. Gupta, S. Kumar, D. Jain, S. Abraham, D. Adak, A. Barai, H. Begum, P. Bhattacharjee, M. Dargude, D. Davies, B. Deshpande, P. Dhakrao, V. Dhyani, S. Duhan, M. Earath, A. Ganatra, S. Giradkar, V. Jain, R. Karthikeyan, L. Kasala, S. Kaur, S. Krishnappa, A. Lawande, B. Lokesh, N. Madarkar, R. Meena, P. More, D. Naik, K. Prashanth, M. Rao, N.M. Rao, N. Sadhu, D. Shah, M. Sharma, P. Shiva, S. Singhal, S. Suresh, V. Vanajakshamma, S.G. Panse, Y. Koretsune, S. Kanamori, K. Yamamoto, K. Kumagai, Y. Katsuda, K. Sadamatsu, F. Toyota, Y. Mizuno, I. Misumi, H. Noguchi, S. Ando, T. Suetsugu, M. Minamoto, Hiroshi Oda, K. Shiraishi, S. Adachi, K. Chiba, H. Norita, M. Tsuruta, T. Koyanagi, H. Ando, T. Higashi, K. Okada, S. Azakami, S. Komaki, K. Kumeda, T. Murayama, J. Matsumura, Y. Oba, R. Sonoda, K. Goto, K. Minoda, Y. Haraguchi, H. Suefuji, H. Miyagi, H. Kato, Tadashi Nakamura, Tsugihiro Nakamura, H. Nandate, R. Zaitsu, Yoshihisa Fujiura, A. Yoshimura, H. Numata, J. Ogawa, H. Tatematsu, Y. Kamogawa, K. Murakami, Y. Wakasa, M. Yamasawa, H. Maekawa, S. Abe, H. Kihara, S. Tsunoda, Katsumi Saito, Kazuyuki Saito, T. Fudo, K. Obunai, H. Tachibana, I. Oba, T. Kuwahata, S. Higa, M. Gushiken, T. Eto, H. Yoshida, D. Ikeda, Yoshitake Fujiura, M. Ishizawa, M. Nakatsuka, K. Murata, C. Ogurusu, M. Shimoyama, M. Akutsu, I. Takamura, F. Hoshino, N. Yokota, T. Iwao, K. Tsuchida, M. Takeuchi, Y. Hatori, Y. Kitami, Yoichi Nakamura, R. Oyama, M. Ageta, Hiroyuki Oda, Y. Go, K. Mishima, T. Unoki, S. Morii, Yuhei Shiga, H. Sumi, T. Nagatomo, K. Sanno, K. Fujisawa, Y. Atsuchi, T. Nagoshi, T. Seto, T. Tabuchi, M. Kameko, K. Nii, K. Oshiro, H. Takezawa, S. Nagano, N. Miyamoto, M. Iwaki, Yuichiro Nakamura, M. Fujii, M. Okawa, Masahiko Abe, Masatake Abe, Mitsunori Abe, T. Saito, T. Mito, K. Nagao, J. Minami, T. Mita, I. Sakuma, T. Taguchi, S. Marusaki, H. Doi, M. Tanaka, T. Fujito, M. Matsuta, T. Kusumoto, S. Kakinoki, K. Ashida, N. Yoshizawa, J. Agata, O. Arasaki, M. Manita, M. Ikemura, S. Fukuoka, H. Murakami, S. Matsukawa, Y. Hata, T. Taniguchi, T. Ko, H. Kubo, M. Imamaki, M. Akiyama, M. Inagaki, H. Odakura, T. Ueda, Y. Katsube, A. Nakata, H. Watanabe, M. Techigawara, M. Igarashi, K. Taga, T. Kimura, S. Tomimoto, M. Shibuya, M. Nakano, K. Ito, T. Seo, S. Hiramitsu, H. Hosokawa, M. Hoshiai, M. Hibino, K. Miyagawa, Hajime Horie, N. Sugishita, Yukio Shiga, A. Soma, K. Neya, Tetsuro Yoshida, Tomoki Yoshida, M. Mizuguchi, M. Ishiguro, T. Minagawa, M. Wada, H. Mukawa, F. Okuda, S. Nagasaka, Y. Abe, Sen Adachi, Susumu Adachi, T. Adachi, K. Akahane, T. Amano, K. Aoki, T. Aoyama, H. Arai, S. Arima, T. Arino, H. Asano, T. Asano, J. Azuma, T. Baba, T. Betsuyaku, H. Chibana, H. Date, J. Doiuchi, Y. Emura, M. Endo, Y. Fujii, R. Fujiki, A. Fujisawa, Y. Fujisawa, T. Fukuda, T. Fukui, N. Furukawa, T. Furukawa, W. Furumoto, T. Goto, M. Hamaoka, N. Hanazono, K. Hasegawa, T. Hatsuno, Y. Hayashi, K. Higuchi, K. Hirasawa, H. Hirayama, M. Hirose, S. Hirota, M. Honda, Hideki Horie, T. Ido, O. Iiji, H. Ikeda, K. Ikeda, K. Ikeoka, M. Imaizumi, H. Inaba, T. Inoue, F. Iseki, A. Ishihara, N. Ishioka, N. Ito, T. Iwase, H. Kakuda, J. Kamata, H. Kanai, H. Kanda, M. Kaneko, H. Kano, T. Kasai, T. Kato, Y. Kato, Y. Kawada, K. Kawai, K. Kawakami, S. Kawakami, T. Kawamoto, S. Kawano, J. Kim, T. Kira, H. Kitazawa, H. Kitazumi, T. Kito, T. Kobayashi, T. Koeda, J. Kojima, H. Komatsu, I. Komatsu, Y. Koshibu, T. Kotani, T. Kozuka, Y. Kumai, T. Kumazaki, I. Maeda, K. Maeda, Y. Maruyama, S. Matsui, K. Matsushita, Y. Matsuura, K. Mineoi, H. Mitsuhashi, N. Miura, S. Miyaguchi, S. Miyajima, H. Miyamoto, A. Miyashita, S. Miyata, I. Mizuguchi, A. Mizuno, T. Mori, O. Moriai, K. Morishita, O. Murai, Sho Nagai, Shunichi Nagai, E. Nagata, H. Nagata, A. Nakagomi, S. Nakahara, M. Nakamura, R. Nakamura, N. Nakanishi, T. Nakayama, R. Nakazato, T. Nanke, J. Nariyama, Y. Niijima, H. Niinuma, Y. Nishida, Y. Nishihata, K. Nishino, H. Nishioka, K. Nishizawa, I. Niwa, K. Nomura, S. Nomura, M. Nozoe, T. Ogawa, N. Ohara, M. Okada, K. Okamoto, H. Okita, M. Okuyama, H. Ono, T. Ono, Y. Onuki Pearce, S. Oriso, A. Ota, E. Otaki, Y. Saito, H. Sakai, N. Sakamoto, Y. Sakamoto, Y. Samejima, Y. Sasagawa, H. Sasaguri, A. Sasaki, T. Sasaki, Kazuki Sato, Kiyoharu Sato, M. Sawano, S. Seki, Y. Sekine, Y. Seta, K. Sezaki, N. Shibata, Y. Shiina, H. Shimono, Y. Shimoyama, T. Shindo, H. Shinohara, R. Shinohe, T. Shinozuka, T. Shirai, T. Shiraiwa, Y. Shozawa, T. Suga, C. Sugimoto, Kazuo Suzuki, Keita Suzuki, Shu Suzuki, Shunji Suzuki, Susumu Suzuki, Y. Suzuki, M. Tada, A. Taguchi, T. Takagi, Y. Takagi, K. Takahashi, S. Takahashi, H. Takai, C. Takanaka, S. Take, H. Takeda, K. Takei, K. Takenaka, T. Tana, G. Tanabe, K. Taya, H. Teragawa, S. Tohyo, S. Toru, Y. Tsuchiya, T. Tsuji, K. Tsuzaki, H. Uchiyama, O. Ueda, Y. Ueyama, N. Wakaki, T. Wakiyama, T. Washizuka, M. Watanabe, T. Yamada, T. Yamagishi, H. Yamaguchi, Kenichi Yamamoto, Kentaro Yamamoto, Kunihiko Yamamoto, T. Yamamoto, M. Yamaura, M. Yamazoe, K. Yasui, Y. Yokoyama, K. Yoshida, T.W. Lim, C.K. Ching, C.G. Foo, J.H. Chow, D.D. Chen, F.R. Jaufeerally, Y.M. Lee, G. Lim, W.T. Lim, S. Thng, S.Y. Yap, C. Yeo, S. Oh, H.N. Pak, J.-B. Kim, J.H. Kim, S.-W. Jang, D.H. Kim, D.R. Ryu, S.W. Park, D.-K. Kim, D.J. Choi, Y.S. Oh, M.-C. Cho, S.-H. Kim, H.-K. Jeon, D.-G. Shin, J.S. Park, H.K. Park, S.-J. Han, J.H. Sung, J.-G. Cho, G.-B. Nam, Y.K. On, H.E. Lim, J.J. Kwak, T.-J. Cha, T.J. Hong, S.H. Park, J.H. Yoon, N.-H. Kim, K.-S. Kim, B.C. Jung, G.-S. Hwang, C.-J. Kim, D.B. Kim, J.J. Ahn, H.J. An, H. Bae, A.L. Baek, W.J. Chi, E.A. Choi, E.H. Choi, H.K. Choi, H.S. Choi, S. Han, E.S. Heo, K.O. Her, S.W. Hwang, E.M. Jang, H.-S. Jang, S. Jang, H.-G. Jeon, S.R. Jeon, Y.R. Jeon, H.K. Jeong, I.-A. Jung, Hyeon Jeong Kim, Hyun Ju Kim, Ji Seon Kim, Jung Sook Kim, J.A. Kim, K.T. Kim, M.S. Kim, Sang Hee Kim, Sang Hyun Kim, Y.-I. Kim, C.S. Lee, E.H. Lee, G.H. Lee, H.Y. Lee, H.-Y. Lee, K.H. Lee, K.R. Lee, M.S. Lee, M.-Y. Lee, R.W. Lee, S.E. Lee, S.H. Lee, S. Lee, W.Y. Lee, I.K. Noh, A.R. Park, B.R. Park, H.N. Park, J.H. Park, M. Park, Y. Park, S.-Y. Seo, J. Shim, J.H. Sim, Y.M. Sohn, W.S. Son, Y.S. Son, H.J. Song, H.K. Wi, J.J. Woo, S. Ye, K.H. Yim, K.M. Yoo, E.J. Yoon, S.Y. Yun, P. Angchaisuksiri, S. Chawanadelert, P. Mongkolwongroj, K. Kanokphatcharakun, S. Cheewatanakornkul, T. Laksomya, S. Pattanaprichakul, T. Chantrarat, S. Rungaramsin, S. Silaruks, W. Wongcharoen, K. Siriwattana, K. Likittanasombat, P. Katekangplu, W. Boonyapisit, D. Cholsaringkarl, B. Chatlaong, P. Chattranukulchai, Y. Santanakorn, P. Hutayanon, P. Khunrong, T. Bunyapipat, S. Jai-Aue, P. Kaewsuwanna, P. Bamungpong, S. Gunaparn, S. Hongsuppinyo, R. Inphontan, R. Khattaroek, K. Khunkong, U. Kitmapawanont, C. Kongsin, B. Naratreekoon, S. Ninwaranon, J. Phangyota, A. Phrommintikul, P. Phunpinyosak, K. Pongmorakot, S. Poomiphol, N. Pornnimitthum, S. Pumprueg, S. Ratchasikaew, K. Sanit, K. Sawanyawisuth, B. Silaruks, R. Sirichai, A. Sriwichian, W. Suebjaksing, P. Sukklad, T. Suttana, A. Tangsirira, O. Thangpet, W. Tiyanon, Y. Vorasettakarnkij, T. Wisaratapong, W. Wongtheptien, A. Wutthimanop, S. Yawila, A. Oto, A. Altun, I. Ozdogru, K. Ozdemir, O. Yilmaz, A. Aydinlar, M.B. Yilmaz, E. Yeter, Z. Ongen, M. Cayli, H. Pekdemir, M. Ozdemir, M. Sucu, T. Sayin, M. Demir, H. 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Subjects: Registrie, Male, Time Factors, Anticoagulant therapy, Arrhythmia, Atrial fibrillation, GARFIELD-AF, 030204 cardiovascular system & hematology, Electrocardiography, 0302 clinical medicine, Risk Factors, Anticoagulant therapy, Arrhythmia, Atrial fibrillation, GARFIELD-AF, Aged, Atrial Fibrillation, Female, Follow-Up Studies, Humans, Incidence, India, Prevalence, Prognosis, Prospective Studies, Survival Rate, Thromboembolism, Registries, Risk Assessment, Medicine, 030212 general & internal medicine, Prospective cohort study, Incidence (epidemiology), cardiovascular system, medicine.symptom, Cardiology and Cardiovascular Medicine, Risk assessment, Human, medicine.medical_specialty, Time Factor, RD1-811, Prognosi, Follow-Up Studie, 03 medical and health sciences, Internal medicine, Diseases of the circulatory (Cardiovascular) system, cardiovascular diseases, Risk factor, Survival rate, Fibrillation, business.industry, Risk Factor, ta3121, medicine.disease, Clinical trial, Prospective Studie, RC666-701, Surgery, Clinical and Preventive Cardiology, business
Abstract: Background: The Global Anticoagulant Registry in the FIELD–Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. Methods and results: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012–2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P
Published: 2018
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11. Characterization of viability, scarring and hibernation of the myocardium supplied by epicardial coronary arteries with low flow grades

Author: M. Y. Norton, S. Walton, Andrew Welch, and Abdallah Al-Mohammad
Subjects: Male, medicine.medical_specialty, 030204 cardiovascular system & hematology, 03 medical and health sciences, Coronary circulation, 0302 clinical medicine, Coronary Circulation, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Myocardial infarction, Tissue Survival, Hibernating myocardium, business.industry, Myocardium, General Medicine, Middle Aged, medicine.disease, Coronary Vessels, Coronary arteries, medicine.anatomical_structure, Ventricle, Positron-Emission Tomography, Cardiology, Female, medicine.symptom, business, Pericardium, Perfusion, TIMI, Artery
Abstract: OBJECTIVE The aim of this study was to analyse the relationship between reduced coronary artery flow and myocardial viability, scarring and hibernation. PATIENTS AND METHODS Coronary flow grades and collateral vessels were scored using the thrombolysis in myocardial infarction trial (TIMI) and the Rentrop and Cohen scoring systems, respectively. N-ammonia and fluorine-18-fluorodeoxyglucose (F-FDG) are the perfusion and metabolic markers on PET, respectively. The left ventricle was divided into three coronary territories. The area with the highest N-ammonia uptake was considered the reference region. Myocardial regions with F-FDG uptake of at least 50% of the reference region were considered viable and those with F-FDG uptake less than 50% of the reference region were considered scarred. Hibernation was considered present if the viable myocardium had significant wall motion abnormality. RESULTS There were 80 (71 males) patients with 240 myocardial territories. TIMI 2-3 arteries supplied 151 regions (group A), and 89 regions were supplied by TIMI 0-1 arteries (group B). Viable myocardium was present in 140 (93%) regions of group A and in 76 (85%) regions of group B (P=0.068). Scarring was present in 40 (26%) regions in group A and in 49 (55%) regions in group B (P
Published: 2017
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12. Immunization of looked-after children and young people: a review of the literature

Author: Helen Bedford and S. Walton
Subjects: Program evaluation, Pediatrics, medicine.medical_specialty, Evidence-based practice, animal diseases, Population, Psychological intervention, chemical and pharmacologic phenomena, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Interim, Developmental and Educational Psychology, medicine, 030212 general & internal medicine, education, education.field_of_study, business.industry, Public health, Public Health, Environmental and Occupational Health, biochemical phenomena, metabolism, and nutrition, Vaccination, Immunization, Family medicine, Pediatrics, Perinatology and Child Health, bacteria, business
Abstract: Background Numbers of looked-after children and young people (LACYP) in the UK have risen over the last seven years. Looked-after children and young people should receive regular health assessments, including establishing immunization status and, if needed, developing a health plan to achieve full immunization. The Department for Education publish data on immunizations among LACYP to monitor both how well they are immunized and service performance. Methods A literature review was conducted using four databases (PubMed, Embase, Scopus and Web of Science) on immunization status of LACYP, factors affecting uptake and challenges to immunization, and interventions to improve immunization rates. Results Thirty-two papers were identified, 16 of which were UK based. Looked-after children and young people are less likely to be ‘up-to-date’ with their immunizations than children in the general population. Looked-after children and young people are less likely to receive timely immunizations, and older LACYP are less likely to be ‘up-to-date’ than younger LACYP. Barriers to immunization include failure to attend health checks, absence from school and frequent placement moves. Unknown and discrepant immunization histories, name changes, sharing of information between organizations and obtaining consent for immunizations are also challenges. Conclusions In recent years, immunization of LACYP has been given a higher priority. However, the immunization figures produced by the Department for Education are problematic because of challenges in determining whether the child is ‘up-to-date’, and data are not comparable with the general population; ideally, this should be changed to correspond to routine immunization data. In the interim, for reporting purposes, the use of a tool to assist with determining a child's immunization status would be beneficial. When a child's immunization status is incomplete or unknown, Public Health England's algorithm for vaccination of individuals with uncertain or incomplete status should be used. Practice to improve immunization uptake amongst LACYP needs to be evaluated to develop evidence-based recommendations.
Published: 2017
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13. Adjuvant statin therapy for oesophageal adenocarcinoma: the STAT‐ROC feasibility study

Author: S. M. Dresner, Simon L. Parsons, H. Warren, Yoon K. Loke, Edward Cheong, Matthew Hammond, Megan Jones, Ann Marie Swart, Erika J. Sims, Leo Alexandre, S. S. Kadirkamanathan, Michael P. Lewis, Andrew Hart, S. Walton, Allan Clark, Bhaskar Kumar, and Marcus Flather
Subjects: Male, 0301 basic medicine, Simvastatin, medicine.medical_specialty, Esophageal Neoplasms, lcsh:Surgery, Adenocarcinoma, Placebo, Medication Adherence, law.invention, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, Quality of life, Randomized controlled trial, law, Internal medicine, Diabetes mellitus, medicine, Upper GI, Humans, Adverse effect, Aged, Aspirin, business.industry, Cholesterol, LDL, General Medicine, lcsh:RD1-811, Middle Aged, medicine.disease, Combined Modality Therapy, United Kingdom, Esophagectomy, Randomized Clinical Trials, Treatment Outcome, 030104 developmental biology, Chemotherapy, Adjuvant, 030220 oncology & carcinogenesis, Randomized Clinical Trial, Quality of Life, Feasibility Studies, Female, Observational study, Hydroxymethylglutaryl-CoA Reductase Inhibitors, business, medicine.drug
Abstract: Background Statins inhibit proliferative signalling in oesophageal adenocarcinoma (OAC) and their use is associated with better survival in observational studies. The present study was undertaken to examine the feasibility of assessing adjuvant statin therapy in patients with operable OAC in a phase III RCT. Methods For this multicentre, double‐blind, parallel‐group, randomized, placebo‐controlled feasibility trial, adults with OAC (including Siewert I–II lesions) who had undergone oesophagectomy were centrally allocated (1 : 1) to simvastatin 40 mg or matching placebo by block randomization, stratified by centre. Participants, clinicians and investigators were blinded to treatment allocation. Patients received treatment for up to 1 year. Feasibility outcomes were recruitment, retention, drug absorption, adherence, safety, quality of life, generalizability and survival. Results A total of 120 patients were assessed for eligibility at four centres, of whom 32 (26·7 per cent) were randomized, 16 in each group. Seven patients withdrew. Participants allocated to simvastatin had lower low‐density lipoprotein cholesterol levels by 3 months (adjusted mean difference −0·83 (95 per cent c.i. −1·4 to −0·22) mmol/l; P = 0·009). Median adherence to medication was greater than 90 per cent between 3 and 12 months' follow‐up. Adverse events were similar between the groups. Quality‐of‐life data were complete for 98·3 per cent of questionnaire items. Cardiovascular disease, diabetes and aspirin use were more prevalent in the non‐randomized group, whereas tumour site, stage and grade were similar between groups. Survival estimates were imprecise. Conclusion This RCT supports the conduct and informs the design considerations for a future phase III trial of adjuvant statin therapy in patients with OAC. Registration number: ISRCTN98060456 (http://www.isrctn/com)., After oesophagectomy for oesophageal adenocarcinoma (OAC), the 5‐year survival rate is currently only 30 per cent. There is strong observational evidence that statin use is associated with reduced all‐cause and cancer‐specific mortality in patients with OAC. This multicentre, double‐blind, parallel‐group, randomized, placebo‐controlled trial has established the feasibility of a future phase III trial of adjuvant statin therapy in patients treated with curative intent for invasive OAC. Justification for a full trial
Published: 2020

14. Vascular Anatomy of the Thorax, Including the Heart

Author: Raj Das, Antony S. Walton, and Robert A. Morgan
Subjects: Thorax, Transcatheter aortic, business.industry, Vascular anatomy, medicine.medical_treatment, Medicine, Anatomy, Embolization, business, Radiological anatomy
Abstract: A comprehensive overview of the vascular anatomy of the heart and thorax has been detailed, with particular reference to radiological anatomy and modern applications such as transcatheter aortic valve implantation and embolization are described.
Published: 2020
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15. Doxycycline versus prednisolone as an initial treatment strategy for bullous pemphigoid: a pragmatic, non-inferiority, randomised controlled trial

Author: John R. Ingram, H K Bell, Gudula Kirtschig, B Walker, Fiona Antony, M Walsh, Eva-B. Bröcker, Ingrid Salvary, J Wee, Emilia Duarte-Williamson, H Santander, Kathy Taghipour, David Gawkrodger, Enno Schmidt, Sam Gibbs, Alison M Layton, Michael Sticherling, J Adams, M Vatve, Joanne R Chalmers, Hywel C Williams, Fiona Craig, S Blackford, A Carmichael, Walter Bottomley, Adzura Azam, Chris Lovell, Karen E. Harman, Margaret Childs, Alexander Vincent Anstey, K. Hussain, Marinella Nik, C Günthert, A. Chapman, N. van Beek, Andrew M Wright, Rainer Hügel, C Barnard, Indre Verpetinske, K Davies, Thomas A. Luger, A Omerod, Karen Gibbon, Alex Waters, V Akhras, Robert Charles-Holmes, Shyamal Wahie, John C. English, James Mason, R.R. Coelho, Girish Khandubhai Patel, Robert Ellis, Jane C. Sterling, A Lloyd Lavery, Thomas R. Godec, Fenella Wojnarowska, Jane Ravenscroft, Richard Groves, H Malhomme, Kerstin Steinbrink, Andrew J. Nunn, Regine Gläser, Emma Veysey, Adam Ferguson, V Lewis, Diane Whitham, V Venning, M Westmoreland, G Wong, Chris Bower, N. Hepburn, C Thomas, P J Hampton, R. Wachsmuth, Andrew Ilchyshyn, Nick J. Levell, M G S Dunnill, S. Walton, and R Rallan
Subjects: Adult, Male, medicine.medical_specialty, Pemphigoid, medicine.medical_treatment, Prednisolone, RL, Administration, Oral, Equivalence Trials as Topic, law.invention, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Germany, Internal medicine, Pemphigoid, Bullous, medicine, Initial treatment, Humans, skin and connective tissue diseases, Glucocorticoids, Aged, Aged, 80 and over, Doxycycline, Medicine(all), Clinical Trials as Topic, integumentary system, business.industry, Standard treatment, General Medicine, Articles, Middle Aged, medicine.disease, R1, Dermatology, United Kingdom, Anti-Bacterial Agents, Treatment Outcome, 030220 oncology & carcinogenesis, Female, Bullous pemphigoid, business, Adjuvant, medicine.drug
Abstract: BACKGROUND: Bullous pemphigoid is a blistering skin disorder with increased mortality. We tested whether a strategy of starting treatment with doxycycline gives acceptable short-term blister control while conferring long-term safety advantages over starting treatment with oral corticosteroids. METHODS: We did a pragmatic, multicentre, parallel-group randomised controlled trial of adults with bullous pemphigoid (three or more blisters at two or more sites and linear basement membrane IgG or C3). Participants were randomly assigned to doxycycline (200 mg per day) or prednisolone (0·5 mg/kg per day) using random permuted blocks of randomly varying size, and stratified by baseline severity (3-9, 10-30, and >30 blisters for mild, moderate, and severe disease, respectively). Localised adjuvant potent topical corticosteroids (
Published: 2017

16. Crystals in the Cornea

Author: Hanna M Prendeville and David S. Walton
Subjects: business.industry, Cystinosis, Slit Lamp Microscopy, Visual Acuity, General Medicine, Refraction, Ocular, Refraction, Corneal Diseases, law.invention, Ophthalmology, Ocular physiology, medicine.anatomical_structure, Optics, law, Child, Preschool, Cornea, Pediatrics, Perinatology and Child Health, medicine, Humans, Female, Crystallization, business
Published: 2020
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17. Report on an Investigation into an Entry Level Clinical Doctorate for the Genetic Counseling Profession and a Survey of the Association of Genetic Counseling Program Directors

Author: Catherine A. Reiser, Robin E. Grubs, Carol S. Walton, and Bonnie S. LeRoy
Subjects: Canada, medicine.medical_specialty, Attitude of Health Personnel, Genetics, Medical, Genetic counseling, education, Entry Level, Genetic Counseling, Physician Executives, Surveys and Questionnaires, Humans, Medicine, Workgroup, Association (psychology), Qualitative Research, Genetics (clinical), Accreditation, business.industry, Task force, Public health, United States, Education, Medical, Graduate, Family medicine, Workforce, Female, business
Abstract: The master's degree is the required entry-level degree for the genetic counseling profession in the US and Canada. In 2012 the Association of Genetic Counseling Program Directors (AGCPD) passed resolutions supporting retention of the master's as the entry-level and terminal degree and opposing introduction of an entry-level clinical doctorate (CD) degree. An AGCPD workgroup surveyed directors of all 34 accredited training programs with the objective of providing the Genetic Counseling Advanced Degrees Task Force (GCADTF) with information regarding potential challenges if master's programs were required to transition to an entry-level CD. Program demographics, projected ability to transition to an entry-level CD, factors influencing ability to transition, and potential effects of transition on programs, students and the genetic counseling workforce were characterized. Two programs would definitely be able to transition, four programs would close, thirteen programs would be at risk to close and fourteen programs would probably be able to transition with varying degrees of difficulty. The most frequently cited limiting factors were economic, stress on clinical sites, and administrative approval of a new degree/program. Student enrollment under an entry-level CD model was projected to decrease by 26.2 %, negatively impacting the workforce pipeline. The results further illuminate and justify AGCPD's position to maintain the master's as the entry-level degree.
Published: 2015
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18. Goniotomy for Steroid-Induced Glaucoma: Clinical and Tonographic Evidence to Support Therapeutic Goniotomy

Author: Eun Young Choi and David S. Walton
Subjects: medicine.medical_specialty, Intraocular pressure, medicine.diagnostic_test, business.industry, Medical record, Steroid induced glaucoma, Glaucoma, Retrospective cohort study, General Medicine, medicine.disease, Surgery, Ophthalmology, Pediatrics, Perinatology and Child Health, medicine, Prednisolone, Gonioscopy, business, Fluorometholone, medicine.drug
Abstract: Purpose: To report the surgical results of goniotomy for corticosteroid-induced glaucoma and to provide evidence to support its use as initial surgical therapy. Methods: The medical records of 5 patients with a history of goniosurgery for steroid-induced glaucoma were reviewed. Preoperative and postoperative clinical findings were reviewed, including the topical use of steroids, tonometric and gonioscopic findings, goniosurgery, and postoperative results. In addition, tonography was performed on one patient to document the improved facility of outflow following successful goniosurgery. Results: Surgical success was achieved in all patients, with intraocular pressures less than 18 mm Hg without the use of medication for an average follow-up period of 11.5 years (range: 9 months to 30 years). A normal postoperative facility of outflow (C = 0.30 mm 3 /min/mm Hg) was determined in one patient. No complications of surgery were experienced. Conclusion: Goniotomy is an effective procedure for persistent steroid-induced glaucoma, and should be considered for initial surgical treatment. [ J Pediatr Ophthalmol Strabismus. 2015;52(3):183–188.]
Published: 2015
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19. Certifications for sight impairment due to age related macular degeneration in England

Author: Praveen J Patel, S. Walton, Catey Bunce, A. Rees, and A Zekite
Subjects: Male, Certification, Databases, Factual, genetic structures, Cross-sectional study, Blindness, Age and sex, Macular Degeneration, Interquartile range, Age related, medicine, Humans, Aged, Aged, 80 and over, business.industry, Public Health, Environmental and Occupational Health, General Medicine, Macular degeneration, medicine.disease, eye diseases, Geographic atrophy, Cross-Sectional Studies, England, Optometry, Female, Standardized rate, business, Demography
Abstract: Objectives To examine variability across England in certification rates for age related macular degeneration (AMD) between 1st April 2011 and 31st March 2012. Study design Cross-sectional survey. Methods An electronic version of the CVI, the ECVI, was used at the Certifications Office, London, to transfer information from paper based certificates into a database. The electronic certifications data set was queried for all certificates completed in England between April 1st 2011 and March 31st 2012 with the main cause of certifiable visual loss being AMD or with the main cause of certifiable visual loss being multiple pathology but a contributory cause being AMD. Data were explored by type of AMD, visual status, age and sex and then directly standardized rates were computed by English region. Results The Certifications Office received 23,616 CVIs for England between April 2011 and March 2012, of which 10,481 (44%) were people certified severely sight-impaired (blind) (SSI) and 12,689 (54%) were certified as sight-impaired (partial sight) (SI). The remainder did not have visual status classified. AMD contributed to 11546 causes of certification on the CVI forms during this period, 53% of forms being for geographic atrophy (GA)/dry AMD which is currently mostly untreatable. The median (interquartile) age at certification for AMD was 86 (81, 90) years and women were more commonly certified than men (66%). Considerable variability was seen across English regions, although there was consistency in that GA was the more common form in all areas. Conclusions There is considerable regional variability in CVI rates in England, which are not attributable to differences in age or sex. Reasons for such variability need examination yet this should not undermine the value of these data in terms of describing those newly registered with sight impairment due to AMD who are predominantly female and over 85 years of age.
Published: 2015
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20. 'My Son's Darker Eye Also Has Increased Pressure'

Author: David S. Walton and Helen H Yeung
Subjects: Male, medicine.medical_specialty, medicine.diagnostic_test, business.industry, MEDLINE, Gonioscopy, Infant, Glaucoma, General Medicine, Melanosis, Diagnosis, Differential, 03 medical and health sciences, Ophthalmology, 0302 clinical medicine, Sturge-Weber Syndrome, Pediatrics, Perinatology and Child Health, 030221 ophthalmology & optometry, medicine, Humans, business, 030217 neurology & neurosurgery, Intraocular Pressure, Ultrasonography
Published: 2017

21. PWE-109 A feasibility study of adjuvant statin therapy in the prevention of post-operative recurrence of oesophageal adenocarcinoma (the stat-roc feasibility study)

Author: S. Walton, Ann Marie Swart, Allan Clark, Bhaskar Kumar, Simon L. Parsons, S. S. Kadirkamanathan, Leo Alexandre, Yoon K. Loke, Andrew Hart, Michael P. Lewis, Edward Cheong, S. M. Dresner, and H. Warren
Subjects: Oncology, medicine.medical_specialty, Aspirin, business.industry, 030503 health policy & services, medicine.disease, Placebo, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Quality of life, law, Simvastatin, Internal medicine, Diabetes mellitus, medicine, Observational study, 030212 general & internal medicine, 0305 other medical science, Adverse effect, business, medicine.drug
Abstract: Introduction Preclinical studies have demonstrated statins inhibit proliferation, promote apoptosis and limit invasiveness of oesophageal adenocarcinoma (OAC) cell lines. Observational research has demonstrated significant improvements in mortality associated with statin use after diagnosis of OAC. We aimed to determine the feasibility of assessing adjuvant statin therapy in patients with operable OAC in a phase III randomised controlled trial. Method For this multi-centre, double-blind, parallel group, randomised, placebo-controlled trial, eligible patients were adults with OAC or Siewert type I/II adenocarcinoma due surgery. Participants were recruited from four UK centres and randomly assigned (1:1) to simvastatin 40 mg or matching placebo by block randomisation, stratified by centre. Participants, clinicians and investigators were blinded to treatment allocation. Treatment started from the date of discharge following surgery and continued for up to one year. Feasibility assessments of recruitment, retention, drug absorption, adherence, safety, quality of life, generalisability, all-cause and disease-free survival were made. Trial registration: ISRCTN98060456. Results Between 23rd November 2014 and 22nd July 2016, 120 patients were assessed for eligibility, of which 32 (26.7%) were randomised. Of patients meeting eligibility criteria, 59.3% (32/54) were randomised. Patients allocated to simvastatin had significantly lower LDL cholesterol levels by three months (adjusted mean difference, −0.83 mmol/L, 95% CI −1.4 to −0.22, p=0.009). Median medication adherence for the preceding three months of follow-up at 3, 6, 9 and 12 months, respectively, was 83%, 94%, 99%, and 94%, with no significant differences in adherence between treatment groups. In total, 87.5% in the simvastatin group and 92.9% in the placebo group (p=0.626) experienced at least one adverse event. Completion of quality of life data was high (98.3% of questionnaire items) with no clinically significant differences observed between treatment groups. Cardiovascular disease (p=0.003), diabetes (p=0.003) and aspirin use (p=0.01) were more prevalent in the non-randomised group compared with the randomised group. There were no significant differences between groups for overall (p=0.716) or disease-free survival (p=0.807). Conclusion This RCT supports the feasibility of assessing adjuvant statin therapy in a future phase III trial in patients with operable OAC. Disclosure of Interest None Declared
Published: 2017
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22. Generating new evidence, improving clinical practice and developing research capacity: the benefits of recruiting to the U.K. Dermatology Clinical Trials Network's STOP GAP and BLISTER trials

Author: Jonathan M. Batchelor, A. Martin‐Clavijo, Anthony Ormerod, S. Walton, Fiona Craig, Hywel C Williams, A. Chapman, Karen E. Harman, and Gudula Kirtschig
Subjects: Research design, medicine.medical_specialty, Attitude of Health Personnel, Prednisolone, MEDLINE, Alternative medicine, Dermatology, law.invention, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Adrenal Cortex Hormones, Pemphigoid, Bullous, Medicine, Humans, Multicenter Studies as Topic, 030212 general & internal medicine, Practice Patterns, Physicians', Adverse effect, Randomized Controlled Trials as Topic, Evidence-Based Medicine, business.industry, Evidence-based medicine, Pyoderma Gangrenosum, Research Personnel, Clinical trial, Clinical research, Doxycycline, Cyclosporine, business, Dermatologists
Abstract: Clinical trials may benefit clinical practice in three ways: firstly, clinicians may change their practice according to the new trial evidence; secondly, clinical processes can improve when working on a trial; and thirdly, research capacity is increased. We held a meeting to present and discuss the results of two large multicentre randomized controlled trials delivered through the U.K. Dermatology Clinical Trials Network. Investigators gave reflections on how the trials had changed their clinical practice. The STOP GAP trial showed that prednisolone and ciclosporin are equally effective as first-line systemic treatment for pyoderma gangrenosum. The final decision of which treatment to use should be based on the different adverse event profiles of the two drugs in relation to comorbidities, along with age, disease severity and patient preference. The BLISTER trial showed that starting people with pemphigoid on doxycycline produces acceptable short-term effectiveness and a superior safety profile to oral corticosteroids. Recruiting to these trials has led to the development of new specialist clinics with improved documentation. It has increased the profile of participating departments and embedded research in the department's activities. Helping to design and run these trials has also allowed trial staff to develop new skills in research design, which has been beneficial for career development. These and other benefits of recruiting to the trials are summarized here. We hope that these reflections will inspire wider involvement in clinical research.
Published: 2017

23. A randomised controlled trial to compare the safety, effectiveness and cost-effectiveness of doxycycline (200 mg/day) with that of oral prednisolone (0.5 mg/kg/day) for initial treatment of bullous pemphigoid : the Bullous Pemphigoid Steroids and Tetracyclines (BLISTER) trial

Author: Karen E. Harman, Margaret Childs, A. Chapman, Enno Schmidt, James Mason, S. Walton, Thomas R. Godec, Fenella Wojnarowska, Hywel C Williams, Diane Whitham, Gudula Kirtschig, Joanne R Chalmers, and Andrew J. Nunn
Subjects: Male, medicine.medical_specialty, lcsh:Medical technology, Technology Assessment, Biomedical, Cost effectiveness, Cost-Benefit Analysis, Prednisolone, RL, Anti-Inflammatory Agents, Administration, Oral, Drug Administration Schedule, law.invention, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, Germany, Pemphigoid, Bullous, medicine, Humans, 030212 general & internal medicine, Adverse effect, Aged, business.industry, Health Policy, Standard treatment, medicine.disease, Confidence interval, United Kingdom, Surgery, Quality-adjusted life year, Anti-Bacterial Agents, lcsh:R855-855.5, Doxycycline, Female, Bullous pemphigoid, Quality-Adjusted Life Years, business, medicine.drug, Research Article
Abstract: BackgroundBullous pemphigoid (BP) is an autoimmune blistering skin disorder with increased morbidity and mortality in the elderly.ObjectivesTo evaluate the effectiveness, safety and cost-effectiveness of a strategy of initiating BP treatment with oral doxycycline or oral prednisolone. We hypothesised that starting treatment with doxycycline gives acceptable short-term blister control while conferring long-term safety advantages over starting treatment with oral prednisolone.DesignPragmatic multicentre two-armed parallel-group randomised controlled trial with an economic evaluation.SettingA total of 54 dermatology secondary care centres in the UK and seven in Germany.ParticipantsAdults with BP [three or more blisters at two sites and positive direct and/or indirect immunofluorescence (immunoglobulin G and/or complement component 3 immunofluorescence at the dermal-epidermal junction)] and able to give informed consent.InterventionsParticipants were allocated using online randomisation to initial doxycycline treatment (200 mg/day) or prednisolone (0.5 mg/kg/day). Up to 30 g/week of potent topical corticosteroids was permitted for weeks 1–3. After 6 weeks, clinicians could switch treatments or alter the prednisolone dose as per normal practice.Main outcome measuresPrimary outcomes: (1) the proportion of participants with three or fewer blisters at 6 weeks (investigator blinded) and (2) the proportion with severe, life-threatening and fatal treatment-related events at 52 weeks. A regression model was used in the analysis adjusting for baseline disease severity, age and Karnofsky score, with missing data imputed. Secondary outcomes included the effectiveness of blister control after 6 weeks, relapses, related adverse events and quality of life. The economic evaluation involved bivariate regression of costs and quality-adjusted life-years (QALYs) from a NHS perspective.ResultsIn total, 132 patients were randomised to doxycycline and 121 to prednisolone. The mean patient age was 77.7 years and baseline severity was as follows: mild 31.6% (three to nine blisters), moderate 39.1% (10–30 blisters) and severe 29.3% (> 30 blisters). For those starting on doxycycline, 83 out of 112 (74.1%) had three or fewer blisters at 6 weeks, whereas for those starting on prednisolone 92 out of 101 (91.1%) had three or fewer blisters at 6 weeks, an adjusted difference of 18.6% in favour of prednisolone [90% confidence interval (CI) 11.1% to 26.1%], using a modified intention-to-treat (mITT) analysis. Per-protocol analysis showed similar results: 74.4% compared with 92.3%, an adjusted difference of 18.7% (90% CI 9.8% to 27.6%). The rate of related severe, life-threatening and fatal events at 52 weeks was 18.2% for those started on doxycycline and 36.6% for those started on prednisolone (mITT analysis), an adjusted difference of 19.0% (95% CI 7.9% to 30.1%;p = 0.001) in favour of doxycycline. Secondary outcomes showed consistent findings. There was no significant difference in costs or QALYs per patient at 1 year between doxycycline-initiated therapy and prednisolone-initiated therapy (incremental cost of doxycycline-initiated therapy £959, 95% CI –£24 to £1941; incremental QALYs of doxycycline-initiated therapy –0.024, 95% CI –0.088 to 0.041). Using a willingness-to-pay criterion of ConclusionsA strategy of starting BP patients on doxycycline is non-inferior to standard treatment with oral prednisolone for short-term blister control and considerably safer in the long term. The limitations of the trial were the wide non-inferiority margin, the moderate dropout rate and that serious adverse event collection was unblinded. Future work might include inducing remission with topical or oral corticosteroids and then randomising to doxycycline or prednisolone for maintenance.Trial registrationCurrent Controlled Trials ISRCTN13704604.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 10. See the NIHR Journals Library website for further project information.
Published: 2017

24. Comparison of the two most commonly used treatments for pyoderma gangrenosum: results of the STOP GAP randomised controlled trial

Author: Hywel C Williams, Eleanor J Mitchell, Anthony Ormerod, Kim S Thomas, Nicola Greenlaw, Graham A. Johnston, John Norrie, James Mason, S. Walton, and Fiona E. Craig
Subjects: Male, medicine.medical_specialty, Time Factors, Prednisolone, Inflammatory bowel disease, Corrections, law.invention, Varicose Ulcer, Randomized controlled trial, law, Recurrence, medicine, Humans, Wound Healing, business.industry, Research, Patient Selection, General Medicine, Middle Aged, medicine.disease, Ciclosporin, Confidence interval, Pyoderma Gangrenosum, United Kingdom, Surgery, Treatment Outcome, Clinical diagnosis, Maximum dose, Cyclosporine, Quality of Life, Female, Dermatologic Agents, business, Pyoderma gangrenosum, medicine.drug
Abstract: Objective To determine whether ciclosporin is superior to prednisolone for the treatment of pyoderma gangrenosum, a painful, ulcerating skin disease with a poor evidence base for management. Design Multicentre, parallel group, observer blind, randomised controlled trial. Setting 39 UK hospitals, recruiting from June 2009 to November 2012. Participants 121 patients (73 women, mean age 54 years) with clinician diagnosed pyoderma gangrenosum. Clinical diagnosis was revised in nine participants after randomisation, leaving 112 participants in the analysis set (59 ciclosporin; 53 prednisolone). Intervention Oral prednisolone 0.75 mg/kg/day compared with ciclosporin 4 mg/kg/day, to a maximum dose of 75 and 400 mg/day, respectively. Main outcome measures The primary outcome was speed of healing over six weeks, captured using digital images and assessed by blinded investigators. Secondary outcomes were time to healing, global treatment response, resolution of inflammation, self reported pain, quality of life, number of treatment failures, adverse reactions, and time to recurrence. Outcomes were assessed at baseline and six weeks and when the ulcer had healed (to a maximum of six months). Results Of the 112 participants, 108 had complete primary outcome data at baseline and six weeks (57 ciclosporin; 51 prednisolone). Groups were balanced at baseline. The mean (SD) speed of healing at six weeks was −0.21 (1.00) cm 2 /day in the ciclosporin group compared with −0.14 (0.42) cm 2 /day in the prednisolone group. The adjusted mean difference showed no between group difference (0.003 cm 2 /day, 95% confidence interval −0.20 to 0.21; P=0.97). By six months, ulcers had healed in 28/59 (47%) participants in the ciclosporin group compared with 25/53 (47%) in the prednisolone group. In those with healed ulcers, eight (30%) receiving ciclosporin and seven (28%) receiving prednisolone had a recurrence. Adverse reactions were similar for the two groups (68% ciclosporin and 66% prednisolone), but serious adverse reactions, especially infections, were more common in the prednisolone group. Conclusion Prednisolone and ciclosporin did not differ across a range of objective and patient reported outcomes. Treatment decisions for individual patients may be guided by the different side effect profiles of the two drugs and patient preference. Trial registration Current Controlled Trials ISRCTN35898459.
Published: 2017

25. Synthesis of embedded iron nanoparticles in Fe3C-derived carbons

Author: Michael R. Dutzer, Krista S. Walton, Faisal M. Alamgir, Michael C. Mangarella, and Jessica L. Ewbank
Subjects: Materials science, Scanning electron microscope, Extraction (chemistry), Inorganic chemistry, Nanoparticle, General Chemistry, Chloride, Carbide, Transmission electron microscopy, medicine, General Materials Science, Absorption (chemistry), Spectroscopy, medicine.drug
Abstract: Carbide-derived carbons with embedded Fe nanoparticles are synthesized by partial chlorination of iron carbide at 600 °C. Interestingly, the residual Fe studied by X-ray absorption near edge spectroscopy, scanning electron microscopy, and transmission electron microscopy show the extraction process does not follow a layer-by-layer extraction process, as proposed in the literature for the chlorination of other carbides. Instead, a large percentage of iron carbide converts to iron (II) and iron (III) chloride nanoparticles, which remain trapped within the resulting nanoporous carbon framework. Further reductive treatment can be used to produce dispersed Fe nanoparticles with an average particle diameter approaching 10 nm.
Published: 2014
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26. Failure of goniosurgery for glaucoma associated with Sturge-Weber syndrome

Author: Helen H Yeung and David S. Walton
Subjects: Ophthalmology, medicine.medical_specialty, business.industry, Pediatrics, Perinatology and Child Health, Sturge–Weber syndrome, Medicine, Glaucoma, business, medicine.disease
Published: 2018
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27. The Effect of a Multidisciplinary Approach to Testing for Clostridium difficile Among Hospital Inpatients

Author: Emily C. Piercy, Kathy Cruise, Jo Ellen S. Walton, and Rashonda Kennedy
Subjects: medicine.medical_specialty, Epidemiology, business.industry, Health Policy, Incidence (epidemiology), Public Health, Environmental and Occupational Health, Psychological intervention, Clostridium difficile, Community hospital, Infectious Diseases, Multidisciplinary approach, Emergency medicine, Health care, medicine, Infection control, Eta squared, business
Abstract: BACKGROUND Kentucky has the sixth highest rate of healthcare facility-onset Clostridium difficile infections (CDI) in the nation. Testing for the presence of the disease is expensive; therefore, the objective of this project was to develop and evaluate an efficient and financially sound plan for monitoring healthcare facility-onset CDIs in a 393-bed community hospital. METHODS In September 2017, the multidisciplinary infection control team began a concerted effort to combat the incidence of healthcare facility-onset CDIs through staff education, creating better communication channels, and implementation of an algorithm leading to appropriate specimen testing for the presence of the C. difficile toxin among hospital inpatients. Independent samples t-tests were calculated on number and cost of tests performed per month before (2017) and following the intervention (2018). RESULTS Statistically significant differences were found in both numbers of tests performed fiscal year (FY) 2017 (M =216.50, SD =16.418) to FY 2018 (M=138.00, SD=34.107; t (22)=7.18, p=.000, two-tailed) and cost of tests FY 2017 (M=6495.00, SD=492.54) to FY 2018 (M=4140.00, SD=1023.20; t(22)=7.18, p=.000, two-tailed). The magnitude of the differences in the means of tests performed (mean difference = 78.50, 95% CI: 55.84 to 101.16) was large (eta squared=0.701). Cost savings following use of the algorithm were $28,260 for FY 2018; an average of $2355 per month. Additionally, we have ?witnessed a significant decrease in the standardized infection ratio (SIR) for healthcare facility-onset CDI from CY 2015=1.16 to CY 2018=0.39. CONCLUSIONS Study findings reveal the importance of effective communication among healthcare professionals as well as developing an interdisciplinary approach to making decisions in relation to C. difficile testing. At this hospital, interventions tested resulted in an accurate understanding of the number of healthcare facility-onset CDIs. In addition, meaningful cost savings were also achieved.
Published: 2019
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28. Late-Recognized Primary Congenital Glaucoma

Author: Steven A. Kane, David S. Walton, Karina Nagao, and Helen H Yeung
Subjects: Male, medicine.medical_specialty, Intraocular pressure, Visual acuity, Adolescent, genetic structures, Photophobia, medicine.medical_treatment, Visual Acuity, Glaucoma, Scleral spur, Ophthalmologic Surgical Procedures, Diagnostic Techniques, Ophthalmological, Tonometry, Ocular, Anterior Eye Segment, Ophthalmology, medicine, Gonioscopy, Glaucoma surgery, Humans, Child, Intraocular Pressure, Retrospective Studies, medicine.diagnostic_test, business.industry, Hydrophthalmos, Infant, General Medicine, medicine.disease, eye diseases, medicine.anatomical_structure, Child, Preschool, Pediatrics, Perinatology and Child Health, Female, sense organs, medicine.symptom, business, Primary juvenile glaucoma
Abstract: Purpose: To describe a cohort of children with late-recognized primary congenital glaucoma (LRPCG), including age of presentation, age-related diagnostic signs, clinical abnormalities, and results of glaucoma surgery. Methods: The medical records of 31 patients (49 eyes) with PCG recognized after 1 year of age were reviewed retrospectively. Patients were confirmed to have PCG based on their increased intraocular pressure (IOP), anterior segment abnormalities including findings on gonioscopy, and the absence of other causes of childhood glaucoma. The outcome of glaucoma surgery was reviewed and success measured by assessment of the relative control of IOP, occurrence of significant complications, and need for additional glaucoma surgery. Results: Average age at diagnosis of glaucoma was 4.7 years (36% diagnosed at > 4 years of age). The most common initial diagnostic signs were corneal enlargement (46%, average age of 2.0 years), photophobia (20%, average age of 3.3 years), and suspected poor visual acuity (32%, average age of 9.9 years). Corneal cloudiness was not an initial sign for any patient. Haab’s striae were present in 60% of the affected 49 eyes. Gonioscopy findings were abnormal in 82%, but the ciliary body band was seen in 81% and the scleral spur was visible in 47%. Sixty-one goniotomy procedures were performed for 39 eyes with overall success in 95% (37 eyes) and complete success in 65% (27 eyes). The final visual acuity was 20/200 or worse in 31% (15 eyes) and 20/40 or better in 60% (29 eyes). Conclusions: An awareness of and familiarity with the subtle diagnostic signs of LRPCG can enable its differentiation from primary juvenile glaucoma and contribute to earlier recognition and treatment. Glaucoma surgery is often required for LRPCG and goniosurgery is the recommended initial procedure. [J Pediatric Ophthalmol Strabismus 2013;50(4): 234–238.]
Published: 2013
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29. Failed School Vision Test…Suspected Myopia and Corneal Dystrophy

Author: David S. Walton and Helen H Yeung
Subjects: medicine.medical_specialty, Intraocular pressure, Visual acuity, medicine.diagnostic_test, business.industry, Follow up studies, Primary congenital glaucoma, Corneal dystrophy, General Medicine, medicine.disease, Ophthalmology, Pediatrics, Perinatology and Child Health, medicine, Gonioscopy, Vision test, medicine.symptom, Differential diagnosis, business
Published: 2013
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30. Ocular Manifestations of Vitamin Disorders

Author: Eun Young Choi, Nancy F. Krebs, Rebecca F. Neustein, and David S. Walton
Subjects: Vitamin, genetic structures, business.industry, Physiology, medicine.disease, Hypervitaminosis, Micronutrient, eye diseases, Optic neuropathy, B vitamins, chemistry.chemical_compound, medicine.anatomical_structure, chemistry, Cornea, medicine, Optic nerve, Xerophthalmia, sense organs, business
Abstract: Vitamins are essential micronutrients that must be obtained from the diet. Deficiencies of vitamins A, B complex, C, D, E, and K can cause nutritional disorders associated with ophthalmic manifestations. Signs of deficiency can occur in the cornea, retina, or optic nerve, and may result in vision loss if no appropriate treatment is given. The ocular signs of vitamin deficiency are seen predominantly in developing countries, but patients with absorptive defects and/or severely restricted diets are also at risk for developing the symptoms. The systemic and ocular effects of deficiencies and excesses of specific vitamins, as well as the diagnosis and treatment of each vitamin disorder, are discussed.
Published: 2017
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31. Characterisation of freeze-dried type II collagen and chondroitin sulfate scaffolds

Author: David D. Brand, Maryam Tamaddon, Jan T. Czernuszka, and Robin S. Walton
Subjects: Materials science, Compressive Strength, Biomedical Engineering, Biophysics, Type II collagen, Bioengineering, Artificial skin, Biomaterials, Extracellular matrix, chemistry.chemical_compound, Materials Testing, Spectroscopy, Fourier Transform Infrared, medicine, Chondroitin, Chondroitin sulfate, Particle Size, Collagen Type II, Tissue Scaffolds, biology, Cartilage, Chondroitin Sulfates, Fibrillogenesis, Freeze Drying, medicine.anatomical_structure, chemistry, Biochemistry, Proteoglycan, Microscopy, Electron, Scanning, biology.protein, Electrophoresis, Polyacrylamide Gel, Rheology, Porosity
Abstract: Collagen type-II is the dominant type of collagen in articular cartilage and chondroitin sulfate is one of the main components of cartilage extracellular matrix. Afibrillar and fibrillar type-II atelocollagen scaffolds with and without chondroitin sulfate were prepared using casting and freeze-drying methods. The scaffolds were characterised to highlight the effects of fibrillogenesis and chondroitin sulfate addition on viscosity, pore structure, porosity and mechanical properties. Microstructure analysis showed that fibrillogenesis increased the circularity of pores significantly in collagen-only scaffolds, whereas with it, no significant change was observed in chondroitin sulfate- containing scaffolds. Addition of chondroitin sulfate to afibrillar scaffolds increased the circularity of the pores and the proportion of pores between 50 and 300 lm suitable for chondrocytes growth. Fourier transform infrared spectroscopy explained the bonding between chondroitin sulfate and afibrillar collagen- confirmed with rheology resultswhich increased the compressive modulus 10-fold to 0.28 kPa. No bonding was observed in other scaffolds and consequently no significant changes in compressive modulus were detected. © Springer Science+Business Media New York 2013.
Published: 2013
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32. Effects of etomidate in the adrenal and cytokine responses to hemorrhagic shock in rats

Author: Luísa Mateus, Isabelle Goy-Thollot, Ronald S. Walton, Nuno M. Félix, Solange Gil, Ana Sofia Matos, Maria M. R. E. Niza, UNIDEMI - Unidade de Investigação e Desenvolvimento em Engenharia Mecânica e Industrial, and DEMI - Departamento de Engenharia Mecânica e Industrial
Subjects: 0301 basic medicine, medicine.medical_specialty, injury, medicine.medical_treatment, Immunology, etomidate, adrenocorticotropic hormone (ACTH), lcsh:Medicine, lung, hemorrhagic shock, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Corticosterone, Etomidate, Internal medicine, medicine, tumor necrosis factor (TNF)-α, Immunology and Allergy, Endocrine system, rat, Interleukin 6, IL-6, Lung, biology, business.industry, corticosterone, lcsh:R, 030208 emergency & critical care medicine, Interleukin 10, 030104 developmental biology, Endocrinology, Cytokine, medicine.anatomical_structure, chemistry, IL-10, biology.protein, business, Homeostasis, medicine.drug
Abstract: This work was supported by Fundacao para a Ciencia e a Tecnologia-FCT (Project PEst-OE/AGR/U10276/2014). Hemorrhagic shock (HS) induces a compensatory endocrine and cytokine response which aims to restore homeostasis. This response can be modulated by general anesthetics. To our knowledge, no studies have evaluated if etomidate modulates this response in experimental HS. After being premedicated with buprenorphine (0.05 mg/kg subcutaneously), male Wistar rats were anaesthetized with 5% isoflurane and divided into three groups: G1 (control, n = 16), G2 (n = 13), and G3 (n = 14). G2 and G3 were subjected to HS by collecting 30% of their blood volume and resuscitated 90 min later with the collected blood and normal saline, in a 1:3 ratio, respectively. G3 received etomidate (1 mg/kg IV) before HS. Blood gas analysis, adrenocorticotropic hormone (ACTH), corticosterone, and plasma levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10 and of TNF-α, IL-6, and IL-10 mRNA obtained through real-time polymerase chain reaction (RT-PCR) were measured at 0, 90, 150, and 240 min after HS induction. Compared with G2, etomidate-treated animals had significantly lower corticosterone, PO2, PO2/FiO2, base excess and HCO3, and higher TNF-α, IL-6, IL-10, and TNF-α mRNA levels (P
Published: 2016

33. Newborn primary congenital glaucoma: Histopathologic features of the anterior chamber filtration angle

Author: Lynn J. Poole Perry, Fouad R. Zakka, David S. Walton, and Frederick A. Jakobiec
Subjects: Intraocular pressure, genetic structures, medicine.medical_treatment, Gonioscopy, Gestational Age, Trabeculectomy, Eye Enucleation, Anterior chamber angle, Tonometry, Ocular, Corneal Opacity, Anterior Eye Segment, Diseases in Twins, medicine, Humans, Intraocular Pressure, medicine.diagnostic_test, business.industry, Corneal Edema, Hydrophthalmos, Infant, Newborn, Primary congenital glaucoma, Twins, Monozygotic, Anatomy, medicine.disease, eye diseases, Hypoplasia, Ophthalmology, Ciliary muscle, medicine.anatomical_structure, Pediatrics, Perinatology and Child Health, Female, sense organs, Trabecular meshwork, business
Abstract: We present histopathologic findings that have not been previously reported as associated with abnormalities of the anterior chamber angle underlying newborn primary congenital glaucoma as a distinct entity. The major histopathologic findings were partial absence and retrodisplacement of Schlemm's canal, hypoplasia of the trabecular meshwork, broad attachment of ciliary muscle to the meshwork, and anterior insertion of hypoplastic iris with the formation of a pseudomembrane. These profound anatomic derangements explain why goniosurgery is frequently unsuccessful in cases of newborn glaucoma.
Published: 2012
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34. Anomalous High Bifurcation of the Common Femoral Artery at the Groin: Management of Gsv Incompetence with Endovenous Laser Ablation

Author: C Lekich, P Hannah, S Walton, and W Campbell
Subjects: Leg, medicine.medical_specialty, Laser ablation, Groin, business.industry, Great saphenous vein, Ultrasonography, Doppler, General Medicine, Femoral artery, Femoral Vein, Femoral Artery, Varicose Veins, medicine.anatomical_structure, medicine.artery, medicine, Humans, Female, Saphenous Vein, Laser Therapy, Radiology, Cardiology and Cardiovascular Medicine, Saphenofemoral junction, business, Aged
Abstract: Objectives: To discuss safety of EVLA in anomalies of the GSV anatomy. To review and discuss complications of surgery involving anomalous anatomy. Method: We report a case of high bifurcation of the common femoral artery wrapping around the saphenofemoral junction. Results: Successful ablation was achieved with no adverse consequences. Conclusion: EVLA is a safe treatment for SFJ/GSV incompetence in the presence of vascular anomalies that have historically resulted in serious vascular complications from surgery.
Published: 2012
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35. Origin of significant visible-light absorption properties of Mn-doped TiO2 thin films

Author: Alex S. Walton, L. Lu, Michael B. Ward, Xiaohong Xia, X.P. Han, Rik Brydson, Jikui Luo, and Guosheng Shao
Subjects: inorganic chemicals, Materials science, Polymers and Plastics, business.industry, Doping, technology, industry, and agriculture, Metals and Alloys, Valency, Nanotechnology, medicine.disease_cause, Electronic, Optical and Magnetic Materials, Condensed Matter::Materials Science, X-ray photoelectron spectroscopy, Ceramics and Composites, medicine, Optoelectronics, Density functional theory, Thin film, business, Electronic band structure, Ultraviolet, Visible spectrum
Abstract: It is highly desirable to induce significant red-shift in the optical absorption edges of TiO2 phases so that this class of low-cost and environmentally friendly materials can be used as effective optical absorbing materials in novel photovoltaic cells with long-term sustainability or smart photo-catalysts beyond the ultraviolet range. This work focuses on studying the mechanisms of Mn-induced red-shift by combining theoretical modeling with advanced structural and spectroscopic characterization of doped thin films, aiming to provide fundamental guidance for effective doping through enhanced understanding of doping chemistry resulting from the interplay between doping atoms and defects. It is shown that Mn atoms doped into the Ti lattice sites are associated with oxidation valency higher than +3, resulting in maximized effectiveness in modifying the band structure to achieve remarkable optical red-shifting. The presence of oxygen vacancies reduces the Mn valency and its red-shifting effect, but their detrimental effect in bringing about localized defect levels is reduced owing to their association with Mn atoms, making Mn doping highly promising in activating various visible light functionalities of TiO2.
Published: 2012
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36. Characterization of the Impaired Glucose Homeostasis Produced in C57BL/6 Mice by Chronic Exposure to Arsenic and High-Fat Diet

Author: David S. Paul, Felecia S. Walton, R. Jesse Saunders, and Miroslav Stýblo
Subjects: Blood Glucose, Male, C57BL/6, medicine.medical_specialty, diet-induced obesity, Health, Toxicology and Mutagenesis, chemistry.chemical_element, Type 2 diabetes, 010501 environmental sciences, Biology, 01 natural sciences, Arsenic, Mice, 03 medical and health sciences, Insulin resistance, insulin resistance, Internal medicine, Diabetes mellitus, medicine, Animals, Homeostasis, Insulin, Glucose homeostasis, Obesity, News | Science Selections, Adiposity, Diet and Nutrition, 030304 developmental biology, 0105 earth and related environmental sciences, 2. Zero hunger, 0303 health sciences, Endocrine Health, diabetes, Arsenic toxicity, Research, Public Health, Environmental and Occupational Health, food and beverages, Fasting, medicine.disease, biology.organism_classification, Dietary Fats, 3. Good health, high-fat diet, Endocrinology, glucose intolerance, chemistry, Metals
Abstract: Background: Type 2 diabetes is characterized by glucose intolerance and insulin resistance. Obesity is the leading cause of type 2 diabetes. Growing evidence suggests that chronic exposure to inorganic arsenic (iAs) also produces symptoms consistent with diabetes. Thus, iAs exposure may further increase the risk of diabetes in obese individuals. Objectives: Our goal was to characterize diabetogenic effects of iAs exposure and high-fat diet (HFD) in weaned C57BL/6 mice. Methods: Mice were fed HFD or low-fat diet (LFD) while exposed to iAs in drinking water (25 or 50 ppm As) for 20 weeks; control HFD and LFD mice drank deionized water. Body mass and adiposity were monitored throughout the study. We measured glucose and insulin levels in fasting blood and in blood collected during oral glucose tolerance tests (OGTT) to evaluate the diabetogenic effects of the treatment. Results: Control mice fed HFD accumulated more fat, had higher fasting blood glucose, and were more insulin resistant than were control LFD mice. However, these diabetes indicators decreased with iAs intake in a dose-dependent manner. OGTT showed impaired glucose tolerance for both control and iAs-treated HFD mice compared with respective LFD mice. Notably, glucose intolerance was more pronounced in HFD mice treated with iAs despite a significant decrease in adiposity, fasting blood glucose, and insulin resistance. Conclusions: Our data suggest that iAs exposure acts synergistically with HFD-induced obesity in producing glucose intolerance. However, mechanisms of the diabetogenic effects of iAs exposure may differ from the mechanisms associated with the obesity-induced type 2 diabetes.
Published: 2011
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37. High-Pressure Adsorption Equilibrium of CO2, CH4, and CO on an Impregnated Activated Carbon

Author: Krista S. Walton and Bin Mu
Subjects: General Chemical Engineering, chemistry.chemical_element, General Chemistry, Methane, chemistry.chemical_compound, Adsorption, Chemical engineering, chemistry, Chemisorption, Desorption, Carbon dioxide, medicine, Physical chemistry, Carbon, Carbon monoxide, Activated carbon, medicine.drug
Abstract: An impregnated activated carbon (I-AC) has been characterized using SEM, EDS, and nitrogen adsorption for micropore structure analysis. A detailed experimental study has been made of the adsorption of pure methane, carbon dioxide, and carbon monoxide at various temperatures [(298 to 318) K] and pressures up to 24 bar. Multitemperature isotherms were modeled using the Toth equation to obtain useful thermodynamic properties including Henry’s law constants and isosteric heats of adsorption. Compared with other activated carbon materials, this impregnated carbon has a decreased surface area and more heterogeneous sites on the surface. CO appears to undergo chemisorption in the impregnated carbon, as indicated by a hysteresis loop upon desorption. The effect becomes more pronounced with increasing temperature.
Published: 2011
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38. Infantile Aphakic Glaucoma: A Proposed Etiologic Role of IL-4 and VEGF

Author: Inbal Michael, Shulamit Levenberg, and David S. Walton
Subjects: Vascular Endothelial Growth Factor A, Adolescent, Glaucoma, Cell morphology, chemistry.chemical_compound, Trabecular Meshwork, Lens, Crystalline, Gene expression, medicine, Humans, Antibodies, Blocking, Cells, Cultured, Interleukin 4, Aphakia, biology, business.industry, Epithelial Cells, General Medicine, medicine.disease, Coculture Techniques, Vascular endothelial growth factor, Ophthalmology, medicine.anatomical_structure, Gene Expression Regulation, chemistry, Pediatrics, Perinatology and Child Health, biology.protein, Cancer research, Interleukin-4, sense organs, Trabecular meshwork, Antibody, business, Glaucoma, Open-Angle, Transforming growth factor
Abstract: Purpose: To identify the factors secreted by lens epithelial cells (LECs) responsible for the altered trabecular meshwork (TM) cells and to compare their effect on monocultured TM cells with that of TM cells co-cultured with LECs. Methods: Such factors were isolated using cytokine antibody array membranes, and their effect on TM cells was assessed by analyzing changes in morphology and gene expression. In addition, inhibition of the isolated factors was performed in the co-culture model by adding specific antibodies to the cell culture media. Results: Transforming growth factor beta-2, interleukin-4 (IL-4), and vascular endothelial growth factor (VEGF) are presented as candidate cytokines responsible for the observed changes in LEC-TM co-cultures. Culturing TM cells in the presence of VEGF and IL-4 triggered alterations closely reflecting those observed in the LEC-TM co-culture model, where their inhibition significantly hindered the alteration of the TM cells. Conclusion: These findings suggest a possible explanation for the development of infantile aphakic glaucoma, based on residual LECs secreting IL-4 and VEGF after removal of congenital cataract, which then alter trabecular meshwork cell morphology and gene expression.
Published: 2011
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39. Infliximab and risk of serious infection in patients with psoriasis

Author: Ian Evans, Darren M. Ashcroft, Kathleen McElhone, Catherine H. Smith, S. Walton, Mark Lunt, Anthony Ormerod, C. E. M. Griffiths, N. J. Reynolds, Z.Z.N. Yiu, Ruth Murphy, and Richard B. Warren
Subjects: medicine.medical_specialty, business.industry, Psoriasis, medicine, In patient, Dermatology, Serious infection, medicine.disease, business, Infliximab, medicine.drug
Published: 2019
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40. Heterochromia Iridis and Pertinent Clinical Findings in Patients with Glaucoma Associated with Sturge–Weber Syndrome

Author: Nalini K. Aggarwal, Sai B. Gandham, Robert Saltzmann, David S. Walton, and Rebecca Weinstein
Subjects: Adult, medicine.medical_specialty, genetic structures, Sturge–Weber syndrome, Gonioscopy, Glaucoma, Iris color, Heterochromia iridis, symbols.namesake, Sturge-Weber Syndrome, Ophthalmology, Humans, Medicine, In patient, Iris (anatomy), Intraocular Pressure, Fisher's exact test, Retrospective Studies, medicine.diagnostic_test, business.industry, General Medicine, medicine.disease, eye diseases, medicine.anatomical_structure, Iris Diseases, Pediatrics, Perinatology and Child Health, symbols, sense organs, business, Pigmentation Disorders
Abstract: Purpose: To examine the clinical and gonioscopic findings in patients with glaucoma associated with Sturge–Weber syndrome. Methods: Retrospective review of clinical findings of all patients with Sturge–Weber syndrome who presented between January 1978 and December 2003. Koeppe gonioscopy was performed under general anesthesia and findings were photographed when feasible. Iris color was documented by color sketch or photograph at initial presentation. Fisher exact test was used to determine whether the presence of heterochromia was statistically higher in the glaucomatous group. Results: Fifty-five patients who met inclusion criteria were identified, of whom 44 (80%) had glaucoma. Unilateral glaucoma was diagnosed in 30 eyes and bilateral glaucoma in 14 eyes, yielding 58 eyes with glaucoma and 52 eyes without. Gonioscopic examination revealed distinct anatomic abnormalities in the anterior chamber angle in 32 (55%) of the glaucomatous eyes in contrast to the normal fellow eyes in patients with unilateral glaucoma and to the patients without glaucoma. Heterochromia iridis with darker iris on the glaucomatous side was present in 11 of the 30 patients with unilateral glaucoma (37%, P < .001) but in none of the patients without glaucoma. Conclusion: The characteristics observed in the anterior chamber angle in this large, uniquely examined series are the first reported to the authors’ knowledge and may support a role for neural crest derived anomalies in the pathogenesis of glaucoma in these infant eyes. Careful examination for heterochromia iridis may be judicious in these patients.
Published: 2010
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41. BP: serum anti-BP180 IgG levels, mortality and Karnofsky score

Author: Nick J. Levell, Hywel C Williams, S. Walton, John S. C. English, Inke R. König, A. Chapman, Enno Schmidt, Maike M. Holtsche, Michael Sticherling, Detlef Zillikens, Karen E. Harman, Stephanie Goletz, Richard Groves, Sandrine Benoit, and N. van Beek
Subjects: medicine.medical_specialty, business.industry, Internal medicine, medicine, Karnofsky score, Dermatology, business, Gastroenterology
Published: 2018
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42. Exon deletions of the EP300 and CREBBP genes in two children with Rubinstein–Taybi syndrome detected by aCGH

Author: Joanna Wiszniewska, Carol S. Walton, Pawel Stankiewicz, Cherilyn J Dossett, Beata Nowakowska, Patti A. Eng, Andrea E Cramer, Amber N. Pursley, Sau Wai Cheung, and Anne Chun Hui Tsai
Subjects: Male, Article, Skeletal phenotype, Exon, Pregnancy, Genetics, medicine, Humans, CREB-binding protein, EP300, Microarray platform, Gene, Genetics (clinical), Oligonucleotide Array Sequence Analysis, Rubinstein-Taybi Syndrome, Comparative Genomic Hybridization, Rubinstein–Taybi syndrome, biology, Infant, Newborn, Exons, medicine.disease, CREB-Binding Protein, Child, Preschool, biology.protein, Female, E1A-Associated p300 Protein, Gene Deletion, Comparative genomic hybridization
Abstract: We demonstrate the utility of an exon coverage microarray platform in detecting intragenic deletions: one in exons 24-27 of the EP300 gene and another in exons 27 and 28 of the CREBBP gene in two patients with Rubinstein-Taybi syndrome (RSTS). RSTS is a heterogeneous disorder in which approximately 45-55% of cases result from deletion or mutations in the CREBBP gene and an unknown portion of cases result from gene changes in EP300. The first case is a 3-year-old female with an exonic deletion of the EP300 gene who has classic facial features of RSTS without the thumb and great toe anomalies, consistent with the milder skeletal phenotype that has been described in other RSTS cases with EP300 mutations. In addition, the mother of this patient also had preeclampsia during pregnancy, which has been infrequently reported. The second case is a newborn male who has the classical features of RSTS. Our results illustrate that exon-targeted array comparative genomic hybridization (aCGH) is a powerful tool for detecting clinically significant intragenic rearrangements that would be otherwise missed by aCGH platforms lacking sufficient exonic coverage or sequencing of the gene of interest.
Published: 2010
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43. Congenital Pupillary-Iris-Lens Membrane With Goniodysgenesis: Histopathologic Findings in an Enucleated Eye

Author: DO Alexander Demidenko, David S. Walton, Frederick A. Jakobiec, and Eissa Hanna
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Lens Capsule, Crystalline, Iris, Cataract, Eye Enucleation, Pupil, Goniodysgenesis, Ophthalmology, Lens, Crystalline, medicine, Glaucoma surgery, Humans, Abnormalities, Multiple, Iris (anatomy), Child, business.industry, Glaucoma, General Medicine, medicine.anatomical_structure, Lens (anatomy), Dilator, Pediatrics, Perinatology and Child Health, Sphincter, business
Abstract: A 10-year-old boy with clinically confirmed congenital pupillary-iris-lens membrane with goniodysgenesis underwent light microscopic examination of the enucleated eye. The anterior segment changes consisted of the absence of the iridial pupillary sphincter muscle and dilator muscle processes. Endothelialization and descemetization of the anterior chamber angle and the anterior surface of the iris covered the original eccentric pupillary opening (occlusio pupillae), but grew around the fibrotic edges of the surgically created, patent pseudopupil, probably secondary responses to surgery. The anterior chamber findings in this case establish a localized syndrome that includes absence of the pupillary sphincter and dilator muscle processes. Incomplete development of the iris may be partly attributable to an abnormality of stromal development and inductions by the anterior neuroectodermal layer, together with anomalies of the pupillo-iridial vasculature. [J Pediatr Ophthalmol Strabismus 2010;47:178–182.]
Published: 2010
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44. Prevention of Pressure Ulcers in the Surgical Patient

Author: Patina S. Walton-Geer
Subjects: Pressure Ulcer, medicine.medical_specialty, Intraoperative Care, business.industry, Posture, MEDLINE, Perioperative, Surgical procedures, Patient Care Planning, digestive system diseases, Medical–Surgical Nursing, Risk Factors, Surgical Procedures, Operative, Health care, medicine, Humans, Pressure Ulcer Prevention, business, Intensive care medicine, Surgical patients
Abstract: Pressure ulcers (PUs) are a serious health care problem, and it is crucial to assess how patients acquire pressure ulcers after admission to a health care facility. In the OR, factors related to positioning, anesthesia, and the duration of surgery, in addition to patient-related factors, all can affect PU development. This article reviews current practices, including AORN recommended practices, regarding pressure ulcer prevention efforts for surgical patients. All surgical patients should be considered at-risk for pressure ulcer development; therefore, perioperative departments should develop and implement strategic plans for pressure ulcer prevention.
Published: 2009
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45. Angle-closure Glaucoma: The Role of the Lens in the Pathogenesis, Prevention, and Treatment

Author: Ching Lin Ho, David S. Walton, and Pamela Tarongoy
Subjects: Iridectomy, medicine.medical_specialty, genetic structures, medicine.medical_treatment, Eye disease, Iris, Glaucoma, Pathogenesis, Vision disorder, Ophthalmology, Lens, Crystalline, medicine, Humans, Angle-closure glaucoma, business.industry, Phacoemulsification, medicine.disease, eye diseases, Surgery, medicine.anatomical_structure, Lens (anatomy), sense organs, medicine.symptom, Glaucoma, Angle-Closure, business
Abstract: Primary angle-closure glaucoma is a major cause of blindness worldwide. It is a disease of ocular anatomy that is related to pupillary-block and angle-crowding mechanisms of filtration angle closure. Eyes at increased risk for primary angle-closure are small with decreased axial length, anterior chamber depth, and filtration angle width, associated with a proportionately large lens. Angle-closure glaucoma afflicts Asian and Eskimo eyes more frequently than eyes in other races with similar predisposing dimensions. The treatment of primary angle closure addresses its causal mechanisms. Laser peripheral iridotomy equalizes the anterior and posterior pressures and widens the filtration angle by reducing the effect of pupillary block. Argon laser peripheral iridoplasty contracts the iris stroma to reduce angle crowding and is helpful for some affected eyes. Lensectomy dramatically widens the angle and eliminates pupillary block. Clinical reports of lensectomy with posterior chamber intraocular lens implantation in the treatment of acute, chronic, and secondary angle-closure glaucoma describe very favorable results. The appropriate role for lensectomy in the management of primary angle closure, however, remains unproven. Prospective, randomized clinical trials are ongoing to determine the value and comparative risks and efficacy of lensectomy versus medical therapy, laser peripheral iridotomy, laser iridoplasty, and filtration procedures for the treatment of acute and chronic primary angle closure and for the prevention of chronic angle-closure glaucoma, both after and in place of laser peripheral iridotomy.
Published: 2009
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46. The Spontaneous Resolution of Primary Congenital Glaucoma

Author: Karina Nagao, Leon Paul Noel, David S. Walton, and Marie Éve Noël
Subjects: Adult, Glaucoma treatments, medicine.medical_specialty, genetic structures, medicine.medical_treatment, Remission, Spontaneous, macromolecular substances, medicine, Humans, In patient, Child, Intraocular Pressure, Glaucoma medication, business.industry, fungi, Hydrophthalmos, Primary congenital glaucoma, Infant, General Medicine, Early glaucoma, eye diseases, Surgery, Ophthalmology, Clinical evidence, Child, Preschool, Pediatrics, Perinatology and Child Health, Optic nerve, sense organs, business
Abstract: Purpose:To describe the ocular findings in a series of children with spontaneous resolution of primary congenital glaucoma (PCG).Methods:The medical records of 356 patients with PCG were reviewed. Nine patients with spontaneous resolution of PCG were studied. Fourteen of 18 eyes possessed evidence of early glaucoma, were found to have normal intraocular pressures, and were clinically classified as having spontaneous resolution of PCG. None of the eyes with spontaneous resolution received surgery or any glaucoma medication.Results:Spontaneous resolution of PCG in all nine patients was recognized after 4 months of age. At the time of diagnosis, large corneas were observed in all affected eyes and Haab’s striae in 10 of 14 eyes. Intraocular pressures were normal in 14 eyes. In all 14 eyes, the anterior chambers were deep, the lenses were clear, and the angles were abnormal with the typical appearance of PCG. Theeyes with spontaneous resolution of PCG possessed angle abnormalities that were less severe compared to three fellow eyes that required glaucoma treatments.Conclusion:The occurrence of spontaneous resolution of PCG in these patients is supported by objective clinical evidence. The explanation for this spontaneous resolution is unknown. Its mechanism could be related to continued postnatal development of the angle structures in eyes possessing milder angle abnormalities. The anterior segment findings in patients with spontaneous resolution of PCG are similar to those of patients with treated PCG, the intraocular pressures are normal, the optic nerve damage is stable, and the filtration angles possess mild or moderate abnormalities.
Published: 2009
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47. Congenital Pupillary-Iris-Lens Membrane With Goniodysgenesis

Author: Alexander Demidenko, Eissa Hanna, Frederick A. Jakobiec, and David S. Walton
Subjects: Male, medicine.medical_specialty, Iris, Glaucoma, Blindness, Eye Enucleation, Anterior Eye Segment, Pupil Disorders, Goniodysgenesis, Ophthalmology, medicine, Humans, Eye Abnormalities, Iris (anatomy), Child, Intraocular Pressure, Membranes, Neovascularization, Pathologic, business.industry, medicine.disease, Glaucoma, Neovascular, medicine.anatomical_structure, Iris Diseases, Lens Diseases, Lens (anatomy), business
Published: 2009
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48. Surgical Management of Glaucoma With the Sturge Weber Syndrome

Author: Thomas D. Patrianakos, David S. Walton, and Karina Nagao
Subjects: medicine.medical_specialty, business.industry, Sturge–Weber syndrome, Infant, Glaucoma, Ophthalmologic Surgical Procedures, medicine.disease, Ophthalmology, Sturge-Weber Syndrome, Child, Preschool, medicine, Humans, business
Published: 2008
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49. Aortic Balloon Valvuloplasty—Review and Case Series

Author: Anthony S. Walton, Richard J. Jabbour, and Ronald Dick
Subjects: Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Percutaneous, medicine.medical_treatment, Hemodynamics, Balloon, History, 21st Century, Catheterization, Restenosis, Internal medicine, medicine, Humans, Aged, 80 and over, Surgical approach, business.industry, Aortic Valve Stenosis, History, 20th Century, medicine.disease, Balloon valvuloplasty, Aortic valvuloplasty, Surgery, Stenosis, cardiovascular system, Cardiology, Female, Cardiology and Cardiovascular Medicine, business
Abstract: Aortic balloon valvuloplasty (BAV) was initially devised in the 1980s as an alternative procedure to the surgical treatment of aortic stenosis, with the theory behind it being both minimally invasive as well as having a lower complication rate [Hara H, et al. Percutaneous balloon aortic valvuloplasty revisited: time for a renaissance? Circulation 2007 March;115(12):e334-8]. In practice however, the procedure was found to have a higher complication rate with only a modest haemodynamic improvement compared to the surgical approach. Most important of all it had an unacceptably high restenosis rate as a substitute for surgery [Otto CM, et al. 3-year outcome after balloon aortic balloon valvuloplasty: insights into prognosis of valvular aortic stenosis. Circulation 1994;89:642-50]. As a result, the procedure has fallen out of favour and has been abandoned at many health care facilities [Hara H, et al. Percutaneous balloon aortic valvuloplasty revisited: time for a renaissance? Circulation 2007 March;115(12):e334-8]. This article will review the management of patients with severe aortic stenosis that are unsuitable to undergo surgery.
Published: 2008
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50. Blood oxygen level-dependent (BOLD) MRI: A novel technique for the assessment of myocardial ischemia as identified by nuclear imaging SPECT

Author: Thomas William Redpath, Gordon D. Waiter, Mohaned Egred, Abdallah Al-Mohammad, Scott Ian Kay Semple, and S. Walton
Subjects: Blood-oxygen-level dependent, medicine.diagnostic_test, business.industry, Ischemia, Magnetic resonance imaging, medicine.disease, Coronary artery disease, Dipyridamole, Spect imaging, Internal Medicine, medicine, Nuclear medicine, business, Perfusion, Cardiac imaging, medicine.drug
Abstract: Background The different levels of deoxyhemoglobin in the ischemic myocardium, induced by stressors such as dipyridamole, can be detected by blood oxygen level-dependent (BOLD) MRI and may be used to diagnose myocardial ischemia. The aim of this study was to assess the signal change in the myocardium on BOLD MRI as well as wall thickening between rest and dipyridamole stress images in ischemic and non-ischemic myocardium as identified on SPECT imaging. Methods Twelve patients with stress-induced myocardial ischemia on SPECT underwent rest and dipyridamole stress MRI using a double breath-hold, T2⁎-weighted, ECG-gated sequence to produce BOLD contrast images as well as cine-MRI for wall thickening assessment in 10 of the 12 patients. Signal change on BOLD MRI and wall thickening were compared between rest and stress images in ischemic and non-ischemic myocardial segments as identified on SPECT. In each patient, two MRI slices containing 16 segments per slice were analysed. Results In total, there were 384 segments for BOLD analysis and 320 for wall thickening. For BOLD signal 137 segments correlated to segments with reversible ischemia on SPECT and 247 to normal segments, while for wall thickening 112 segments correlated to segments with reversible ischemia and 208 to normal segments. The average BOLD MRI signal intensity change was − 13.8 (± 16.3)% in the ischemic segments compared to − 10.3 (± 14.7)% in the non-ischemic segments (p = 0.05). The average wall thickening was 6.4 (± 3.4) mm in the ischemic segments compared to 8.7 (± 3.8) mm in the non-ischemic segments (p Conclusion Stress-induced ischemic myocardium has a different signal change and wall thickening than non-ischemic myocardium and may be differentiated on BOLD MRI. Larger studies are needed to define a threshold for detection and to determine the sensitivity and specificity of this technique.
Published: 2007
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