Lorene M. Nelson's scientific contributions

Publications (72)

Publications citing this author (2540)

    • The continuous variables were the number of comorbid medical conditions, body mass index, depression determined using the Patient Health Questionnaire-9 (PHQ-9) [42], anxiety determined using the Hospital Anxiety and Depression Scale (HADS-A) [43], pain determined by the Pain Visual Analog Scale (P-VAS) [44], sleep apnea determined using the STOP-Bang questionnaire [45], restless legs determined by adopted Restless Legs Questionnaire [46] , and narcolepsy , as determined by the Swiss Narcolepsy Scale (SNS) [47]. Binary variables were the severity of brain injury determined by the presence of LOC, retrograde or anterograde PTA, the mechanism of injury, and the presence of previous head trauma; the presence of DSM-IV-TR disorders [13], including mood, anxiety, adjustment, substance-related, somatoform, sleep, and personality disorders; comorbid conditions (heart disease, arthritis, diabetes mellitus, and thyroid dysfunction [hypo-or hyperthyroidism]); and the symptom load affecting sleep, such as snoring, observed pauses in breathing during sleep, head or neck pain, and bodily pain.
    [Show abstract] [Hide abstract] ABSTRACT: Objective/background/aim: Insomnia has not been explored as it relates to recovery after mild traumatic brain injury (mTBI). We aimed to evaluate the prevalence of insomnia among Ontario workers with delayed recovery from mTBI, and its relationship with sociodemographic, TBI- and claim-related, behavioral, and clinical factors. Patients/methods: This was a cross-sectional study carried out over a period of 24 months in a large rehabilitation hospital in Ontario. To assess the prevalence of insomnia, we used the Insomnia Severity Index (ISI). Data were collected from standardized questionnaires, insurer records, and clinical assessment at the time of recruitment. Bivariate associations were calculated using the Spearman's correlation coefficient or analysis of variance. We established stepwise multivariate linear regression models of factors associated with insomnia. Additional analyses, including the assessment of the internal consistency of the ISI, were performed. Results: Of the 94 participants diagnosed with mTBI, clinical insomnia was reported by 69.2%. The mean age was 45.20 ± 9.94 years; 61.2% were men. No sex-related differences were observed in insomnia prevalence or severity. Insomnia was significantly associated with certain sociodemographic, claim-related, behavioral, and clinical variables. In the multivariable regression analysis, several determinants explained 53% of the insomnia variance. The internal consistency of the ISI, as measured by Cronbach's α, was 0.86. Conclusions: Insomnia is common in persons with delayed recovery from mTBI, and is significantly associated with potentially modifiable clinical and nonclinical variables. Care of persons with brain injury requires greater attention with regard to the diagnosis and management of insomnia and associated disorders.
    Full-text · Article · Sep 2015
    • As widely reviewed by Borthen[31], recent studies strongly indicate an association between AEDs use, and complications during pregnancy and labour. In particular, women with epilepsy seem to have a higher risk of preeclampsia and gestational hypertension[31], bleeding in pregnancy[32], caesarean delivery[33,34], excessive bleeding post-partum, preterm birth and small for gestational age child[35,36]. It is unclear whether the increased risk of complications is due to epilepsy per se, AEDs use, or combination of both.
    [Show abstract] [Hide abstract] ABSTRACT: Purpose: The physiological changes during pregnancy can significantly alter antiepileptic drug (AED)'s absorption, distribution, metabolism and elimination, thus influencing their plasma concentration. Considering that the risks of using old and new AEDs during pregnancy are still debated, our aim is to review the available evidence on this topic. Methods: Narrative overview, synthesizing the findings of literature retrieved from searches of computerized databases. Results: The old AEDs generation (benzodiazepines, phenytoin, carbamazepine, phenobarbital and valproic acid) is teratogenic: minor congenital malformations, such as facial dysmorphism and other anomalies, occur in 6-20 % of infants exposed to AEDs in utero; this value is two times greater than the value reported in the general population. Major congenital malformations (MCM) such as cleft lip and cleft palate, heart defects (atrial septal defect, Fallot's tetralogy, ventricular septal defect, aortic coarctation, patent ductus arteriosus, and pulmonary stenosis) and urogenital anomalies were estimated to be 4-6 % of infants born from mothers treated with AEDs, compared to 2-3 % of the general population. Conclusion: It is essential to inform women treated with AED that planning pregnancy is necessary, when possible. The problems related to antiepileptic therapy and the possibilities of prenatal diagnosis should be accurately discussed with the patient, when possible before pregnancy: individual circumstances, desire to have children, severity of epilepsy, risks of seizures, family history of congenital malformations and all other potential risk factors must be considered, involving the patient in shared clinical decision-making.
    Full-text · Article · Nov 2015
    • Executive deficits are arguably the most common cognitive impairment observed in the LBD spectrum (Levin et al., 1991; Rosenthal et al., 2010; Dirnberger and Jahanshahi, 2013). This is closely aligned with difficulties in decision-making and social functioning (Bodden et al., 2010; Djamshidian et al., 2014), and these deficits can have a profound impact on patients' daily lives (Lo et al., 2009; Rosenthal et al., 2010). With the emergence of potential disease-modifying treatments, there is considerable interest in defining more specifically the neurobiologic basis for cognitive difficulties, and developing inexpensive, non-invasive screening tools that can both help improve pathology-associated diagnosis and serve as a validated, repeatable endpoint in an intervention study.
    [Show abstract] [Hide abstract] ABSTRACT: Background: Lewy body disorders (LBD) are clinical syndromes characterized by pathological inclusions containing α-synuclein. Cognitive deficits are common or diagnostic in LBD, and may be associated with the presence of beta-amyloid (Aβ), which is a hallmark histopathologic abnormality characteristic of Alzheimer's disease (AD) that can also co-occur with LBD. Objective: In the present study we evaluated whether social decision-making difficulties in LBD are associated with Aβ burden. Methods: Decision-making abilities were measured with a simple, untimed, behavioral task previously validated in patients with behavioral variant frontotemporal dementia, and performance was related to gray matter atrophy on MRI. Aβ burden was assessed by examination of cerebrospinal fluid (CSF) level of Aβ1−42 and by autopsy confirmation in a subgroup of patients. Results: The results revealed that LBD patients with evidence of Aβ have reduced social decision-making abilities compared to patients with no evidence of Aβ. The imaging analysis related greater decision-making difficulty in Aβ-positive patients in respect to Aβ-negative patients to gray matter atrophy in medial orbitofrontal. This region is a critical node of a decision-making network as well as a region previously associated with comorbid α-synuclein and Aβ in LBD. Conclusions: These preliminary findings suggest that cognitive difficulties in LBD extend to include deficits in social decision-making and that this may be related to the presence of Aβ.
    Full-text · Article · Jan 2017
    • Genetic epidemiology investigates genetic and environmental determinants of disorders [6] and family studies are often used for association, segregation and linkage analyses. Case–control studies based on comparisons of unrelated individuals are useful in the identification of novel disease-associated genes [7], but have several important limitations for heritability studies. In a detailed review of epidemiological study designs, Zhao [8] suggested that designs combining case–control with familybased analyses are more appropriate for studies of aggregation (of clinical phenotypes or endophenotypes) and segregation (penetrance or allele frequency), also providing information on possible gene versus environment interactions .
    [Show abstract] [Hide abstract] ABSTRACT: A strong genetic role in the etiology of attention-deficit hyperactivity disorder (ADHD) has been demonstrated by several studies using different methodologies. Shortcomings of genetic studies often include the lack of golden standard practices for diagnosis for ADHD, the use of categorical instead of a dimensional approach, and the disregard for assortative mating phenomenon in parents. The current study aimed to overcome these shortcomings and analyze data through a novel statistical approach, using multilevel analyses with Bayesian procedures and a specific mathematical model, which takes into account data with an elevated number of zero responses (expected in samples with few or no ADHD symptoms). Correlations of parental clinical variables (ADHD, anxiety and depression) to offspring psychopathology may vary according to gender and type of symptoms. We aimed to investigate how those variables interact within each other. One hundred families, comprising a proband child or adolescent with ADHD or a typically developing child or adolescent were included and all family members (both biological parents, the proband child or adolescent and their sibling) were examined through semi-structured interviews using DSM-IV criteria. Results indicated that: (a) maternal clinical variables (ADHD, anxiety and depression) were more correlated with offspring variables than paternal ones; (b) maternal inattention (but not hyperactivity) was correlated with both inattention and hyperactivity in the offspring; (c) maternal anxiety was correlated with offspring inattention; on the other hand, maternal inattention was correlated with anxiety in the offspring. Although a family study design limits the possibility of revealing causality and cannot disentangle genetic and environmental factors, our findings suggest that ADHD, anxiety and depression are variables that correlate in families and should be addressed together. Maternal variables significantly correlated with offspring variables, but the paternal variables did not.
    Article · Aug 2014
    • Classification tree analysis (CTA), a form of recursive partitioning, provides an alternative approach with several advantages: this non-parametric technique is valuable for studying a complex set of predictor variables, and large sample size; it is data-adaptive, handles high dimensionality, a mixture of data types, and non-standard data structure, while providing insight into the predictive structure of the data (Breiman et al., 1984 ). Treebased methods have been used to partition individuals and establish high risk groups by clinical signs and symptoms (Kershaw et al., 2007); they may also uncover interactions potentially overlooked in logistic regression, unless modeled a priori (Forthofer and Bryant, 2000; Lemon et al., 2003; Nelson et al., 1998). The aim of this study is to apply CTA to investigate combinations of multi-domain health determinants associated with self-rated health (SRH), and conduct an exploratory analysis of their combinations and relative importance in income-based groups.
    [Show abstract] [Hide abstract] ABSTRACT: An understanding of factors influencing health in socioeconomic groups is required to reduce health inequalities. This study investigated combinations of health determinants associated with self-rated health (SRH), and their relative importance, in income-based groups. Cross-sectional data from year 15 (2000 − 2001) of the CARDIA study (Coronary Artery Risk Development in Young Adults, USA) - 3648 men and women (mean 40 years) - were split into 5 income-based groups. SRH responses were categorized as ‘higher’/‘lower’. Health determinants (medical, lifestyle, and social factors, living conditions) associated with SRH in each group were analyzed using classification tree analysis (CTA). Income and SRH were positively associated (p < 0.05). Data suggested an income-based gradient for lifestyle/medical/social factors/living conditions. Profiles, and relative importance ranking, of multi-domain health determinants, in relation to SRH, differed by income group. The highest ranking variable for each income group was chronic burden-personal health problem (<$25,000); physical activity ($25–50,000; $50–75,000; $100,000 +); and cigarettes/day ($75–100,000). In lower income groups, more risk factors and chronic burden indicators were associated with SRH. Social support, control over life, optimism, and resources for paying for basics/medical care/health insurance were greater (%) with higher income. SRH is a multidimensional measure; CTA is useful for contextualizing risk factors in relation to health status. Findings suggest that for lower income groups, addressing contributors to chronic burden is important alongside lifestyle/medical factors. In a proportionate universalism context, in addition to differences in intensity of public health action across the socioeconomic gradient, differences in the type of interventions to improve SRH may also be important.
    Full-text · Article · Jun 2016
    • Having a primary care physician within the same hospital network improved the likelihood of receiving care recommended in QIs for osteoporosis and cardiovascular disease screening. Application of 2009 SLE QIs related to bone health were assessed using the 2007–2008 wave of the LOS [23]. One hundred and twenty seven patients met criteria for the recommendation of osteoporosis screening and preventive treatment with calcium and vitamin D (taking at least 7.5 mg of prednisone per day for at least 3 months); 91 patients met the criteria for the recommendation of antiresorptive or anabolic osteoporosis medications (taking at least 7.5 mg of prednisone per day for at least 1 month, and having either a central T score of less than or equal to −2.5 or a history of fragility fracture).
    [Show abstract] [Hide abstract] ABSTRACT: Healthcare quality improvement has the potential to reduce the striking disparities in health outcomes among patients with systemic lupus erythematosus (SLE). Donabedian's framework for assessment of healthcare quality, which divides factors impacting quality into structures, processes and outcomes, provides a theoretical framework for research and interventions in quality improvement. This review applies Donabedian's model to current research describing quality of care in SLE, highlighting structures and processes that may lead to improved outcomes. Work remains to be done to develop meaningful metrics to assess quality and to understand the structures and processes that improve outcomes. Quality indicators have emerged as an important tool to measure quality, but further validation is required to define their validity and feasibility in clinical practice, as well as their association with improved outcomes. Implementation science also shows promise as a means to create meaningful systematic improvements in healthcare quality for patients with SLE.
    Full-text · Article · Feb 2012
    • Several different methods have been used including general questionnaires on job characteristics , self-reported exposure via questionnaires, expert evaluation by an occupational hygienist, and the application of a Job Exposure Matrix (JEM) to self-reported work histories [14,23]. A JEM is a systematic tool for assigning exposure based on the cross-classification of occupational titles with agents [13,24]. The first JEM was developed for carcinogen exposures in the 1980s [24].
    [Show abstract] [Hide abstract] ABSTRACT: Introduction: Due to contradictory literature we have performed a systematic review and meta-analyse of population-based studies that have used Job Exposure Matrices to assess occupational exposure and risk of Chronic Obstructive Pulmonary Disease (COPD). Areas covered: Two researchers independently searched databases for published articles using predefined inclusion criteria. Study quality was assessed, and results pooled for COPD and chronic bronchitis for exposure to biological dust, mineral dust, and gases/fumes using a fixed and random effect model. Five studies met predetermined inclusion criteria. The meta-analysis showed low exposure to mineral dust, and high exposure to gases/fumes were associated with an increased risk of COPD. We also found significantly increased the risk of chronic bronchitis for low and high exposure to biological dust and mineral dust. Expert review: The relationship between occupational exposure assessed by the JEM and the risk of COPD and chronic bronchitis shows significant association with occupational exposure. However, the heterogeneity of the meta-analyses suggests more wide population based studies with older age groups and longitudinal phenotype assessment of COPD to clarify the role of occupational exposure to COPD risk.
    Full-text · Article · May 2016
    • In the subgroup analysis by gender, we included 9 studies for men [2, 5, 19, 21, 22, 24,282930 and 7 studies for women [2, 5, 19, 22, 24, 28, 29] . In men, one study provided data separately for melanoma before and after PD diagnosis [24]. Our results (Fig. 4 ) showed that the association between melanoma and PD was similar in both men (OR 1.64, 95 % CI 1.27–2.13)
    [Show abstract] [Hide abstract] ABSTRACT: Objective: To assess the association between Parkinson's disease (PD) and melanoma via systematic review and meta-analysis. Methods: Comprehensive search in PubMed, Web of Science, Embase and four China databases (SinoMed, WanFang data, CNKI and VIP database) of epidemiologic evidences on PD and melanoma published before April 30, 2015. Studies which reported risk estimates of melanoma among PD patients or risk estimates of PD in patients with melanoma were included. Pooled odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated by random-effects models. Heterogeneity across studies was assessed using Cochran Q and I(2) statistics. Subgroup analyses and sensitivity analyses were conducted to evaluate sources of heterogeneity. Subgroup analyses were done according to temporal relationship, geographic region and gender respectively. We assessed publication bias using the Begg and Egger test. In addition, study appraisal was done using a scale for observational studies to ensure the quality of evidence. Results: We identified 24 eligible studies on PD and melanoma with a total number of 292,275 PD patients: the pooled OR was 1.83 (95 % CI 1.46-2.30) overall, subgroup analyses by temporal relationship showed that risk of melanoma after PD diagnosis was significantly higher (OR 2.43, 95 % CI 1.77-3.32), but not before the diagnosis of PD (OR 1.09, 95 % CI 0.78-1.54). Subgroup analysis by geographic region showed that increased risk of melanoma in PD was found both in Europe (OR 1.44, 95 % CI 1.22-1.70) and in North America (OR 2.64, 95 % CI 1.63-4.28). Gender-specific subgroup analyses did not show difference between men (OR 1.64, 95 % CI 1.27-2.13) and women (OR 1.38, 95 % CI 1.04-1.82) in the risk of melanoma. In addition, we found the risk of non-melanoma skin cancers in PD was slightly higher (OR 1.20, 95 % CI 1.11-1.29) than general population. It was impossible to evaluate the association between PD and melanoma according to use of levodopa or gene polymorphism via meta-analysis since few observational or cohort studies have focused on it. Conclusions: An association between PD and melanoma was confirmed. Most of the evidences were of high quality, and the conclusion was robust. Further research is needed to explore the mechanisms underlying this relationship.
    Full-text · Article · Nov 2015
    • A number of commonly occurring species have the ability to produce potent toxins that require removal prior to the water being safe for potable use (Zamyadi et al., 2012a), and which can poison domestic and wild animals drinking from impacted waters (Stewart et al., 2008). Cyanobacteria have also been hypothesised to be a possible cause of neurodegenerative illness (Holtcamp, 2012; Bradley et al., 2013), and their cell walls contain compounds (lipopolysaccharides) that can act as contact irritants (Pilotto, 2008). Because of the public health risk, the management of cyanobacteria in freshwater systems , especially those used as a source of drinking water and for recreation, is a major activity in many parts of the world (Chorus, 2012; Ibelings et al., 2014).
    [Show abstract] [Hide abstract] ABSTRACT: A YSI EXO2 water quality sonde fitted with fluorometric sensors for chlorophyll-a (Chl-a) and phycocyanin (CPC) was used to determine its applicability in cyanobacterial quantification in three small urban ponds in Sydney, Australia displaying considerable variations in cyanobacterial community composition and abundance, as well as eukaryotic algae, turbidity and chromophoric dissolved organic matter. CPC and Chl-a measured in situ with the instrument was compared against laboratory measures of cyanobacterial biovolume over two summer sampling periods. A good correlation was found between CPC and total cyanobacterial biovolume in two of the three ponds. The poor correlation in the third was due to the frequent dominance of picoplanktonic sized cyanobacteria. CPC did not correlate well with cell counts, and Chl-a was a poor measure of cyanobacterial presence. The relationship between CPC measured by fluorometry varied according to the dominant cyanobacterial taxa present in the ponds at any one time. Fluorometry has good potential for use in environmental monitoring of cyanobacterial biovolume, but may need to be based on predetermined relations applicable to local water bodies. Management guidelines based on CPC concentrations would also enhance the usefulness of in situ CPC measurements.
    Article · Aug 2016
    • For example, PD risk can be associated with clinical or environmental time-varying covariates. For example, studies have reported that cigaratte smoking is inversely associated with PD[23]. Therefore, taking into account of duration of smoking or time since quitting is important in estimating penetrance[24].
    [Show abstract] [Hide abstract] ABSTRACT: In genetic epidemiological studies, family history data are collected on relatives of study participants and used to estimate the age-specific risk of disease for individuals who carry a causal mutation. However, a family member's genotype data may not be collected due to the high cost of in-person interview to obtain blood sample or death of a relative. Previously, efficient nonparametric genotype-specific risk estimation in censored mixture data has been proposed without considering covariates. With multiple predictive risk factors available, risk estimation requires a multivariate model to account for additional covariates that may affect disease risk simultaneously. Therefore, it is important to consider the role of covariates in the genotype-specific distribution estimation using family history data. We propose an estimation method that permits more precise risk prediction by controlling for individual characteristics and incorporating interaction effects with missing genotypes in relatives, and thus gene-gene interactions and gene-environment interactions can be handled within the framework of a single model. We examine performance of the proposed methods by simulations and apply them to estimate the age-specific cumulative risk of Parkinson's disease (PD) in carriers of LRRK2 G2019S mutation using first-degree relatives who are at genetic risk for PD. The utility of estimated carrier risk is demonstrated through designing a future clinical trial under various assumptions. Such sample size estimation is seen in the Huntington's disease literature using the length of abnormal expansion of a CAG repeat in the HTT gene, but is less common in the PD literature.
    Full-text · Article · May 2017
    • PD affects around 1% of the general population a rate that increases with age reaching up to 5% of the 80 years old population [1]. Its annual incidence is between 16 and 19 per 100,000 per year [2].
    [Show abstract] [Hide abstract] ABSTRACT: Neurodegenerative diseases are characterized by a progressive dysfunction of the nervous system. Often associated with atrophy of the affected central or peripheral nervous structures, they include diseases such as Parkinson's Disease (PD), Alzheimer's Disease and other dementias, Genetic Brain Disorders, Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig's Disease), Huntington's Disease, Prion Diseases, and others. The prevalence of neurodegenerative diseases has increased over the last years. This has had a major impact both on patients and their families and has exponentially increased the medical bill by hundreds of billions of Euros. Therefore, understanding the role of environmental and genetic factors in the pathogenesis of PD is crucial to develop preventive strategies. While some authors believe that PD is mainly genetic and that the aging of the society is the principal cause for this increase, different studies suggest that PD may be due to an increased exposure to environmental toxins. In this article we review epidemiological, sociological and experimental studies to determine which hypothesis is more plausible. Our conclusion is that, at least in idiopathic PD (iPD), the exposure to toxic environmental substances could play an important role in its aetiology.
    Full-text · Article · May 2014
    • While, it is possible that optimal management of postpartum hemorrhage may reduce the need for transfusion[22], improved care with an increased awareness of hemorrhage risk factors, and better blood product availability could also lead to increased transfusion. Research suggests that preparedness for hemorrhage including the availability of hemorrhage protocols and the use of routine risk assessment varies significantlyFigure 2(A) demonstrates a temporal rise in hemorrhage/transfusion-related morbidity as a proportion of all morbidity over the study period.
    [Show abstract] [Hide abstract] ABSTRACT: Objective: The objective of this study was to characterize risk for and temporal trends in postpartum hemorrhage across hospitals with different delivery volumes. Study design: This study used the Nationwide Inpatient Sample (NIS) to characterize risk for postpartum hemorrhage from 1998 to 2011. Hospitals were classified as having either low, moderate or high delivery volume (?1000, 1001 to 2000,?>2000 deliveries per year, respectively). The primary outcomes included postpartum hemorrhage, transfusion, and related severe maternal morbidity. Adjusted models were created to assess factors associated with hemorrhage and transfusion. Results: Of 55,140,088 deliveries included for analysis 1,512,212 (2.7%) had a diagnosis of postpartum hemorrhage and 361,081 (0.7%) received transfusion. Risk for morbidity and transfusion increased over the study period, while the rate of hemorrhage was stable ranging from 2.5 to 2.9%. After adjustment, hospital volume was not a major risk factor for transfusion or hemorrhage. Discussion: While obstetric volume does not appear to be a major risk factor for either transfusion or hemorrhage, given that transfusion and hemorrhage-related maternal morbidity are increasing across hospital volume categories, there is an urgent need to improve obstetrical care for postpartum hemorrhage. Those risk factors are able to discriminate women at increased risk supports routine use of hemorrhage risk assessment.
    Full-text · Article · Apr 2017
    • For example: how many people are there sniffing at regular levels in this community aged between 10 and 14 years? In the second, informants serve as 'proxy respondents' (Nelson, Longstreth, Koepsell, & van Belle, 1990), who are presented with a list of names of community residents and asked to identify the petrol sniffing status of individuals on the list. The 'key informant estimates' approach is logistically simple and economical, especially when conducted via telephone or email.
    Full-text · Technical Report · Aug 2016 · Mediators of Inflammation
    • After Figure 1Decision tree model structure. reviewing the reference lists of the identified studies and removing duplicates, 5 studies containing potentially relevant utility data were identified [16][17][18][19][20]. The utility scores used in the model were from one study [19], selected because values were presented for different points over time, because utility scores for all the health states in the model were included in this study enabling better comparability between values, and the values reported also reflected trends in disease-specific quality of life measures found in other studies [11][12][13](Additional file 1).
    [Show abstract] [Hide abstract] ABSTRACT: Surgical resection is the only curative treatment for pancreatic and periampullary cancer, but many patients undergo unnecessary laparotomy because tumours can be understaged by computerised tomography (CT). A recent Cochrane review found diagnostic laparoscopy can decrease unnecessary laparotomy. We compared the cost-effectiveness of diagnostic laparoscopy prior to laparotomy versus direct laparotomy in patients with pancreatic and periampullary cancer with resectable disease based on CT scanning. Model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service. A decision tree model was constructed using probabilities, outcomes and cost data from published sources. One-way and probabilistic sensitivity analyses were undertaken. When laparotomy following diagnostic laparoscopy occurred in a subsequent admission, diagnostic laparoscopy incurred similar mean costs per patient to direct laparotomy (£7470 versus £7480); diagnostic laparoscopy costs (£995) were offset by avoiding unnecessary laparotomy costs. Diagnostic laparoscopy produced significantly more mean QALYs per patient than direct laparotomy (0.346 versus 0.337). Results were sensitive to the accuracy of diagnostic laparoscopy and the probability that disease was unresectable. Diagnostic laparoscopy had 63 to 66% probability of being cost-effective at a maximum willingness to pay for a QALY of £20 000 to £30 000. When laparotomy was undertaken in the same admission as diagnostic laparoscopy the mean cost per patient of diagnostic laparoscopy increased to £8224. Diagnostic laparoscopy prior to laparotomy in patients with CT-resectable cancer appears to be cost-effective in pancreatic cancer (but not in periampullary cancer), when laparotomy following diagnostic laparoscopy occurs in a subsequent admission.
    Full-text · Article · Apr 2015
    • In this sense, CD4+ IFN-í µí»¾producing cells fluctuate with MS relapses: declining during pregnancy, in women with MS, and continuing to decline after parturition, in women with relapses. In contrast, these cells rise, or remain stable, in women with nonrelapsing MS or healthy pregnant women [146]. In contrast, Th2 cells have been described as being protective in MS/EAE [147].
    [Show abstract] [Hide abstract] ABSTRACT: Multiple Sclerosis (MS) is an autoimmune disorder of the Central Nervous System that has been associated with several environmental factors, such as diet and obesity. The possible link between MS and obesity has become more interesting in recent years since the discovery of the remarkable properties of adipose tissue. Once MS is initiated, obesity can contribute to increased disease severity by negatively influencing disease progress and treatment response, but, also, obesity in early life is highly relevant as a susceptibility factor and causally related risk for late MS development. The aim of this review was to discuss recent evidence about the link between obesity, as a chronic inflammatory state, and the pathogenesis of MS as a chronic autoimmune and inflammatory disease. First, we describe the main cells involved in MS pathogenesis, both from neural tissue and from the immune system, and including a new participant, the adipocyte, focusing on their roles in MS. Second, we concentrate on the role of several adipokines that are able to participate in the mediation of the immune response in MS and on the possible cross talk between the latter. Finally, we explore recent therapy that involves the transplantation of adipocyte precursor cells for the treatment of MS.
    Full-text · Article · Jan 2016