Ashwin Venkatesh - Academia.edu (original) (raw)
Papers by Ashwin Venkatesh
British Journal of Neurosurgery
AIM Cervical Spondylotic Myelopathy (CSM) is a disabling condition arising from arthritic compres... more AIM Cervical Spondylotic Myelopathy (CSM) is a disabling condition arising from arthritic compression and consequent injury of the cervical spinal cord. Stratification of CSM severity has been useful to inform clinical practice and research analysis. In the UK the Myelopathy Disability Index (MDI) is a popular assessment tool and has been adopted by the British Spinal Registry. However, no categories of severity exist. Therefore, the aim of this study was to define categories of mild, moderate and severe. METHOD An anchor-based analysis was carried out on previously collected data from a prospective observational cohort (N = 404) of patients with CSM scheduled for surgery and assessed pre-operatively and at 3, 12, 24 and 60 months post-operatively. Outcomes collected included the SF-36 version-1 quality of life measure, visual analogue scales for neck/arm/hand pain, MDI and Neck Disability Index (NDI). A Receiver Operating Curve (ROC) analysis, using the NDI for an anchor-based approach, was performed to identify MDI thresholds. RESULTS Complete data was available for 404 patients (219 Men, 185 Women). The majority of patients underwent anterior surgery (284, 70.3%). ROC curves plotted to identify the thresholds from mild to moderate to severe disease, selected optimal thresholds of 4-5 (AUC 0.83) and 8-9 (AUC 0.87). These MDI categories were validated against domains of the SF36 and VAS scores with expected positive linear correlations. CONCLUSION Categories of mild, moderate and severe CSM according to the MDI of 4-5 and 8-9 were established based on the NDI.
Psychiatr Danub, Mar 24, 2020
Background: Although there have been studies investigating emotional eating, impulsivity and ange... more Background: Although there have been studies investigating emotional eating, impulsivity and anger, the relationship between differentiated eating attitudes, impulsivity and anger in atypical depression has not yet been studied. Therefore, the aim of this study was to evaluate eating attitudes, impulsivity and anger in participants with atypical and non-atypical depression and to compare their behaviours with those of the control group. Binge eating comorbidity was also investigated. The relationship between eating attitudes, impulsivity and anger was explored and the factors contributing to disordered eating attitudes were analysed. Subjects and methods: The participants were divided into three groups; 56 with atypical depression, 36 with non-atypical depression and 32 healthy controls for comparison. Clinical assessment was carried out using the Structured Clinical Interview for
Global Spine Journal, 2021
Study Design Survey. Introduction AO Spine Research Objectives and Common Data Elements for Degen... more Study Design Survey. Introduction AO Spine Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy (AO Spine RECODE-DCM) is an international initiative that aims to accelerate knowledge discovery and improve outcomes by developing a consensus framework for research. This includes defining the top research priorities, an index term and a minimum data set (core outcome set and core data elements set – core outcome set (COS)/core data elements (CDE)). Objective To describe how perspectives were gathered and report the detailed sampling characteristics. Methods A two-stage, electronic survey was used to gather and seek initial consensus. Perspectives were sought from spinal surgeons, other healthcare professionals and people with degenerative cervical myelopathy (DCM). Participants were allocated to one of two parallel streams: (1) priority setting or (2) minimum dataset. An email campaign was developed to advertise the survey to relevant global stakeholder ind...
Psychiatria Danubina, 2020
Neuropsychiatric disorders are closely associated with a persistent low-grade inflammatory state.... more Neuropsychiatric disorders are closely associated with a persistent low-grade inflammatory state. This suggests that the development of psychopathology is not only limited to the brain, but rather involves an additional systemic aspect, accounting for the large body of evidence demonstrating co-presentation of mental illness with chronic inflammatory conditions and metabolic syndromes. Studies have shown that inflammatory processes underlie the development of neuropsychiatric symptoms, with recent studies revealing not only correlative, but causative relationships between the immune system and psychopathology. Lifestyle factors such as diet and exercise may influence psychopathology, and this may occur via a bidirectional relationship. Mental illness may prevent health-seeking behaviours such as failing to maintain a balanced diet, whilst adopting a 'healthy' diet rich in fruits, vegetables and fish alongside nutritional supplementation correlates with a reduction in psychia...
Current Problems in Cancer, 2021
Epithelioid glioblastoma multiforme (eGBM) is a rare and aggressive variant of glioblastoma multi... more Epithelioid glioblastoma multiforme (eGBM) is a rare and aggressive variant of glioblastoma multiforme (GBM) that predominantly affects younger patients and can be difficult to distinguish from other gliomas. Data on how patients with eGBM might be best treated are limited, although genomic analyses have shown that almost half of tumours harbour activating BRAF gene mutations. Here we present the case of a young female with BRAF V600E-mutant eGBM who had a prolonged response to targeted therapy with the BRAF and MEK1/2 inhibitors dabrafenib and trametinib. We review current knowledge about eGBM, including the emerging role for BRAF- ± MEK1/2- targeted therapy.
Plastic & Reconstructive Surgery, 2020
I n 2017, members of the American Society of Plastic Surgeons performed over 106,000 breast recon... more I n 2017, members of the American Society of Plastic Surgeons performed over 106,000 breast reconstruction procedures. 1 Under the Women's Health and Cancer Rights Act of 1998, group insurance plans that cover mastectomies must also cover breast reconstruction and necessary symmetry procedures. 2 Between 1998 and 2008, on average, immediate breast reconstruction has been increasing by 5 percent per year in the United States, based on data from the Nationwide Inpatient Sample database. 3 In the current and future health care environment, health care redesign is widespread, as there is mounting pressure to improve value of health care with financially sustainable models while
Archives of Disease in Childhood, 2020
### Clinical bottom line A newborn baby was observed to have a unilateral port-wine stain (PWS) i... more ### Clinical bottom line A newborn baby was observed to have a unilateral port-wine stain (PWS) in the distribution of the maxillary branch of the trigeminal nerve on the right side of the face, including the right lower eyelid. Further examinations, including neurological and ophthalmological assessments, were unremarkable and the patient was not routinely followed up for ophthalmic assessment, in keeping with the hospital guidelines. Twelve years later, the patient presented to their optometrist complaining of worsening vision in their right eye, secondary to glaucoma. As early detection of glaucoma improves long-term visual outcomes, you wonder whether all children with a PWS on their face, not just those with a forehead mark, should be offered routine ophthalmic surveillance. In a neonate or child presenting with a facial port-wine stain (population), what is the chance of developing glaucoma (outcome) depending on facial distributions of the port-wine stain mark (risk factor)? Cochrane Library was searched in January 2020 using “port wine OR nevus flammeus OR naevus flammeus OR facial capillary …
Eye, 2021
Emerging infectious diseases (EIDs) are an increasing threat to public health on a global scale. ... more Emerging infectious diseases (EIDs) are an increasing threat to public health on a global scale. In recent times, the most prominent outbreaks have constituted RNA viruses, spreading via droplets (COVID-19 and Influenza A H1N1), directly between humans (Ebola and Marburg), via arthropod vectors (Dengue, Zika, West Nile, Chikungunya, Crimean Congo) and zoonotically (Lassa fever, Nipah, Rift Valley fever, Hantaviruses). However, specific approved antiviral therapies and vaccine availability are scarce, and public health measures remain critical. Patients can present with a spectrum of ocular manifestations. Emerging infectious diseases should therefore be considered in the differential diagnosis of ocular inflammatory conditions in patients inhabiting or returning from endemic territories, and more general vigilance is advisable in the context of a global pandemic. Eye specialists are in a position to facilitate swift diagnosis, improve clinical outcomes, and contribute to wider publi...
The Physician, 2020
Poster presented at BAPIO National Conference, London 2019 Peer reviewed by Subarna Chakravorty P... more Poster presented at BAPIO National Conference, London 2019 Peer reviewed by Subarna Chakravorty PhD & Sunil Daga PhD
Annals of Surgical Oncology, 2020
To the Editors: We read with great interest the editorial by Agafonoff et al. discussing opportun... more To the Editors: We read with great interest the editorial by Agafonoff et al. discussing opportunities for direct-to-implant (DTI) implant breast reconstruction (IBR) for patients undergoing post-mastectomy radiation therapy (PMRT). As the authors point out, appropriate reconstruction following mastectomy is dependent upon the optimization of both clinical and patient-reported outcomes (PROs), and the context of radiation therapy poses unique oncological and toxicity considerations for successful reconstruction to be achieved. We write to highlight the ongoing controversies surrounding immediate, one-stage IBR, and whether autologous breast reconstruction (ABR) may be chosen over IBR in the context of PMRT in the absence of any contraindications. At present, there is insufficient evidence to support immediate, one-stage IBR for PMRT patients. The Breast Reconstruction in One Stage (BRIOS) randomised controlled trial concluded that one-stage DTI breast reconstruction with an acellular dermal matrix showed no difference in terms of PROs yet carried significantly higher risk for adverse outcomes when compared with a two-stage approach. Moreover, our group’s recent meta-analysis found that ABR may be more cost-effective and yield both superior clinical outcomes and PROs relative to IBR. A consistent finding is also well established in the context of patients receiving PMRT, with prospective multicentre cohort studies providing evidence that ABR appears to yield superior PROs and a significantly lower risk of complications than implant-based approaches. However, we are mindful that ABR may not be appropriate or desirable for all patients, given important factors such as the time and magnitude of the operation and the duration of recovery, which influence clinical decision-making. Moreover, advancements in IBR have reduced complication rates, and studies have reported lower incidence and severity of capsular contractures in PMRT patients undergoing prepectoral IBR compared with subpectoral IBR. As such, the evidence base is currently divided. The first step towards resolving this clinical equipoise is to ensure that the quality of clinical outcome reporting is improved in future studies. As shown by our group’s metaanalysis, poor quality, heterogeneous reporting impedes meta-analysis and adequate outcome assessment. We recommend that all studies endeavor to grade clinical complications using accepted outcome tools, such as the Clavien-Dindo classification for surgical complications. Moreover, individual complications should be graded using classifications, for example, the Baker classification for capsular contracture severity. These graded clinical outcomes are important determinants for optimally informing management strategies, and failure to report them creates difficulty for practitioners and patients to interpret study findings in the clinical context and for future metaanalyses. Moreover, definitive recommendations for reconstruction in this clinical context will be borne out of higher quality, prospective level I/II evidence. It is paramount that Society of Surgical Oncology 2020
World Neurosurgery, 2020
We are looking to submit a 'Letter to the Editor' entitled "Why are aspiring neurosurgeons consid... more We are looking to submit a 'Letter to the Editor' entitled "Why are aspiring neurosurgeons considering leaving the NHS to pursue a career in North America?" for publication in your prestigious journal. We believe this would be of interest to your readership. The aim of this letter was to highlight the interest of medical students and junior doctors, who are prospective neurosurgeons, in leaving the NHS in the UK. We believe this article would fit in well with 'World Neurosurgery' as you publish a large amount surrounding the topic of 'international medical graduates' who want to pursue a career in neurosurgery. It would draw attention particularly from UK students and policy makers, interested in making changes to neurosurgical training (and overall, medical training). We also believe that the publication of this would be particularly interesting to readers, given the hard work of NHS staff throughout the COVID-19 pandemic. Yes, we have an amazing NHS... but why are so many doctors leaving/considering leaving? How can we address these problems and prevent jeopardising the future of our NHS? As you may already be aware, the NHS is under immense strain. Recent issues with the junior doctor contract and Brexit (in the UK) have meant that many doctors are considering leaving the NHS-this puts the NHS in an incredibly risky position. We put together this piece on behalf of The Neurology and Neurosurgery Interest Group (NANSIG), the official student wing of the Society of British Neurological Surgeons (SBNS). Given the most recent high-profile coverage of the struggles within the NHS (including doctor shortage, low pay etc) we hope you will consider this article for publication in your journal. It will also draw a worldwide readership for those interested in pursuing a career in the UK.
Archives of Disease in Childhood, 2020
A 9-year-old boy presents with a distal radial fracture following a fall from playground climbing... more A 9-year-old boy presents with a distal radial fracture following a fall from playground climbing equipment. Four years previously, subsequent to two episodes of generalised seizures, he was diagnosed with epilepsy and prescribed an ongoing long-term treatment of sodium valproate which has allowed effective seizure control. You have heard that antiepileptic medications have adverse effects on bone health, and wonder if he should have had bone mineral density (BMD) measurements to assess for that risk. This critically appraised topic therefore aims to assess whether the current evidence base is supportive of routine screening for low BMD after extended therapy and if so, after what duration. Should children on prolonged antiepileptic drug therapy (population) undergo dual-energy X-ray absorptiometry (DEXA) scanning (intervention) to assess BMD (outcome)? Pubmed and Embase were searched in January 2020 with (epilepsy OR epileptic OR convulsive OR convulsant) AND (monitor OR screen OR surveillance OR DEXA OR Dual energy x-ray absorptiometry OR densitometry) AND (osteoporosis OR osteopenia OR osteopaenia OR bone mineral density OR fracture), yielding 334 studies and 314 studies, respectively. Cochrane library was searched with the search terms (epilepsy OR epileptic OR convulsive OR convulsant) AND (osteoporosis OR osteopenia OR osteopaenia OR bone mineral density OR fracture), yielding 72 studies. Within this search, 30 relevant studies were identified, 6 of which are included in this review (table 1). View this table: Table 1 Bone mineral density in epileptic children on AEDs ### Commentary AED therapy has been correlated to reduced BMD within both adult1 and paediatric cohorts.2–8 …
Therapeutic Advances in Vaccines and Immunotherapy, 2020
Taken together, the development of a successful oral formulation may offer relative advantages co... more Taken together, the development of a successful oral formulation may offer relative advantages concerning safety, efficacy, compliance, ease of manufacturing and administration. These factors are essential to consider when developing globally scalable immunisation strategies against SARS-CoV-2.
Journal of Medical Virology, 2020
Plastic and Reconstructive Surgery - Global Open, 2020
British Journal of General Practice, 2020
Theranostics, 2020
Microglial activation participates in white matter injury after cerebral hypoperfusion. However, ... more Microglial activation participates in white matter injury after cerebral hypoperfusion. However, the underlying mechanism is unclear. Here, we explore whether activated microglia aggravate white matter injury via complement C3-C3aR pathway after chronic cerebral hypoperfusion. Methods: Adult male Sprague-Dawley rats (n = 80) underwent bilateral common carotid artery occlusion for 7, 14, and 28 days. Cerebral vessel density and blood flow were examined by synchrotron radiation angiography and three-dimensional arterial spin labeling. Neurobehavioral assessments, CLARITY imaging, and immunohistochemistry were performed to evaluate activation of microglia and C3-C3aR pathway. Furthermore, C3aR knockout mice were used to establish the causal relationship of C3-C3aR signaling on microglia activation and white matter injury after hypoperfusion. Results: Cerebral vessel density and blood flow were reduced after hypoperfusion (p<0.05). Spatial learning and memory deficits and white matter injury were shown (p<0.05). These impairments were correlated with aberrant microglia activation and an increase in the number of reactive microglia adhering to and phagocytosed myelin in the hypoperfusion group (p<0.05), which were accompanied by the up-regulation of complement C3 and its receptors C3aR (p<0.05). Genetic deletion of C3ar1 significantly inhibited aberrant microglial activation and reversed white matter injury after hypoperfusion (p<0.05). Furthermore, the C3aR antagonist SB290157 decreased the number of microglia adhering to myelin (p<0.05), attenuated white matter injury and cognitive deficits in chronic hypoperfusion rats (p<0.05). Conclusions: Our results demonstrated that aberrant activated microglia aggravate white matter injury via C3-C3aR pathway during chronic hypoperfusion. These findings indicate C3aR plays a critical role in mediating neuroinflammation and white matter injury through aberrant microglia activation, which provides a novel therapeutic target for the small vessel disease and vascular dementia.
British Journal of Neurosurgery
AIM Cervical Spondylotic Myelopathy (CSM) is a disabling condition arising from arthritic compres... more AIM Cervical Spondylotic Myelopathy (CSM) is a disabling condition arising from arthritic compression and consequent injury of the cervical spinal cord. Stratification of CSM severity has been useful to inform clinical practice and research analysis. In the UK the Myelopathy Disability Index (MDI) is a popular assessment tool and has been adopted by the British Spinal Registry. However, no categories of severity exist. Therefore, the aim of this study was to define categories of mild, moderate and severe. METHOD An anchor-based analysis was carried out on previously collected data from a prospective observational cohort (N = 404) of patients with CSM scheduled for surgery and assessed pre-operatively and at 3, 12, 24 and 60 months post-operatively. Outcomes collected included the SF-36 version-1 quality of life measure, visual analogue scales for neck/arm/hand pain, MDI and Neck Disability Index (NDI). A Receiver Operating Curve (ROC) analysis, using the NDI for an anchor-based approach, was performed to identify MDI thresholds. RESULTS Complete data was available for 404 patients (219 Men, 185 Women). The majority of patients underwent anterior surgery (284, 70.3%). ROC curves plotted to identify the thresholds from mild to moderate to severe disease, selected optimal thresholds of 4-5 (AUC 0.83) and 8-9 (AUC 0.87). These MDI categories were validated against domains of the SF36 and VAS scores with expected positive linear correlations. CONCLUSION Categories of mild, moderate and severe CSM according to the MDI of 4-5 and 8-9 were established based on the NDI.
Psychiatr Danub, Mar 24, 2020
Background: Although there have been studies investigating emotional eating, impulsivity and ange... more Background: Although there have been studies investigating emotional eating, impulsivity and anger, the relationship between differentiated eating attitudes, impulsivity and anger in atypical depression has not yet been studied. Therefore, the aim of this study was to evaluate eating attitudes, impulsivity and anger in participants with atypical and non-atypical depression and to compare their behaviours with those of the control group. Binge eating comorbidity was also investigated. The relationship between eating attitudes, impulsivity and anger was explored and the factors contributing to disordered eating attitudes were analysed. Subjects and methods: The participants were divided into three groups; 56 with atypical depression, 36 with non-atypical depression and 32 healthy controls for comparison. Clinical assessment was carried out using the Structured Clinical Interview for
Global Spine Journal, 2021
Study Design Survey. Introduction AO Spine Research Objectives and Common Data Elements for Degen... more Study Design Survey. Introduction AO Spine Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy (AO Spine RECODE-DCM) is an international initiative that aims to accelerate knowledge discovery and improve outcomes by developing a consensus framework for research. This includes defining the top research priorities, an index term and a minimum data set (core outcome set and core data elements set – core outcome set (COS)/core data elements (CDE)). Objective To describe how perspectives were gathered and report the detailed sampling characteristics. Methods A two-stage, electronic survey was used to gather and seek initial consensus. Perspectives were sought from spinal surgeons, other healthcare professionals and people with degenerative cervical myelopathy (DCM). Participants were allocated to one of two parallel streams: (1) priority setting or (2) minimum dataset. An email campaign was developed to advertise the survey to relevant global stakeholder ind...
Psychiatria Danubina, 2020
Neuropsychiatric disorders are closely associated with a persistent low-grade inflammatory state.... more Neuropsychiatric disorders are closely associated with a persistent low-grade inflammatory state. This suggests that the development of psychopathology is not only limited to the brain, but rather involves an additional systemic aspect, accounting for the large body of evidence demonstrating co-presentation of mental illness with chronic inflammatory conditions and metabolic syndromes. Studies have shown that inflammatory processes underlie the development of neuropsychiatric symptoms, with recent studies revealing not only correlative, but causative relationships between the immune system and psychopathology. Lifestyle factors such as diet and exercise may influence psychopathology, and this may occur via a bidirectional relationship. Mental illness may prevent health-seeking behaviours such as failing to maintain a balanced diet, whilst adopting a 'healthy' diet rich in fruits, vegetables and fish alongside nutritional supplementation correlates with a reduction in psychia...
Current Problems in Cancer, 2021
Epithelioid glioblastoma multiforme (eGBM) is a rare and aggressive variant of glioblastoma multi... more Epithelioid glioblastoma multiforme (eGBM) is a rare and aggressive variant of glioblastoma multiforme (GBM) that predominantly affects younger patients and can be difficult to distinguish from other gliomas. Data on how patients with eGBM might be best treated are limited, although genomic analyses have shown that almost half of tumours harbour activating BRAF gene mutations. Here we present the case of a young female with BRAF V600E-mutant eGBM who had a prolonged response to targeted therapy with the BRAF and MEK1/2 inhibitors dabrafenib and trametinib. We review current knowledge about eGBM, including the emerging role for BRAF- ± MEK1/2- targeted therapy.
Plastic & Reconstructive Surgery, 2020
I n 2017, members of the American Society of Plastic Surgeons performed over 106,000 breast recon... more I n 2017, members of the American Society of Plastic Surgeons performed over 106,000 breast reconstruction procedures. 1 Under the Women's Health and Cancer Rights Act of 1998, group insurance plans that cover mastectomies must also cover breast reconstruction and necessary symmetry procedures. 2 Between 1998 and 2008, on average, immediate breast reconstruction has been increasing by 5 percent per year in the United States, based on data from the Nationwide Inpatient Sample database. 3 In the current and future health care environment, health care redesign is widespread, as there is mounting pressure to improve value of health care with financially sustainable models while
Archives of Disease in Childhood, 2020
### Clinical bottom line A newborn baby was observed to have a unilateral port-wine stain (PWS) i... more ### Clinical bottom line A newborn baby was observed to have a unilateral port-wine stain (PWS) in the distribution of the maxillary branch of the trigeminal nerve on the right side of the face, including the right lower eyelid. Further examinations, including neurological and ophthalmological assessments, were unremarkable and the patient was not routinely followed up for ophthalmic assessment, in keeping with the hospital guidelines. Twelve years later, the patient presented to their optometrist complaining of worsening vision in their right eye, secondary to glaucoma. As early detection of glaucoma improves long-term visual outcomes, you wonder whether all children with a PWS on their face, not just those with a forehead mark, should be offered routine ophthalmic surveillance. In a neonate or child presenting with a facial port-wine stain (population), what is the chance of developing glaucoma (outcome) depending on facial distributions of the port-wine stain mark (risk factor)? Cochrane Library was searched in January 2020 using “port wine OR nevus flammeus OR naevus flammeus OR facial capillary …
Eye, 2021
Emerging infectious diseases (EIDs) are an increasing threat to public health on a global scale. ... more Emerging infectious diseases (EIDs) are an increasing threat to public health on a global scale. In recent times, the most prominent outbreaks have constituted RNA viruses, spreading via droplets (COVID-19 and Influenza A H1N1), directly between humans (Ebola and Marburg), via arthropod vectors (Dengue, Zika, West Nile, Chikungunya, Crimean Congo) and zoonotically (Lassa fever, Nipah, Rift Valley fever, Hantaviruses). However, specific approved antiviral therapies and vaccine availability are scarce, and public health measures remain critical. Patients can present with a spectrum of ocular manifestations. Emerging infectious diseases should therefore be considered in the differential diagnosis of ocular inflammatory conditions in patients inhabiting or returning from endemic territories, and more general vigilance is advisable in the context of a global pandemic. Eye specialists are in a position to facilitate swift diagnosis, improve clinical outcomes, and contribute to wider publi...
The Physician, 2020
Poster presented at BAPIO National Conference, London 2019 Peer reviewed by Subarna Chakravorty P... more Poster presented at BAPIO National Conference, London 2019 Peer reviewed by Subarna Chakravorty PhD & Sunil Daga PhD
Annals of Surgical Oncology, 2020
To the Editors: We read with great interest the editorial by Agafonoff et al. discussing opportun... more To the Editors: We read with great interest the editorial by Agafonoff et al. discussing opportunities for direct-to-implant (DTI) implant breast reconstruction (IBR) for patients undergoing post-mastectomy radiation therapy (PMRT). As the authors point out, appropriate reconstruction following mastectomy is dependent upon the optimization of both clinical and patient-reported outcomes (PROs), and the context of radiation therapy poses unique oncological and toxicity considerations for successful reconstruction to be achieved. We write to highlight the ongoing controversies surrounding immediate, one-stage IBR, and whether autologous breast reconstruction (ABR) may be chosen over IBR in the context of PMRT in the absence of any contraindications. At present, there is insufficient evidence to support immediate, one-stage IBR for PMRT patients. The Breast Reconstruction in One Stage (BRIOS) randomised controlled trial concluded that one-stage DTI breast reconstruction with an acellular dermal matrix showed no difference in terms of PROs yet carried significantly higher risk for adverse outcomes when compared with a two-stage approach. Moreover, our group’s recent meta-analysis found that ABR may be more cost-effective and yield both superior clinical outcomes and PROs relative to IBR. A consistent finding is also well established in the context of patients receiving PMRT, with prospective multicentre cohort studies providing evidence that ABR appears to yield superior PROs and a significantly lower risk of complications than implant-based approaches. However, we are mindful that ABR may not be appropriate or desirable for all patients, given important factors such as the time and magnitude of the operation and the duration of recovery, which influence clinical decision-making. Moreover, advancements in IBR have reduced complication rates, and studies have reported lower incidence and severity of capsular contractures in PMRT patients undergoing prepectoral IBR compared with subpectoral IBR. As such, the evidence base is currently divided. The first step towards resolving this clinical equipoise is to ensure that the quality of clinical outcome reporting is improved in future studies. As shown by our group’s metaanalysis, poor quality, heterogeneous reporting impedes meta-analysis and adequate outcome assessment. We recommend that all studies endeavor to grade clinical complications using accepted outcome tools, such as the Clavien-Dindo classification for surgical complications. Moreover, individual complications should be graded using classifications, for example, the Baker classification for capsular contracture severity. These graded clinical outcomes are important determinants for optimally informing management strategies, and failure to report them creates difficulty for practitioners and patients to interpret study findings in the clinical context and for future metaanalyses. Moreover, definitive recommendations for reconstruction in this clinical context will be borne out of higher quality, prospective level I/II evidence. It is paramount that Society of Surgical Oncology 2020
World Neurosurgery, 2020
We are looking to submit a 'Letter to the Editor' entitled "Why are aspiring neurosurgeons consid... more We are looking to submit a 'Letter to the Editor' entitled "Why are aspiring neurosurgeons considering leaving the NHS to pursue a career in North America?" for publication in your prestigious journal. We believe this would be of interest to your readership. The aim of this letter was to highlight the interest of medical students and junior doctors, who are prospective neurosurgeons, in leaving the NHS in the UK. We believe this article would fit in well with 'World Neurosurgery' as you publish a large amount surrounding the topic of 'international medical graduates' who want to pursue a career in neurosurgery. It would draw attention particularly from UK students and policy makers, interested in making changes to neurosurgical training (and overall, medical training). We also believe that the publication of this would be particularly interesting to readers, given the hard work of NHS staff throughout the COVID-19 pandemic. Yes, we have an amazing NHS... but why are so many doctors leaving/considering leaving? How can we address these problems and prevent jeopardising the future of our NHS? As you may already be aware, the NHS is under immense strain. Recent issues with the junior doctor contract and Brexit (in the UK) have meant that many doctors are considering leaving the NHS-this puts the NHS in an incredibly risky position. We put together this piece on behalf of The Neurology and Neurosurgery Interest Group (NANSIG), the official student wing of the Society of British Neurological Surgeons (SBNS). Given the most recent high-profile coverage of the struggles within the NHS (including doctor shortage, low pay etc) we hope you will consider this article for publication in your journal. It will also draw a worldwide readership for those interested in pursuing a career in the UK.
Archives of Disease in Childhood, 2020
A 9-year-old boy presents with a distal radial fracture following a fall from playground climbing... more A 9-year-old boy presents with a distal radial fracture following a fall from playground climbing equipment. Four years previously, subsequent to two episodes of generalised seizures, he was diagnosed with epilepsy and prescribed an ongoing long-term treatment of sodium valproate which has allowed effective seizure control. You have heard that antiepileptic medications have adverse effects on bone health, and wonder if he should have had bone mineral density (BMD) measurements to assess for that risk. This critically appraised topic therefore aims to assess whether the current evidence base is supportive of routine screening for low BMD after extended therapy and if so, after what duration. Should children on prolonged antiepileptic drug therapy (population) undergo dual-energy X-ray absorptiometry (DEXA) scanning (intervention) to assess BMD (outcome)? Pubmed and Embase were searched in January 2020 with (epilepsy OR epileptic OR convulsive OR convulsant) AND (monitor OR screen OR surveillance OR DEXA OR Dual energy x-ray absorptiometry OR densitometry) AND (osteoporosis OR osteopenia OR osteopaenia OR bone mineral density OR fracture), yielding 334 studies and 314 studies, respectively. Cochrane library was searched with the search terms (epilepsy OR epileptic OR convulsive OR convulsant) AND (osteoporosis OR osteopenia OR osteopaenia OR bone mineral density OR fracture), yielding 72 studies. Within this search, 30 relevant studies were identified, 6 of which are included in this review (table 1). View this table: Table 1 Bone mineral density in epileptic children on AEDs ### Commentary AED therapy has been correlated to reduced BMD within both adult1 and paediatric cohorts.2–8 …
Therapeutic Advances in Vaccines and Immunotherapy, 2020
Taken together, the development of a successful oral formulation may offer relative advantages co... more Taken together, the development of a successful oral formulation may offer relative advantages concerning safety, efficacy, compliance, ease of manufacturing and administration. These factors are essential to consider when developing globally scalable immunisation strategies against SARS-CoV-2.
Journal of Medical Virology, 2020
Plastic and Reconstructive Surgery - Global Open, 2020
British Journal of General Practice, 2020
Theranostics, 2020
Microglial activation participates in white matter injury after cerebral hypoperfusion. However, ... more Microglial activation participates in white matter injury after cerebral hypoperfusion. However, the underlying mechanism is unclear. Here, we explore whether activated microglia aggravate white matter injury via complement C3-C3aR pathway after chronic cerebral hypoperfusion. Methods: Adult male Sprague-Dawley rats (n = 80) underwent bilateral common carotid artery occlusion for 7, 14, and 28 days. Cerebral vessel density and blood flow were examined by synchrotron radiation angiography and three-dimensional arterial spin labeling. Neurobehavioral assessments, CLARITY imaging, and immunohistochemistry were performed to evaluate activation of microglia and C3-C3aR pathway. Furthermore, C3aR knockout mice were used to establish the causal relationship of C3-C3aR signaling on microglia activation and white matter injury after hypoperfusion. Results: Cerebral vessel density and blood flow were reduced after hypoperfusion (p<0.05). Spatial learning and memory deficits and white matter injury were shown (p<0.05). These impairments were correlated with aberrant microglia activation and an increase in the number of reactive microglia adhering to and phagocytosed myelin in the hypoperfusion group (p<0.05), which were accompanied by the up-regulation of complement C3 and its receptors C3aR (p<0.05). Genetic deletion of C3ar1 significantly inhibited aberrant microglial activation and reversed white matter injury after hypoperfusion (p<0.05). Furthermore, the C3aR antagonist SB290157 decreased the number of microglia adhering to myelin (p<0.05), attenuated white matter injury and cognitive deficits in chronic hypoperfusion rats (p<0.05). Conclusions: Our results demonstrated that aberrant activated microglia aggravate white matter injury via C3-C3aR pathway during chronic hypoperfusion. These findings indicate C3aR plays a critical role in mediating neuroinflammation and white matter injury through aberrant microglia activation, which provides a novel therapeutic target for the small vessel disease and vascular dementia.