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- 저자 : Michael D. Ross (검색결과 4 건)
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Michael L. Alosco,Mary Beth Spitznagel,Gladys Strain,Michael Devlin,Ronald Cohen,Ross D. Crosby,James E. Mitchell,John Gunstad 대한신경과학회 2015 Journal of Clinical Neurology Vol.11 No.1
Background and Purpose Bariatric surgery is associated with improved cognitive function,but the mechanisms underlying these gains remain poorly understood. Disturbed leptin andghrelin systems are common in obese individuals and are associated with impaired cognitivefunction in other samples. Bariatric surgery has been shown to improve serum leptin and ghrelinlevels, and these changes may underlie postoperative cognitive improvements. Methods Eighty-four patients completed a computerized cognitive test battery prior to bariatric surgery and at 12 months postoperatively. Participants also submitted to an 8-hour fastingblood draw to quantify serum leptin and ghrelin concentrations at these same time points. Results Baseline cognitive impairments and disturbed leptin and ghrelin levels improved atthe 12-month follow-up compared to presurgery. Higher leptin levels were associated withworse attention/executive function at baseline; no such findings emerged for ghrelin. Regressionanalyses controlling for baseline factors and demographic characteristics showed that both decreased leptin and increased ghrelin following surgery was associated with better attention/executive function at the 12-month follow-up. These effects diminished after controlling for the postoperative change in body mass index (BMI); however, BMI change did not predict 12-month cognitive function. Conclusions Improvements in leptin and ghrelin levels following bariatric surgery appear to contribute to postoperative cognitive benefits. These gains may involve multiple mechanisms, such as reduced inflammation and improved glycemic control. Future studies that employ neuroimaging are needed to clarify the underlying mechanisms and determine whether the effects of bariatric surgery on leptin and ghrelin levels can attenuate adverse brain changes and/or risk of dementia in severely obese individuals.
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In vivo tumour imaging employing regional delivery of novel Gallium radiolabelled polymer composites
Ross W. Stephens,Gregory D. Tredwell,Jessica L. Bell,Karen J. Knox,Lee A. Philip,Tim J. Senden,Michael J. Tapner,Stephanie A. Bickley,Marcel R. Tanudji,Stephen K. Jones 한국생체재료학회 2021 생체재료학회지 Vol.25 No.2
Background: Understanding the regional vascular delivery of particles to tumour sites is a prerequisite for developing new diagnostic and therapeutic composites for treatment of oncology patients. We describe a novel imageable 67Ga-radiolabelled polymer composite that is biocompatible in an animal tumour model and can be used for preclinical imaging investigations of the transit of different sized particles through arterial networks of normal and tumour-bearing organs. Results: Radiolabelling of polymer microspheres with 67Ga was achieved using a simple mix and wash method, with tannic acid as an immobilising agent. Final in vitro binding yields after autoclaving averaged 94.7%. In vivo stability of the composite was demonstrated in New Zealand white rabbits by intravenous administration, and intrahepatic artery instillations were made in normal and VX2 tumour implanted rabbit livers. Stability of radiolabel was sufficient for rabbit lung and liver imaging over at least 3 hours and 1 hour respectively, with lung retention of radiolabel over 91%, and retention in both normal and VX2 implanted livers of over 95%. SPECT-CT imaging of anaesthetised animals and planar imaging of excised livers showed visible accumulation of radiolabel in tumours. Importantly, microsphere administration and complete liver dispersal was more easily achieved with 8 μm diameter MS than with 30 μm MS, and the smaller microspheres provided more distinct and localised tumour imaging. Conclusion: This method of producing 67Ga-radiolabelled polymer microspheres is suitable for SPECT-CT imaging of the regional vascular delivery of microspheres to tumour sites in animal models. Sharper distinction of model tumours from normal liver was obtained with smaller MS, and tumour resolution may be further improved by the use of 68Ga instead of 67Ga, to enable PET imaging.
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Surgical revascularization for Moyamoya disease in the United States: A cost-effectiveness analysis
Wali Arvin R.,Santiago-Dieppa David. R.,Srinivas Shanmukha,Brandel Michael G.,Steinberg Jeffrey A.,Rennert Robert C,Mandeville Ross,Murphy James D.,Olson Scott,Pannell J. Scott,Khalessi Alexander A. 대한뇌혈관외과학회 2021 Journal of Cerebrovascular and Endovascular Neuros Vol.23 No.1
Objective Moyamoya disease (MMD) is a vasculopathy of the internal carotid arteries with ischemic and hemorrhagic sequelae. Surgical revascularization confers upfront peri-procedural risk and costs in exchange for long-term protective benefit against hemorrhagic disease. The authors present a cost-effectiveness analysis (CEA) of surgical versus non-surgical management of MMD. Methods A Markov Model was used to simulate a 41-year-old suffering a transient ischemic attack (TIA) secondary to MMD and now faced with operative versus nonoperative treatment options. Health utilities, costs, and outcome probabilities were obtained from the CEA registry and the published literature. The primary outcome was incremental cost-effectiveness ratio which compared the quality adjusted life years (QALYs) and costs of surgical and nonsurgical treatments. Base-case, one-way sensitivity, two-way sensitivity, and probabilistic sensitivity analyses were performed with a willingness to pay threshold of $50,000. Results The base case model yielded 3.81 QALYs with a cost of $99,500 for surgery, and 3.76 QALYs with a cost of $106,500 for nonsurgical management. One-way sensitivity analysis demonstrated the greatest sensitivity in assumptions to cost of surgery and cost of admission for hemorrhagic stroke, and probabilities of stroke with no surgery, stroke after surgery, poor surgical outcome, and death after surgery. Probabilistic sensitivity analyses demonstrated that surgical revascularization was the cost-effective strategy in over 87.4% of simulations. Conclusions Considering both direct and indirect costs and the postoperative QALY, surgery is considerably more cost-effective than non-surgical management for adults with MMD.
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