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Article ; Online: Dynamic associations between glucose and ecological momentary cognition in Type 1 Diabetes.

Hawks, Z W / Beck, E D / Jung, L / Fonseca, L M / Sliwinski, M J / Weinstock, R S / Grinspoon, E / Xu, I / Strong, R W / Singh, S / Van Dongen, H P A / Frumkin, M R / Bulger, J / Cleveland, M J / Janess, K / Kudva, Y C / Pratley, R / Rickels, M R / Rizvi, S R /

Chaytor, N S / Germine, L T

NPJ digital medicine

2024 Volume 7, Issue 1, Page(s) 59

Abstract: Type 1 diabetes (T1D) is a chronic condition characterized by glucose fluctuations. Laboratory studies suggest that cognition is reduced when glucose is very low (hypoglycemia) and very high (hyperglycemia). Until recently, technological limitations ... ...

Abstract	Type 1 diabetes (T1D) is a chronic condition characterized by glucose fluctuations. Laboratory studies suggest that cognition is reduced when glucose is very low (hypoglycemia) and very high (hyperglycemia). Until recently, technological limitations prevented researchers from understanding how naturally-occurring glucose fluctuations impact cognitive fluctuations. This study leveraged advances in continuous glucose monitoring (CGM) and cognitive ecological momentary assessment (EMA) to characterize dynamic, within-person associations between glucose and cognition in naturalistic environments. Using CGM and EMA, we obtained intensive longitudinal measurements of glucose and cognition (processing speed, sustained attention) in 200 adults with T1D. First, we used hierarchical Bayesian modeling to estimate dynamic, within-person associations between glucose and cognition. Consistent with laboratory studies, we hypothesized that cognitive performance would be reduced at low and high glucose, reflecting cognitive vulnerability to glucose fluctuations. Second, we used data-driven lasso regression to identify clinical characteristics that predicted individual differences in cognitive vulnerability to glucose fluctuations. Large glucose fluctuations were associated with slower and less accurate processing speed, although slight glucose elevations (relative to person-level means) were associated with faster processing speed. Glucose fluctuations were not related to sustained attention. Seven clinical characteristics predicted individual differences in cognitive vulnerability to glucose fluctuations: age, time in hypoglycemia, lifetime severe hypoglycemic events, microvascular complications, glucose variability, fatigue, and neck circumference. Results establish the impact of glucose on processing speed in naturalistic environments, suggest that minimizing glucose fluctuations is important for optimizing processing speed, and identify several clinical characteristics that may exacerbate cognitive vulnerability to glucose fluctuations.
Language	English
Publishing date	2024-03-18
Publishing country	England
Document type	Journal Article
ISSN	2398-6352
ISSN (online)	2398-6352
DOI	10.1038/s41746-024-01036-5
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Article: Bile duct injury.

Strong, R W

The Medical journal of Malaysia

2005 Volume 60 Suppl B, Page(s) 141–143

MeSH term(s)	Bile Duct Diseases/etiology ; Bile Ducts/injuries ; Cholecystectomy, Laparoscopic/adverse effects ; Humans
Language	English
Publishing date	2005-07
Publishing country	Malaysia
Document type	Journal Article
ZDB-ID	604286-7
ISSN	0300-5283
ISSN	0300-5283
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Zs.A 1206: Show issues

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Article: J.H. Louw Memorial Lecture. Liver surgery: 'traveller, there is no path, a path is made by walking'.

Strong, R W

South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie

2001 Volume 39, Issue 3, Page(s) 74–78

Abstract: Liver resection today is a product of rapid development over the past two decades. The description of the functional anatomy of the liver was the foundation of modern liver surgery. However, it has been the technological advances in radiology that have ... ...

Abstract	Liver resection today is a product of rapid development over the past two decades. The description of the functional anatomy of the liver was the foundation of modern liver surgery. However, it has been the technological advances in radiology that have had the biggest impact in the management of hepatobiliary disease. Major hepatectomies dominated the earlier experience of modern liver surgery, but segment-orientated resections now play a more prominent role. Resections may be performed for both malignant and benign lesions or as an emergency procedure for trauma or other catastrophic event. At Princess Alexandra Hospital, Brisbane, 1,108 liver resections have been undertaken. Of the elective resections, 45% were for metastases, 29% for primary malignancy and 26% for benign disease. Two-thirds of the 102 emergency hepatectomies were for severe liver trauma. The 30-day mortality was 3.2% for the total series, 2.6% for the elective cases and 1.5% for the elective, non-jaundiced patients. Innovative graft reduction techniques have become a major component in liver transplantation. The successful transplantation of a reduced-size segmental graft from an adult donor liver to an infant paved the way for other procedures such as split-liver, auxiliary partial orthotopic and living-donor transplantation.
MeSH term(s)	Carcinoma, Hepatocellular/surgery ; Hepatectomy/methods ; Humans ; Liver Neoplasms/secondary ; Liver Neoplasms/surgery ; Liver Transplantation ; Living Donors
Language	English
Publishing date	2001-08
Publishing country	South Africa
Document type	Lectures
ZDB-ID	416504-4
ISSN	0038-2361
ISSN	0038-2361
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Zs.B 593: Show issues

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Article: Liver transplantation: current status and future prospects.

Strong, R W

Journal of the Royal College of Surgeons of Edinburgh

2001 Volume 46, Issue 1, Page(s) 1–8

Abstract: The enormous progress that has been made in liver transplantation over the past two decades has culminated in survival approaching 90% at 12 months. The success of the procedure combined with the widening spectrum of disease processes deemed amenable to ... ...

Abstract	The enormous progress that has been made in liver transplantation over the past two decades has culminated in survival approaching 90% at 12 months. The success of the procedure combined with the widening spectrum of disease processes deemed amenable to liver transplantation has meant that there are too few donors for those awaiting transplantation. This has extrapolated to many patients having such advanced disease by the time a suitable donor liver is available, that they are almost non-transplantable. The immediate options facing the transplant community are to decrease the number of patients listed or to increase the number of living donor transplants. Alternatives to liver transplantation such as hepatocyte transplantation, gene therapy, xenotransplantation and the bioartificial liver are being sought but, at best, are some way from clinical application. It is anticipated that a number of liver diseases that are indications for liver transplantation at this time will have progression arrested or will be cured by medical therapy in the future.
MeSH term(s)	Adult ; Child ; Hepatocytes/transplantation ; Humans ; Liver Diseases/therapy ; Liver Transplantation/methods ; Liver Transplantation/mortality ; Liver Transplantation/trends ; Patient Selection ; Survival Rate ; Tissue Donors
Language	English
Publishing date	2001-02
Publishing country	Scotland
Document type	Journal Article ; Review
ZDB-ID	390854-9
ISSN	0035-8835
ISSN	0035-8835
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Zs.A 305: Show issues

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Article: Transplantation for liver and biliary cancer.

Strong, R W

Seminars in surgical oncology

2000 Volume 19, Issue 2, Page(s) 189–199

Abstract: The early survival of patients transplanted for liver and biliary cancer is excellent, but the overall mid- to long-term survival is poor. In an era of severe donor organ shortage, it is not justified to allocate donor liver to patients with a suboptimal ...

Abstract	The early survival of patients transplanted for liver and biliary cancer is excellent, but the overall mid- to long-term survival is poor. In an era of severe donor organ shortage, it is not justified to allocate donor liver to patients with a suboptimal outcome. Patients with non-resectable hepatocellular carcinoma in a non-cirrhotic liver should not be assigned to liver transplantation. Although patients with the fibrolamellar variant have a somewhat better outlook, they are still likely to recur, and the young age of many of these patients is likely to overwhelm any rational approach. The results of transplantation for early-stage hepatocellular carcinoma in a cirrhotic liver are similar to those achieved with benign disease. The inclusion of such cases as a group is justified, but attempts should be made to resect tumors whenever possible and to not assign the entire group to transplantation as the first and only option. The value of pre- and postoperative adjuvant therapy for this group is still under debate, but the present waiting period is so long that some form of therapy to slow growth and prevent dissemination of tumor cells is probably required. The results following transplantation for cholangiocarcinoma can only be regarded as dismal, and the diagnosis of cholangiocarcinoma is a contraindication for the procedure. Liver transplantation has a definite place in the treatment of epithelioid hemangioendothelioma and unresectable chemo-responsive hepatoblastoma when confined to the liver, and in a limited number of metastatic neuroendocrine tumors.
MeSH term(s)	Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Bile Duct Neoplasms/pathology ; Bile Duct Neoplasms/therapy ; Carcinoma, Hepatocellular/pathology ; Carcinoma, Hepatocellular/therapy ; Chemotherapy, Adjuvant ; Cholangiocarcinoma/pathology ; Cholangiocarcinoma/therapy ; Hepatoblastoma/pathology ; Hepatoblastoma/therapy ; Humans ; Liver Cirrhosis/complications ; Liver Neoplasms/pathology ; Liver Neoplasms/therapy ; Liver Transplantation ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Palliative Care ; Patient Selection
Language	English
Publishing date	2000-07-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	632539-7
ISSN	1098-2388 ; 8756-0437
ISSN (online)	1098-2388
ISSN	8756-0437
DOI	10.1002/1098-2388(200009)19:2<189::aid-ssu10>3.0.co;2-u
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Zs.A 2059: Show issues

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Article: Does sphincteroplasty predispose to bile duct cancer?

Strong, R W

HPB surgery : a world journal of hepatic, pancreatic and biliary surgery

1999 Volume 11, Issue 3, Page(s) 204–206

MeSH term(s)	Bile Duct Neoplasms/etiology ; Biliary Tract Surgical Procedures/adverse effects ; Follow-Up Studies ; Humans ; Retrospective Studies ; Risk Factors ; Time Factors
Language	English
Publishing date	1999-04-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	1025964-8
ISSN	1607-8462 ; 0894-8569
ISSN (online)	1607-8462
ISSN	0894-8569
DOI	10.1155/1999/93568
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Zs.A 2850: Show issues

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Article: 1998 Distinguished Academician Lecture: hepatic resection--a Western perspective.

Strong, R W

Annals of the Academy of Medicine, Singapore

1999 Volume 28, Issue 3, Page(s) 330–335

Abstract: During the past two decades, resection of the liver has progressed from a rarely to a commonly performed operation with a low morbidity and mortality. The description of the functional anatomy of the liver was instrumental in the change from non-anatomic ...

Abstract	During the past two decades, resection of the liver has progressed from a rarely to a commonly performed operation with a low morbidity and mortality. The description of the functional anatomy of the liver was instrumental in the change from non-anatomic to anatomic resections. Major hepatectomies dominated the early experience but segment orientated resections now play a more prominent role. Resections may be performed for a variety of malignant or benign lesions or as an emergency for trauma or other catastrophic event. In the author's institution, 923 liver resections have been performed. The indications for the 825 elective resections were: metastases (46%), primary malignancy (30%) and non-malignant disease (24%). Two-thirds of the 98 emergency hepatectomies were for severe liver trauma. The 30-day mortality was 3.6% for the total series; 2.9% for elective resection, 1.6% for the non-jaundiced patients. In the last 300 elective resections, there has been one postoperative death and the median blood transfusion was zero. The development of innovative graft reduction techniques has made a major contribution to liver transplantation. The lack of suitable whole liver grafts for paediatric recipients was addressed by volume of reduction of adult donor livers so that the left lateral segment could be implanted safely in an infant's abdomen. This technique was the forerunner of split-liver transplantation, auxiliary partial orthotopic transplantation and living-related liver transplantation.
MeSH term(s)	Adult ; Child ; Elective Surgical Procedures ; Emergencies ; Hepatectomy/classification ; Hepatectomy/methods ; Humans ; Liver Transplantation
Language	English
Publishing date	1999-05
Publishing country	Singapore
Document type	Journal Article ; Lecture ; Review
ZDB-ID	604527-3
ISSN	0304-4602
ISSN	0304-4602
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Zs.B 2420: Show issues

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Article: Whither living donor liver transplantation?

Strong, R W

Liver transplantation and surgery : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society

1999 Volume 5, Issue 6, Page(s) 536–538

MeSH term(s)	Adult ; Child ; Humans ; Liver Transplantation/mortality ; Liver Transplantation/trends ; Living Donors ; Risk Assessment ; Survival Rate
Language	English
Publishing date	1999-11
Publishing country	United States
Document type	Editorial
ZDB-ID	1302933-2
ISSN	1074-3022
ISSN	1074-3022
DOI	10.1002/lt.500050613
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Zs.A 4702: Show issues

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Article: Late bile duct cancer complicating biliary-enteric anastomosis for benign disease.

Strong, R W

American journal of surgery

1999 Volume 177, Issue 6, Page(s) 472–474

Abstract: Background: Anastomosis between the biliary tree and the intestinal tract has been, and is, a relatively common procedure. Aside from cholangitis secondary to anastomotic stricture, it is generally regarded as innocuous.: Methods: The recent ... ...

Abstract	Background: Anastomosis between the biliary tree and the intestinal tract has been, and is, a relatively common procedure. Aside from cholangitis secondary to anastomotic stricture, it is generally regarded as innocuous. Methods: The recent experience with 3 patients who developed bile duct cancer many years after biliary-enteric anastomosis for benign disease prompted a review of whether the procedure was potentially carcinogenic. Results: There have been very few reports of late cholangiocarcinoma complicating this surgery for benign disease. However, there is some experimental evidence to support the hypothesis, and the time interval between surgery and the development of malignancy may be important. Conclusions: Reflux of duodenal or small intestinal contents into the biliary tree causes changes in the biliary epithelium that may be adaptive to the new environment but also have the potential to progress to malignant transformation.
MeSH term(s)	Aged ; Bile Duct Neoplasms/etiology ; Bile Ducts/injuries ; Biliary Tract Surgical Procedures ; Cholangiocarcinoma/etiology ; Duodenogastric Reflux/complications ; Female ; Hepatic Duct, Common ; Humans ; Iatrogenic Disease ; Middle Aged ; Postoperative Complications/etiology ; Time Factors
Language	English
Publishing date	1999-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/s0002-9610(99)00087-2
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Uk I Zs.42: Show issues

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Article: The management of blunt liver injuries.

Strong, R W

The Australian and New Zealand journal of surgery

1999 Volume 69, Issue 8, Page(s) 609–616

Abstract: Although the general surgeon who takes emergency call may be confronted with a patient who has sustained a blunt liver injury, the decrease in road trauma and work-place accidents has meant that this will be an infrequent occurrence. Minimal exposure ... ...

Abstract	Although the general surgeon who takes emergency call may be confronted with a patient who has sustained a blunt liver injury, the decrease in road trauma and work-place accidents has meant that this will be an infrequent occurrence. Minimal exposure will, of necessity, extrapolate to difficulty in coping with a catastrophic event which comes unheralded, at an inconvenient time and usually when there is less than ideal support. During the past 15 years, there has been an evolution in the treatment of liver injuries which is exemplified by a non-operative approach in selected patients and more conservative procedures in those who require operative intervention. At present, 'damage control' is in vogue; do the least possible to control life-threatening injuries and come back another day. This is a cogent and admirable philosophy, provided that the pendulum does not swing too far and that a planned course of action is in place. This paper reviews the present status of managing blunt liver injuries, with an emphasis on the general surgeon who has little cause to be involved with surgery of the liver.
MeSH term(s)	Humans ; Liver/injuries ; Wounds, Nonpenetrating/diagnosis ; Wounds, Nonpenetrating/surgery ; Wounds, Nonpenetrating/therapy
Language	English
Publishing date	1999-08
Publishing country	Australia
Document type	Journal Article ; Review
ZDB-ID	390816-1
ISSN	0004-8682 ; 1445-1433
ISSN	0004-8682 ; 1445-1433
DOI	10.1046/j.1440-1622.1999.01645.x
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