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Edwards DM, Hopkins A, Scott A, Mannan R, Cao X, Zhang L, Andren A, Heth JA, Muraszko K, Sagher O, Orringer D, Hollon T, Hervey-Jumper S, Venneti S, Camelo-Piragua S, Al-Holou W, Chinnaiyan A, Lyssiotis CA, Wahl DR. Identification of Excellent Prognosis IDH Wildtype Glioblastomas Using Genomic and Metabolic Profiling. Int J Radiat Oncol Biol Phys 2023; 117:e101. [PMID: 37784627 DOI: 10.1016/j.ijrobp.2023.06.870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) High grade gliomas (HGGs) are aggressive brain tumors with altered cellular metabolism. HGGs can carry mutations in the tricarboxylic acid (TCA) cycle enzyme isocitrate dehydrogenase 1 (IDH1), conferring distinct biology and improved patient prognosis compared to IDH wildtype (wt) tumors. Using metabolomic analyses of tumor tissue, we previously showed that IDH wt and IDH mutant (IDH mut) tumors have unique metabolomic signatures that correlate with different survival outcomes. Among this cohort of 69 HGG samples, we identified two unique patient tumors that metabolically clustered with IDH mut tumors, but lacked both the IDH mutation and its product 2-hydroxyglutarate. We aimed to discover unique mutations in these two tumors that may impart an IDH mutant-like phenotype in the absence of an IDH1 or IDH2 mutation. MATERIALS/METHODS Whole exome sequencing (WES) was performed on frozen tumor samples from two patients diagnosed as glioblastoma (GBM), IDH wt via Agilent v5 + IncRNA platform. Alignment to the hg38 genome and variant calling were completed using an accelerated implementation of GATK's BWA and MuTect2 algorithms from Sentieon. Variants were filtered based on supporting reads and variant allele thresholds, with synonymous variants and common SNPs removed. High-confidence variants were further filtered by membership in the four KEGG pathways associated with IDH1 and IDH2. Identified variants were corroborated with metabolomics data from the two unique IDH wt tumors compared with classical GBM IDH wt, oligodendrogliomas IDH mut and astrocytomas IDH mut to identify putative drivers of an IDH mutant-like metabolomic phenotype in these unique IDH wt tumors. RESULTS Despite the lack of an IDH mutation, one patient survived 45.6 months and the other patient remains alive at last follow up 64 months post diagnosis, much longer than the 16-18-month median survival typical of patients with GBM IDH wt. WES of outlier IDH wt tumor samples revealed 65 unique mutations in the queried KEGG pathways, of which 34 had a variant allele frequency > = 0.15. These variants were processed in Gprofiler, confirming expected enrichment of the carboxylic acid metabolic biologic process, a functional gene set consisting of TCA genes, among these variants (p = 0.002, 3.6-fold enrichment). Accordingly, metabolite levels of intermediates of the TCA cycle, including malate and isocitrate were decreased in the outlier tumor samples compared to classic GBMs IDH wt (p<0.001). Presence of genetic alterations in key variants of the carboxylic acid metabolic biologic process (including ME1, GYP4F3, PTGIS, PFKL, PSPH, AKR1A1, HK2, NOS1) correlated with improved overall survival among GBM patients in the TCGA (p = 0.04). Laboratory validation of these findings in preclinical GBM models is ongoing. CONCLUSION Disruption of the TCA cycle independent of an IDH mutation is associated with favorable survival in GBM. Pharmacologic inhibition of these pathways may be a promising strategy to improve GBM outcomes.
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Affiliation(s)
- D M Edwards
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - A Hopkins
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI
| | - A Scott
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - R Mannan
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI
| | - X Cao
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI
| | - L Zhang
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI
| | - A Andren
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI
| | - J A Heth
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | - K Muraszko
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | - O Sagher
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | - D Orringer
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | - T Hollon
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | - S Hervey-Jumper
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | - S Venneti
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | | | - W Al-Holou
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | - A Chinnaiyan
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI
| | - C A Lyssiotis
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI
| | - D R Wahl
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
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Leung J, Pender P, French J, Leung D, Mussap C, Asrress K, Taylor D, Naguib Badie T, Kadappu K, Gibbs O, Kachwalla K, Nguyen P, Hopkins A, Lo S. Intravascular lithotripsy during percutaneous coronary intervention for calcified coronary lesions: analysis of patient and procedural characteristics and clinical outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction
Coronary artery calcification is frequently encountered during percutaneous coronary intervention (PCI). It can reduce PCI success and increase intra-procedural and post-procedural complications, including stent embolization, under-expansion and mal-apposition. Intravascular lithotripsy (IVL) is a new tool developed to treat calcified coronary lesions.
Purpose
Retrospective analysis of all cases of intravascular lithotripsy performed within our local health district to examine patient and procedural characteristics and clinical outcomes.
Methods
All patients undergoing PCI with intravascular lithotripsy between September 2019-August 2021 within our local health district were analysed. Patient and procedural characteristics and clinical outcomes were recorded.
Results
67 patients (50 men) were included with mean age 71.4 ± 8.7years. Risk factors prevalence included smoking (34%), hypertension (82%), dyslipidaemia (69%) and diabetes (46%). Trans-radial artery access was used in 38 patients (57%). IVL was performed most commonly in the left anterior descending artery (52%),[Figure 1]. IVL was utilised in 9 chronic total occlusions and 12 bifurcation lesions. Intracoronary (IC) imaging was performed in 59 patients (88%), intravascular ultrasound in 41(61%) and optical coherence tomography in 18 (27%). 41 (69%) patients had imaging performed pre and post IVL and post PCI. IC imaging identified 14 cases with 270º calcification arc and 45 cases with 360º arc. Nine cases (13.4%) required rotational atherectomy prior to IVL (most commonly 1.75mm burr). Mean reference vessel diameter was 3.2 ± 0.3mm. Mean lesion length was 36.3 ± 16.5mm. Mean pre-PCI stenosis was 85.5 ± 10.8%. Drug eluting stents were successfully deployed in 57 cases (85%), 10 had balloon angioplasty alone. Mean stent length was 39.2 ± 17.8mm. Mean post-PCI stenosis was 4.5 ± 13.3% (median 0%). Figure 2 shows a statistically significant increase in minimum lumen diameter and minimum lumen area post-IVL and minimal-stent-area (MSA) post-PCI. Mean stent expansion was 83%. Mean screening time 35.8 ± 17.8 minutes with mean contrast used 207.3 ± 78.7mL. No sustained arrhythmias or side-branch loss occurred. Vessel rupture was recorded in one patient necessitating urgent cardiac surgery (due to oversized balloon) and in 4 cases the IVL balloon could not cross the lesion.
Conclusion
Our experience shows that IVL is safe and effective and facilitates stent delivery and expansion. Intracoronary imaging is important to determine the need for calcium modification and evaluate its success prior to stent delivery and to confirm optimised stent expansion. Abstract Figure. Breakdown of PCI Artery Abstract Figure. IC Dimensions Pre/Post IVL/Post PCI
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Affiliation(s)
- J Leung
- Liverpool Hospital, Liverpool, Australia
| | - P Pender
- Liverpool Hospital, Liverpool, Australia
| | - J French
- Liverpool Hospital, Liverpool, Australia
| | - D Leung
- Liverpool Hospital, Liverpool, Australia
| | - C Mussap
- Liverpool Hospital, Liverpool, Australia
| | - K Asrress
- Liverpool Hospital, Liverpool, Australia
| | - D Taylor
- Liverpool Hospital, Liverpool, Australia
| | | | - K Kadappu
- Liverpool Hospital, Liverpool, Australia
| | - O Gibbs
- Liverpool Hospital, Liverpool, Australia
| | | | - P Nguyen
- Liverpool Hospital, Liverpool, Australia
| | - A Hopkins
- Liverpool Hospital, Liverpool, Australia
| | - S Lo
- Liverpool Hospital, Liverpool, Australia
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Kaul R, Khoo J, Pender P, Hopkins A, Lo S. P2Y12 pre-treatment for NSTE-ACS in a tertiary hospital centre: real world compliance experience with ESC 2020 guidelines. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The 2020 ESC guidelines for managing NSTE-ACS recommend against routine pre-treatment with a P2Y12 receptor inhibitor if coronary anatomy is not known and an early (<24h) invasive management is planned. With delayed (>24h) invasive management, pre-treatment may be considered in selected cases.
Purpose
Evaluate antiplatelet pre-treatment practices for NSTE-ACS in a tertiary cardiology centre in Australia.
Methods
Retrospective analysis of NSTE-ACS cases from January to August 2021 were obtained from the cardiac laboratory database. Patients on a P2Y12 inhibitor prior to presentation were excluded. Clinical, demographic, angiographic and medication data were obtained from the electronic database.
Results
85 cases were included. Mean age was 62 ± 11.5 and 81% were male. The prevalence of hypertension, hypercholesterolaemia, type 2 diabetes and active smoking was 54.8%, 51.2%, 38.1% and 34.5% respectively. Mean time to angiography was 1.7 ± 1.4 days and the median peak pre-procedural troponin T was 191.5 (80 to 852). Access was predominantly radial (84.5%) with the remainder femoral (15.5%).
Angiographic findings included, obstructive disease amenable to percutaneous coronary intervention (50.0%), obstructive disease for surgical revascularisation (22.6%), and non-obstructive disease (27.4%). The mean time from angiography to surgical revascularisation was 6.4 ± 4.4 days. Three patients (3.6%) had bleeding [managed conservatively], specifically upper limb haematoma, groin haematoma, and haemoptysis.
The majority of patients (79.8%) received P2Y12 inhibitors (40.5% clopidogrel and 39.3% ticagrelor) prior to angiography. Of these, 49.3% had percutaneous angioplasty, 17.9% had surgical revascularisation and 32.8% had non-obstructive disease (managed with single antithrombotic agent). Of those who did not receive P2Y12 inhibitors [n = 17, 20.2%]. Of these, 53% had percutaneous angioplasty, 40% had surgical revascularisation, and 5% had non-obstructive disease.
Conclusions
Overall, pre-treatment with a P2Y12 inhibitor was still very common, risking delays to bypass surgery and increasing bleeding. Practice did not generally align with contemporary ESC 2020 guidelines. Understanding the reasons for guideline non-compliance would be important for optimising treatments. Education for emergency and cardiology staff as well as creation of local practice policies may help increase compliance with evidence-based guidelines.
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Affiliation(s)
- R Kaul
- Liverpool Hospital, Liverpool, Australia
| | - J Khoo
- Liverpool Hospital, Liverpool, Australia
| | - P Pender
- Liverpool Hospital, Liverpool, Australia
| | - A Hopkins
- Liverpool Hospital, Liverpool, Australia
| | - S Lo
- Liverpool Hospital, Liverpool, Australia
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Leung J, Pender P, French J, Leung D, Mussap C, Asrress K, Taylor D, Naguib Badie T, Kaddapu K, Xu J, Kachwalla H, Hopkins A, Gibbs O, Lo S. Intravascular Lithotripsy versus Rotational Atherectomy Cutting Balloon on Stent Expansion for Heavily Calcified Coronary Lesions. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Hooper J, Assad J, Pender P, Hopkins A, Dimitri H. Temporary Pacing Wires in a Single Centre: Indications, Complications and Outcomes. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Dang V, Pender P, Hopkins A, Rajaratnam R, Leung D, Lo S. Percutaneous Coronary Intervention (PCI) for Spontaneous Coronary Artery Dissection (SCAD) Induced Acute Coronary Syndrome (ACS): 21 Year Experience in a Single Australian Centre. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hopkins A, Lerner K, Grinich E, Ahn J, Choi Y, Simpson E. 321 The frequency and utility of drug cessation trials in older adults with chronic eczematous dermatitis of unknown etiology. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cho K, Hopkins A, Shugman I, Akrawi D, Nguyen T, Nguyen P, Premawardhana U. Supraventricular and Atrial Tachycardia Radiofrequency Catheter Ablation Without On-Site Surgical Backup – Single Centre Experience. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Leung J, Pender P, French J, Leung D, Mussap C, Asrress K, Taylor D, Naguib BT, Kaddapu K, Gibbs O, Kachwalla H, Nguyen P, Hopkins A, Lo S. Initial Experience with Intravascular Lithotripsy with Shockwave Balloon for Calcified Coronary Lesions During Percutaneous Coronary Intervention (PCI). Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Femia G, Ramachandran J, Poon J, Hopkins A, Mussap C, Rajaratnam R, French J, Leung D, Lo S, Juergens C. The Impact of COVID-19 on ST Elevation Myocardial Infarction. Heart Lung Circ 2021. [PMCID: PMC8324111 DOI: 10.1016/j.hlc.2021.06.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cho K, Hopkins A, Akrawi D, Soosapilla K, Randall C, Kachwalla H, Kadappu K, Badie T, Gibbs O, O'Loughlin A, Femia G, Premawardhana U, Nguyen P. Coronary Angiography and Angioplasty Without On-Site Surgical Backup: A Single-Centre 5-Year Experience. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pender P, Leung J, Gibbs O, Hopkins A, Kadapu K, Asrress K, Juergens C, Lo S. Contemporary Management of Coronary Stent Embolisation: Southwestern Sydney Local Health District Experience. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Li Z, Satchithanandha A, Hopkins A, Otton J, Descallar J, Adams D, Tang S, Field M, Batumalai V, Holloway L, Delaney G, Koh E. PH-0595: Cardiovascular sequelae after adjuvant therapy in a 10-year cohort of breast cancer patients. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00617-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ertel M, Staley A, Johnson A, Nguyen T, Hopkins A, Desravines N, Recknagel J, Clark L. Contemporary incidence of medical inoperability in clinical stage I endometrial cancer. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Al-zuhairi K, Hyasat K, Femia G, Gibbs O, Faour A, Hopkins A, Sechi R, Kamand J, Ha A, Juergens C, Rajaratnam R, Liou K, Chiha J, Nguyen P, Lo S, Asrress K. 801 Changing Utility of Coronary Physiology to Guide Treatment Decisions in Patients With Coronary Artery Disease Over the Last Decade. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Al-zuhairi K, Hyasat K, Femia G, Gibbs O, Faour A, Hopkins A, Sechi R, Juergens C, Rajaratnam R, Liou K, Chiha J, Nguyen P, Lo S, Asrress K. 802 Changing Utility of Intra Coronary Imaging in South Western Sydney Over the Last Decade. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Xu J, Hopkins A, Leung D, Mussap C, French J, Juergens C, Lo S. Intravascular Ultrasound (IVUS) Analysis of Intensive Plaque Modification with Rotational Atherectomy with or without Adjunctive Cutting Balloon for Extremely Calcified Coronary Lesions. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pender P, Faour A, Gibbs O, Dang V, Hopkins A, Leung D, Mussap C, French J, Juergens C, Lo S. Use of Mechanical Cardiac Support (MCS) for ST-elevated Myocardial Infarction with Cardiogenic Shock(STEMI-CS) in a Non-transplant Centre. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nguyen NN, Faour A, Lo S, Hopkins A, Juergens C, French J, Hee L, Mussap C. Long Term Clinical Outcomes for All-comer Denovo Coronary Artery Lesions Treated with SeQuent Please Paclitaxel-Coated Balloons. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Femia G, Assas J, Sharma L, Idris H, Gibbs O, Hopkins A, Rajaratnam R, Juergens C, Mussap C, French J, Lo S. Prognostic Impact of Proximal versus Distal Dominant Right Coronary Artery (RCA) Myocardial Infarction. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pender P, Gibbs O, Faour A, Dang V, Hopkins A, Leung D, Mussap C, French J, Juergens C, Lo S. Mechanical Circulatory Support for Semi – elective PCI in High-risk Patients with Extracorporeal Membranous Oxygenation (ECMO) Compared to Impella Heart Pump Device. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Stump DC, Topol EJ, Chen AB, Hopkins A, Collen D. Monitoring of Hemostasis Parameters During Coronary Thrombolysis with Recombinant Tissue-Type Plasminogen Activator. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1642741] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
SummaryThe monitoring of changes in the blood coagulation and fibrinolytic systems during thrombolytic therapy with recombinant tissue-type plasminogen activator (rt-PA) may be complicated by artifacts due to in vitro activation after blood collection and to interference of other agents (e. g., heparin) in the assays. In 106 patients with early acute myocardial infarction, infused with 150 mg of rt-PA (G11044) intravenously over 5 to 8 hours, blood samples were collected into liquid citrate supplemented with the plasmin inhibitor aprotinin (200 KlU/ml plasma) or on a lyophilized mixture of acidified citrate and the synthetic t-PA inhibitor D-Phe-Pro-Arg-CH2Cl (PPACK). A good correlation between precipitable (sulphite) and functional (clotting rate) fibrinogen levels was observed in plasma collected on citrate before therapy (r = 0.76) and in samples collected after 3 hours on either aprotinin (r = 0.87) or PPACK (r = 0.82). Precipitable fibrinogen levels were approximately 10% higher than functional level, in baseline samples collected on citrate alone and approximately 20% higher in 3 hour samples collected on either PPACK or aprotinin. Fibrinogen levels measured with both assays correlated well, but were somewhat higher in samples collected on PPACK than on aprotinin. rt-PA antigen levels assayed in plasma collected in either inhibitor correlated well (r = 0.90) but were 10-20% higher in PPACK containing samples. Addition of heparin up to 9 units/ml to plasma had no effect on the functional fibrinogen assay.Even with these precautions for assay artifact, a very poor correlation (r =-0.15) was observed between the plasma rt-PA level and the residual functional fibrinogen level, both after 3 hours and towards the end of the rt-PA infusion. A decrease of the fibrinogen level at the end of the infusion to below 1 g/l was observed in 36% of the patients and to below 0.5 g/l in 11%. Optimal monitoring of hemostasis during rt-PA infusion is achieved by fibrinogen assays with a clotting rate method on samples collected on either PPACK or aprotinin. Heparin at therapeutic levels does not interfere with this assay.
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Affiliation(s)
- D C Stump
- The Departments of Medicine and Biochemistry, University of Vermont College of Medicine, Burlington, VT, the Department of Internal Medicine, University of Michigan, Ann Arbor, Ml, and Genentech, Inc., South San Francisco, CA, USA
| | - E J Topol
- The Departments of Medicine and Biochemistry, University of Vermont College of Medicine, Burlington, VT, the Department of Internal Medicine, University of Michigan, Ann Arbor, Ml, and Genentech, Inc., South San Francisco, CA, USA
| | - A B Chen
- The Departments of Medicine and Biochemistry, University of Vermont College of Medicine, Burlington, VT, the Department of Internal Medicine, University of Michigan, Ann Arbor, Ml, and Genentech, Inc., South San Francisco, CA, USA
| | - A Hopkins
- The Departments of Medicine and Biochemistry, University of Vermont College of Medicine, Burlington, VT, the Department of Internal Medicine, University of Michigan, Ann Arbor, Ml, and Genentech, Inc., South San Francisco, CA, USA
| | - D Collen
- The Departments of Medicine and Biochemistry, University of Vermont College of Medicine, Burlington, VT, the Department of Internal Medicine, University of Michigan, Ann Arbor, Ml, and Genentech, Inc., South San Francisco, CA, USA
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Satchithanandha A, Hopkins A, Otton J, Kiely B, Tang S, Field M, Batumalai V, Holloway L, Delaney G, Koh E. EP-1306: Cardiovascular sequelae in breast cancer patients receiving adjuvant therapy. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31616-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
The nature of the work undertaken by different health professionals and inter-professional boundaries are constantly shifting. The greater knowledge of users of health care, and the increasing technical and organizational complexity of modern medicine, have partly eroded the control of health professionals over the substance of their work. The definition of a field of work as lying within the province of any one profession is culturally rather than scientifically determined. It is evident that care of good quality should be delivered at the lowest possible cost. This might include delivery of care by a less trained person than heretofore, or by someone with limited but focused training. Sharing of skills is a more sensible subject for discussion than transfer of tasks. We review a number of studies which show the effectiveness of inter-professional substitution in various care settings, and also the effectiveness of substitution by those other than health professionals. The views of users of health services on inter-professional substitution need to be considered. Health professionals and others need to work together to devise innovative ways of delivering effective health care. The legal issues need clarification.
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Affiliation(s)
- A Hopkins
- Research Unit, Royal College of Physicians of London, England
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Gibbs O, Assad J, Faour A, Ang T, Xu J, Rajaratnam R, Leung D, Mussap C, French J, Hopkins A, Juergens C, Lo S. Clinical Outcomes of Cre8 Coronary Stent in Complex Percutaneous Coronary Intervention. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Femia G, Gibbs O, Assad J, Sharma L, Hopkins A, Rajaratnam R, Juergens C, Mussap C, Lo S. Prognostic Impact of Proximal Versus Distal Dominant Right Coronary Artery Myocardial Infarction. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Femia G, Hopkins A, Rajaratnam R, Juergens C, Lo S. Subclavian Vein Balloon Angioplasty Treatment of Stenosis-Assisted Replacement of Fractured Defibrillator Lead. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Pender P, Xu J, Hopkins A, Leung D, Mussap C, Rajaratnam R, French J, Juergens C, Lo S. Mechanical Circulatory Support for Semi-Elective Percutaneous Coronary Intervention in High-Risk Patients with Intra-Aortic Balloon Pump Counter Pulsation and Extracorporeal Membranous Oxygenation. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rateesh S, Hopkins A, Richards D, Dimitri H. Use of a Hybrid Cardiac Resynchronisation-P/Subcutaneous Implantable Cardioverter Defibrillator System to Avoid High-Risk Defibrillator Lead Extraction. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Pender P, Xu J, Hopkins A, Leung D, Mussap C, Rajaratnam R, French J, Juergens C, Lo S. Current Indications and Outcomes of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) in a Non–Transplant Centre. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Assad J, Pender P, Faour A, Gibbs O, Hopkins A, Leung D, Rajaratnam R, Mussap C, French J, Juergens C, Lo S. Left Main Coronary Artery Disease in ST-Elevation Myocardial Infarction With Cardiogenic Shock. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kahn MB, Unsworth A, Evenson N, Dawson N, Hopkins A, Campbell NG. P1447Incorrect coding of atrial fibrillation leads to under-treatment with anticoagulation in pacing clinics. Europace 2017. [DOI: 10.1093/ehjci/eux158.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Affiliation(s)
| | | | - B Moulton
- Informed Medical Decisions Foundation, Boston, MA, US
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Moss S, Nagaraja V, Hopkins A. An Uncommon Presentation in a Patient with Type 2 Brugada Pattern. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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35
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Tanaka H, Walker RT, Hopkins AL, Ren J, Jones EY, Fujimoto K, Hayashi M, Miyasaka T, Baba M, Stammers DK, Stuart DI. Allosteric Inhibitors against HIV-1 Reverse Transcriptase: Design and Synthesis of MKC-442 Analogues Having an Ω-Functionalized Acyclic Structure. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/095632029800900404] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Based on X-ray crystallographic analysis of MKC-442/human immunodeficiency virus type 1 reverse transcriptase (HIV-1 RT) complex, analogues in which the N1-substituent is replaced with ω-functionalized alkyl groups were designed to improve the affinity for the enzyme. Synthesis of these compounds was carried out starting from MKC-442 by a sequence of reactions (N3-protection, removal of N1-ethoxymethyl group, alkylation, and N3-deprotection). The compounds were evaluated for anti-HIV activity. Structure–activity relationships are discussed in terms of the possible interaction with the enzyme.
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Affiliation(s)
- H Tanaka
- School of Pharmaceutical Sciences, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142, Japan
| | - RT Walker
- School of Chemistry, The University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - AL Hopkins
- The Laboratory of Molecular Biophysics, Rex Richards Building, South Parks Road, Oxford OX1 3QU, UK
| | - J Ren
- The Laboratory of Molecular Biophysics, Rex Richards Building, South Parks Road, Oxford OX1 3QU, UK
| | - EY Jones
- The Laboratory of Molecular Biophysics, Rex Richards Building, South Parks Road, Oxford OX1 3QU, UK
- The Oxford Centre for Molecular Sciences, New Chemistry Building, South Parks Road, Oxford OX1 3QT, UK
| | - K Fujimoto
- School of Pharmaceutical Sciences, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142, Japan
| | - M Hayashi
- School of Pharmaceutical Sciences, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142, Japan
| | - T Miyasaka
- School of Pharmaceutical Sciences, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142, Japan
| | - M Baba
- Division of Human Retroviruses, Center for Chronic Viral Diseases, Faculty of Medicine, Kagoshima University, Kagoshima 890, Japan
| | - DK Stammers
- The Laboratory of Molecular Biophysics, Rex Richards Building, South Parks Road, Oxford OX1 3QU, UK
| | - DI Stuart
- The Laboratory of Molecular Biophysics, Rex Richards Building, South Parks Road, Oxford OX1 3QU, UK
- The Oxford Centre for Molecular Sciences, New Chemistry Building, South Parks Road, Oxford OX1 3QT, UK
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Gibbs O, Hee L, Hopkins A, Lo S, Juergens C, French J, Mussap C. Predictive Accuracy of GRACE and TIMI Risk Scores: A Single-Centre Observational Study of In-Hospital Mortality in PCI Treated STEMI Patients. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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37
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Zhou E, Hopkins A, Lo S, Juergens C. An article on intravascular ultrasound-guided treatment for angiographically equivocal unprotected left main coronary artery disease: an Australian experience. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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38
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Hee L, Terluk A, Thomas L, Hopkins A, Juergens C, French J, Mussap C. Outcomes of drug eluting balloons in coronary revascularisation. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chu JSM, McSherry E, Brennan K, Hopkins A. Assessing the effect of mutant JAM-A overexpression on downstream signalling in breast cancer cells. BMC Proc 2015. [PMCID: PMC4306061 DOI: 10.1186/1753-6561-9-s1-a47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Xu J, Leung D, Mussap C, Rajaratnam R, Naguib Badie T, Hopkins A, French J, Juergens C, Lo S. Current indications and outcomes of intra-aortic balloon counterpulsation: The Liverpool Hospital experience. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Makenga Bof JC, Maketa V, Bakajika DK, Ntumba F, Mpunga D, Murdoch ME, Hopkins A, Noma MM, Zouré H, Tekle AH, Katabarwa MN, Lutumba P. Onchocerciasis control in the Democratic Republic of Congo (DRC): challenges in a post-war environment. Trop Med Int Health 2014; 20:48-62. [PMID: 25302560 DOI: 10.1111/tmi.12397] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate onchocerciasis control activities in the Democratic Republic of Congo (DRC) in the first 12 years of community-directed treatment with ivermectin (CDTI). METHODS Data from the National Programme for Onchocerciasis (NPO) provided by the National Onchocerciasis Task Force (NOTF) through the annual reports of the 21 CDTI projects for the years 2001-2012 were reviewed retrospectively. A hypothetical-inputs-process-outputs-outcomes table was constructed. RESULTS Community-directed treatment with ivermectin expanded from 1968 communities in 2001 to 39 100 communities by 2012 while the number of community-directed distributors (CDD) and health workers (HW) multiplied. By 2012, there were ratios of 1 CDD per 262 persons and 1 HW per 2318 persons at risk. More than 80% of the funding came from the fiduciary funds of the African Programme for Onchocerciasis Control. The cost of treatment per person treated fell from US$ 1.1 in 2001 to US$ 0.1 in 2012. The therapeutic coverage increased from 2.7% (2001) to 74.2% (2012); the geographical coverage, from 4.7% (2001) to 93.9% (2012). Geographical coverage fell in 2005 due to deaths in loiasis co-endemic areas, and the therapeutic coverage fell in 2008 due to insecurity. CONCLUSIONS Challenges to CDTI in DRC have been serious adverse reactions to ivermectin in loiasis co-endemic areas and political conflict. Targets for personnel or therapeutic and geographical coverages were not met. Longer term funding and renewed efforts are required to achieve control and elimination of onchocerciasis in DRC.
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Affiliation(s)
- J-C Makenga Bof
- Faculty of Public Health, Université Catholique de Louvain, Brussels, Belgium
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Mariani CL, Schubert TA, House RA, Wong MA, Hopkins AL, Barnes Heller HL, Milner RJ, Lester NV, Lurie DM, Rajon DA, Friedman WA, Bova FJ. Frameless stereotactic radiosurgery for the treatment of primary intracranial tumours in dogs. Vet Comp Oncol 2013; 13:409-23. [PMID: 24007303 DOI: 10.1111/vco.12056] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 06/01/2013] [Accepted: 06/24/2013] [Indexed: 11/29/2022]
Abstract
Stereotactic radiosurgery (SRS) is a procedure that delivers a single large radiation dose to a well-defined target. Here, we describe a frameless SRS technique suitable for intracranial targets in canines. Medical records of dogs diagnosed with a primary intracranial tumour by imaging or histopathology that underwent SRS were retrospectively reviewed. Frameless SRS was used successfully to treat tumours in 51 dogs with a variety of head sizes and shapes. Tumours diagnosed included 38 meningiomas, 4 pituitary tumours, 4 trigeminal nerve tumours, 3 gliomas, 1 histiocytic sarcoma and 1 choroid plexus tumour. Median survival time was 399 days for all tumours and for dogs with meningiomas; cause-specific survival was 493 days for both cohorts. Acute grade III central nervous system toxicity (altered mentation) occurred in two dogs. Frameless SRS resulted in survival times comparable to conventional radiation therapy, but with fewer acute adverse effects and only a single anaesthetic episode required for therapy.
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Affiliation(s)
- C L Mariani
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - T A Schubert
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - R A House
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - M A Wong
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - A L Hopkins
- North Florida Neurology, Orange Park, FL, USA
| | - H L Barnes Heller
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - R J Milner
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - N V Lester
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - D M Lurie
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - D A Rajon
- Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - W A Friedman
- Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - F J Bova
- Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA
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Idris H, Shugman I, Saad Y, Lo S, Hopkins A, Hee L, Thomas L, Mussap C, Juergens C, French JK. Has the frequency of peri-procedural myocardial infarction reduced using third universal definition? Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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44
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Pala O, Messing S, Hopkins A, Reed G, Perez-Rivera M, Acosta M, Kremer J, Lozada C, Pappas D. FRI0170 Effect of alcohol on response to therapy with TNF-a inhibitors for rheumatoid arthritis: Results from corrona registry. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pala O, Messing S, Hopkins A, Reed G, Perez-Rivera M, Acosta M, Kremer J, Lozada C, Pappas D. SAT0147 Effect of smoking on response to therapy with TNF-A inhibitors for rheumatoid arthritis: Results from the corrona registry. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.3094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hee L, Kumar M, Thomas L, Juergens C, Lo S, Hopkins A, French J, Mussap C. ‘Target-lesion’ SYNTAX Score (tSS) Correlates with Radiation Dose During Percutaneous Coronary Intervention. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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47
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Idris H, Shugman I, Thomas L, Hee L, Mussap C, Lo S, Leung D, Hopkins A, Juergens C, French J. Clinical Outcomes for Percutaneous Coronary Intervention Following Acute Coronary Syndromes Using Selective use of 1st and 2nd Generation Drug-Eluting Stent in Patients at High Risk of Restenosis. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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48
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Idris H, Shugman I, Lo S, Hopkins A, Hee L, Mussap C, Leung D, Juergens C, French J, Thomas L. Influence of Age and Gender on Clinical Outcomes Following Percutaneous Coronary Intervention for Acute Coronary Syndromes. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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49
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Saad Y, Kumar M, Shugman I, Pauk I, Leung D, Mussap C, Hopkins A, Rajaratnam R, Lo S, Juergens C, French J. Safety and Efficacy of Same-Day Discharge Following Elective Percutaneous Coronary Intervention. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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50
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Luu J, Hopkins A, Lo S, Mussap C, Shugman I, Thomas L, French J, Juergens C. Transradial Access in Coronary Catheterisation to Reduce Bleeding Complications. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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