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Huang J, Huang A, Xu R, Wu M, Wang P, Wang Q. Automatic Segmentation and Assessment of Valvular Regurgitations with Color Doppler Echocardiography Images: A VABC-UNet-Based Framework. Bioengineering (Basel) 2023; 10:1319. [PMID: 38002443 PMCID: PMC10669048 DOI: 10.3390/bioengineering10111319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/23/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
This study investigated the automatic segmentation and classification of mitral regurgitation (MR) and tricuspid regurgitation (TR) using a deep learning-based method, aiming to improve the efficiency and accuracy of diagnosis of valvular regurgitations. A VABC-UNet model was proposed consisting of VGG16 encoder, U-Net decoder, batch normalization, attention block and deepened convolution layer based on the U-Net backbone. Then, a VABC-UNet-based assessment framework was established for automatic segmentation, classification, and evaluation of valvular regurgitations. A total of 315 color Doppler echocardiography images of MR and/or TR in an apical four-chamber view were collected, including 35 images in the test dataset and 280 images in the training dataset. In comparison with the classic U-Net and VGG16-UNet models, the segmentation performance of the VABC-UNet model was evaluated via four metrics: Dice, Jaccard, Precision, and Recall. According to the features of regurgitation jet and atrium, the regurgitation could automatically be classified into MR or TR, and evaluated to mild, moderate, moderate-severe, or severe grade by the framework. The results show that the VABC-UNet model has a superior performance in the segmentation of valvular regurgitation jets and atria to the other two models and consequently a higher accuracy of classification and evaluation. There were fewer pseudo- and over-segmentations by the VABC-UNet model and the values of the metrics significantly improved (p < 0.05). The proposed VABC-UNet-based framework achieves automatic segmentation, classification, and evaluation of MR and TR, having potential to assist radiologists in clinical decision making of the regurgitations in valvular heart diseases.
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Affiliation(s)
- Jun Huang
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China; (J.H.); (A.H.); (M.W.); (P.W.)
| | - Aiyue Huang
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China; (J.H.); (A.H.); (M.W.); (P.W.)
| | - Ruqin Xu
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China;
| | - Musheng Wu
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China; (J.H.); (A.H.); (M.W.); (P.W.)
| | - Peng Wang
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China; (J.H.); (A.H.); (M.W.); (P.W.)
| | - Qing Wang
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China; (J.H.); (A.H.); (M.W.); (P.W.)
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou 510515, China
- Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou 510515, China
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Schumacher K, Aridgides PD, Gossett J, Kang G, Huang A, Merchant TE, Mazewski C. Outcomes Following Radiation Therapy (RT) for Very Young Age CNS Embryonal Tumors on COG ACNS0334 According to Molecular-Confirmed Diagnosis. Int J Radiat Oncol Biol Phys 2023; 117:S76. [PMID: 37784570 DOI: 10.1016/j.ijrobp.2023.06.390] [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) The outcomes of upfront or relapse radiation therapy (RT) for the Children's Oncology Group ACNS0334 protocol based on molecular diagnosis were assessed. Therapy included maximal safe surgery, high-dose chemotherapy with stem cell rescue, randomization for inclusion of high dose methotrexate (MTX) and optional RT. MATERIALS/METHODS There were 24 patients that received RT on COG ACNS0334 of 77 evaluable patients with a diagnosis of either high-risk medulloblastoma (MB) or supratentorial primitive neuroectodermal tumor (SPNET). RT was a recommendation (M0: Focal, M+: CSI 18 Gy) given young patient age <36 months at enrollment. Seven RT patients were excluded for ineligible pathology (1 ATRT, 1 HGG) or insufficient tissue. The aim of this report is to review outcomes of 17 patients on ACNS0334 receiving RT (8 Upfront, 9 at relapse) with a molecular diagnosis that included MB, Pineoblastoma (PB), or Embryonal tumor with multilayered rosettes (ETMR). RESULTS In the MB group, there were 9 patients irradiated with MB (Group 3 = 8, SHH = 1). 5-year OS for MB Group 3 receiving RT (median primary dose 54 Gy) was 62.5% with no difference observed comparing 6 patients treated with upfront RT versus 2 treated at relapse (p = 0.27). All upfront RT for MB Group 3 had initial partial response (PR) to 0334 chemotherapy. RT delivery for upfront RT MB Group 3 included craniospinal radiation (CSI) in 5 patients and 1 patient who received focal RT to the primary (50 Gy) and metastatic site (44 Gy). Eighty percent of CSI for upfront RT in Group 3 was 18 Gy or 23.4 Gy. Relapse RT for MB Group 3 (2 patients) utilized full dose CSI (36 Gy, 39.6 Gy) and both patients are survivors with 5+ years follow-up. CSI dose for Group 3 MB was higher for relapse RT (mean 37.8 Gy) as compared to upfront RT (mean 19.8 Gy, p = 0.013). Use of MTX was 50% in both upfront RT and relapse RT Group 3 MB cohorts. One patient with MB SHH (classic histology) underwent upfront focal RT (54 Gy) after initial PR to systemic therapy (without MTX) and is surviving 5+ years. PB: Of 4 PB patients (median primary dose 48.8 Gy) 1 had RT upfront (CSI 18 Gy) and 3 had RT at relapse (1 patient received CSI, 21 Gy). All patients with PB expired within 2 years. MTX was given in 75% (including 1 upfront RT PB). Two of 3 patients treated at relapse had prior complete response (CR). ETMR: All 4 patients (median primary dose 54 Gy) with ETMR were treated at relapse, with CSI given in 1 patient (23.4 Gy). All patients with ETMR expired within 2 years, and 2 (50%) had received MTX. Two patients (50%) had initial CR. CONCLUSION The RT cohort for Group 3 MB on ACNS0334 exhibited long-term survival both for both upfront and relapse RT, however relapsed Group 3 MB received higher dose CSI. RT upfront for MB, including one surviving MB SHH patient receiving focal RT, was solely given for incomplete initial chemotherapy response. There were no survivors for either PB or ETMR when the majority (88%) were treated at relapse.
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Affiliation(s)
| | | | - J Gossett
- St Jude Childrens Research Hospital, Memphis, TN
| | - G Kang
- St. Jude Children's Research Hospital, Memphis, TN
| | - A Huang
- Division of Haematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - T E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - C Mazewski
- Emory University School of Medicine, Atlanta, GA
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Shum S, Huang A, Slinger P. Hypoxaemia during one lung ventilation. BJA Educ 2023; 23:328-336. [PMID: 37600211 PMCID: PMC10435364 DOI: 10.1016/j.bjae.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 08/22/2023] Open
Affiliation(s)
- S. Shum
- Toronto General Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - A. Huang
- Toronto General Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - P. Slinger
- Toronto General Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
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Taheri N, Huang A. Gender and menopausal status correlate with success of maxillomandibular advancement surgery for sleep apnea. Int J Oral Maxillofac Surg 2023. [DOI: 10.1016/j.ijom.2022.09.025] [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: 01/31/2023]
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Abdelwahab M, Hong Y, Taheri N, Huang A, Fleury T, Marques S, Liu S, Capasso R. Value of Surgical and Non-surgical Treatment for Sleep Apnea: A Closer Look At Healthcare Utilization. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.778] [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: 11/30/2022]
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Fleury Curado T, Pham L, Freire C, Amorim M, Abdelwahab M, Huang A, Taheri N, Hong Y, Dedhia R, Liu S, Capasso R, Polotsky V, Eisele D, Schwartz A. Changes in Tongue Morphology Predict Responses in Pharyngeal Patency to Selective Hypoglossal Nerve Stimulation. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.647] [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: 11/26/2022]
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Huang A, Hong Y, Abdelwahab M, Taheri N, Liu S, Lee K, Fleury T. Skeletal Surgery in Treating Obstructive Sleep Apnea: Gender Specific Outcomes. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.739] [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: 11/26/2022]
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Abdelwahab M, Chang C, Huang A, Liu S. Outcome of OSA Subjects Undergoing Both Maxillomandibular Advancement and Hypoglossal Nerve Stimulation. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.708] [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: 10/17/2022]
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Abdelwahab M, Ibrahim B, Huang A, Yoon A, Chou C, Liu S. Precision in Performing Distraction Osteogenesis Maxillary Expansion For OSA. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.723] [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: 10/17/2022]
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Huang A, Abdelwahab M, Capasso R, Liu S, Oliveira F. Improving CPAP Compliance: Transcutaneous Nasal Valve Stabilization. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.683] [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: 10/17/2022]
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Abdelwahab M, Chou C, Huang A, Liu S. Perception of Nasal Function and Cosmesis after Maxillomandibular advancement for obstructive sleep apnea. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.712] [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: 10/17/2022]
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Taheri N, Hong Y, Abdelwahab M, Huang A, Fleury T, Lee K, Liu S. Gender and Menopausal Status Correlate with Sleep Surgery Outcome. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.676] [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: 11/28/2022]
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Taheri N, Hong Y, Abdelwahab M, Huang A, Fleury T, Liu S, Cheng A. Achieving Reduced Treatment Time for Obstructive Sleep Apnea Utilizing Surgery First Approach: A Comparison of Traditional versus Novel Techniques. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.627] [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: 10/17/2022]
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Curado TF, Pho H, Freire C, Amorim M, Sennes LU, Taheri N, Hong Y, Abdelwahab M, Huang A, Fishbein K, Liu S, Capasso R, Schwartz A, Fuller D, Polotsky V. Designer Receptors Exclusively Activated by Designer Drugs Treatment of Sleep-disordered Breathing. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.657] [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: 11/27/2022]
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He K, Osorio N, Barsoumian H, Leyton CK, Hu Y, Voss T, Huang A, Cortez M, Lopes J, Losey H, Winquist R, Welsh J. Selective Agonism of Intermediate-Affinity IL-2 Receptor Promotes Systemic Antitumor Responses in Combination with Radiotherapy in Metastatic Lung Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.576] [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: 10/31/2022]
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Bono K, Palmeri M, Huang A, Gunther J, Mattes M. Assessment of Medical Student Research Mentorship Based on Publications in ASTRO Journals. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1771] [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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Zhang W, Gong S, Cottrell K, Briggs K, Tonini M, Gu L, Whittington D, Yuan H, Gotur D, Jahic H, Huang A, Maxwell J, Mallender W. Biochemical characterization of TNG908 as a novel, potent MTA-cooperative PRMT5 inhibitor for the treatment of MTAP-deleted cancers. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00872-3] [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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Briggs K, Cottrell K, Tsai A, Zhang M, Tonini M, Yoda S, Lombardo S, Teng T, Davis C, Whittington D, DiBenedetto H, Huang A, Maxwell J. TNG908 is a brain-penetrant, MTA-cooperative PRMT5 inhibitor for the treatment of MTAP-deleted cancer. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01021-8] [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: 11/03/2022]
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Briggs K, Tsai A, Zhang M, Tonini M, Haines B, Huang A, Cottrell K. TNG462 is a potential best-in-class MTA-cooperative PRMT5 inhibitor for the treatment of peripheral MTAP-deleted solid tumors. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01022-x] [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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Nguyen J, Huang A, Fleming J, MacGregor D, Wilks D. 074 ALK-positive desmoplastic Spitz naevus in a patient with corresponding ALK-positive anaplastic large cell lymphoma. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.009] [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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Li R, Zhu X, Liu S, Zhang X, Xie C, Fu Z, Huang A, Sun L, Liu D, Zhao J, Wu L, Qin Z, Li S, Liu Y, Li Z. LB0005 ORELABRUTINIB, AN IRREVERSIBLE INHIBITOR OF BRUTON’S TYROSINE KINASE (BTK), FOR THE TREATMENT OF SYSTEMIC LUPUS ERYTHEMATOSUS (SLE): RESULTS OF A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED, PHASE IB/IIA DOSE-FINDING STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5086a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundOrelabrutinib is an oral, highly-selective, irreversible inhibitor of Bruton’s tyrosine kinase (BTK). Orelabrutinib has been approved for the treatment of B cell malignancies in China. Two distinct lupus animal models showed significant efficacy of orelabrutinib in reducing disease activity, which supported the clinical development of orelabrutinib in Systemic Lupus Erythematosus (SLE).ObjectivesThis phase Ib/IIa, randomized, double-blind, placebo-controlled, dose-finding study aimed to evaluate the safety, tolerability, pharmacokinetics (PK), pharmacodynamics (PD), preliminary efficacy and biomarkers of orelabrutinib in patients with mild to moderate SLE who received standard of care (SoC) therapy.MethodsPatients diagnosed with SLE by the ACR classification criteria for ≥ 6 months, who had a SLEDAI-2K score ≥5 at screening, and were autoantibody-positive, were randomized 1:1:1:1 to receive oral orelabrutinib at 50mg, 80mg, 100mg or placebo once daily for 12 weeks, respectively.ResultsThis study randomized 60 patients with 55 patients who completed 12-week treatment. Age at baseline was 33.7±9.8 years and 96.7% were female. Baseline disease characteristics were generally balanced across treatment groups. Adverse events (AEs) were reported in 80%, 93.3% and 100% of orelabrutinib treated patients at doses of 50mg, 80mg and 100mg QD respectively versus 85.5% in placebo group. AEs were mostly mild or moderate. Treatment-related SAEs were reported in 3 patients treated with orelabrutinib, only 1 of which was grade 3. No deaths were reported. The plasma exposure of orelabrutinib (AUC and Cmax) was proportionally increased with doses. Nearly complete BTK occupancy was achieved at all dose levels, and the occupancy lasted for 24 hours without any decrease compared to that at 4 hour post-dosing. In all evaluable patients, the SLE Response Index (SRI)-4 response rates at week 12 were 50.0%, 61.5% and 64.3% in patients treated with orelabrutinib at 50mg (n=14), 80mg (n=13) and 100mg (n=14) respectively, compared with 35.7% in patients treated with placebo (n=14), which indicated the trend of dose-dependent improvement. Among the subgroup of patients with SLEDAI-2K≥8 at screening, SRI-4 response occurred in 70%, 70% and 66.7% of patients treated with orelabrutinib at 50mg (n=10), 80mg (n=10) and 100mg (n=9), respectively, compared with 30% who received placebo (n=10). Trends of reduced proteinuria, anti-dsDNA and IgG, total B cells and increased complements C4 were also observed following orelabrutinib treatment.ConclusionOrelabrutinib was generally safe and well tolerated in patients with SLE. Preliminary results also suggested encouraging efficacy which supports further development of orelabrutinib in larger and longer trials for SLE.Table 1.Efficacy results at week 12.All Evaluable PatientsPlaceboOrelabrutinibOrelabrutinibOrelabrutinib50 mg80 mg100 mgN=5514141314SRI-4 response, n (%)5 (35.7%)7 (50.0%)8 (61.5%)9 (64.3%)Treatment difference vs. PBO (%)14.3%25.8%28.6%SLEDAI-2K≥8, N=391010109SRI-4 response, n (%)3 (30.0%)7 (70.0%)7 (70.0%)6 (66.7%)Treatment difference vs. PBO (%)40.0%40.0%36.7%Note: All evaluable patients at week 12 efficacy data were included in the efficacy analysis.Figure 1.SRI-4 response rates at week 12.Disclosure of InterestsRu Li: None declared, Xiaoxia Zhu: None declared, Shengyun Liu: None declared, Xiao Zhang: None declared, Changhao Xie: None declared, Zili Fu: None declared, Anbin Huang: None declared, Lingyun Sun: None declared, Dongzhou Liu: None declared, Jinxia Zhao: None declared, Lin Wu: None declared, Zhoushuai Qin Employee of: InnoCare Pharma Limited., Sichen Li Employee of: InnoCare pharma Limited., Yaorong Liu Employee of: InnoCare pharma Limited., Zhanguo Li: None declared
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Warne MSJ, Turner RDR, Davis AM, Smith R, Huang A. Temporal variation of imidacloprid concentration and risk in waterways discharging to the Great Barrier Reef and potential causes. Sci Total Environ 2022; 823:153556. [PMID: 35104522 DOI: 10.1016/j.scitotenv.2022.153556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/22/2022] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
The widely used neonicotinoid insecticide imidacloprid has emerged as a significant risk to surface waters and the diverse aquatic and terrestrial fauna these ecosystems support. While herbicides have been the focus of research on pesticides in Australia's Great Barrier Reef catchment area, imidacloprid has been monitored in catchments across the region since 2009. This study assessed the spatial and temporal dynamics of imidacloprid in 14 waterways in Queensland, Australia over seven years in relation to land use and concentration trends. Imidacloprid could be quantified (i.e., concentrations were greater than the limit of reporting) in approximately 54% of all samples, but within individual waterways imidacloprid was quantified in 0 to 99.7% of samples. The percent of each catchment used to grow bananas, sugar cane and urban explained approximately 45% of the variation in imidacloprid concentrations and waterway discharge accounted for another 18%. In six waterways there were significant increases in imidacloprid concentrations and the frequency and magnitude of exceedances of aquatic ecosystem protection guidelines over time. Overall, the risk posed by imidacloprid was low with 74% of samples protecting at least 99% of species but it was estimated that upto 42% of aquatic species would experience harmful chronic effects. Potential explanations of the changes in imidacloprid were examined. Not surprisingly, the only plausible explanation of the increases was increased use of imidacloprid. While field-based measurement of the effects of imidacloprid are limited in the Great Barrier Reef Catchment Area (GBRCA) the risk assessment indicates that biological harm to aquatic organisms is highly likely. Action to reduce imidacloprid concentrations in the GBRCA waterways is urgently required to reverse the current trends and mitigate environmental impacts.
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Affiliation(s)
- Michael St J Warne
- Reef Catchments Science Partnership, School of Earth and Environmental Sciences, University of Queensland, Brisbane, Queensland 4108, Australia; Water Quality and Investigations, Environmental Monitoring and Assessment Science, Science Delivery, Department of Environment and Science, Brisbane, Queensland 4102, Australia; Centre for Agroecology, Water and Resilience, Coventry University, Coventry, United Kingdom.
| | - Ryan D R Turner
- Reef Catchments Science Partnership, School of Earth and Environmental Sciences, University of Queensland, Brisbane, Queensland 4108, Australia; Water Quality and Investigations, Environmental Monitoring and Assessment Science, Science Delivery, Department of Environment and Science, Brisbane, Queensland 4102, Australia; Managing for Resilient Landscapes, Institute for Future Environments, Queensland University of Technology, Brisbane, Queensland 4000, Australia.
| | - Aaron M Davis
- Centre for Tropical Water and Aquatic Ecosystem Research (TropWATER), School of Marine and Tropical Biology, James Cook University, Townsville, Queensland 4811, Australia.
| | - Rachael Smith
- Office of the Great Barrier Reef, Department of Environment and Science, Brisbane, Queensland 4102, Australia.
| | - A Huang
- School of Mathematics and Physics, University of Queensland, Brisbane, Queensland 4108, Australia.
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Huang A, Jiang L, Zhang J, Wang Q. Attention-VGG16-UNet: a novel deep learning approach for automatic segmentation of the median nerve in ultrasound images. Quant Imaging Med Surg 2022; 12:3138-3150. [PMID: 35655843 PMCID: PMC9131343 DOI: 10.21037/qims-21-1074] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 11/03/2021] [Accepted: 03/07/2022] [Indexed: 10/15/2023]
Abstract
BACKGROUND Ultrasonography-an imaging technique that can show the anatomical section of nerves and surrounding tissues-is one of the most effective imaging methods to diagnose nerve diseases. However, segmenting the median nerve in two-dimensional (2D) ultrasound images is challenging due to the tiny and inconspicuous size of the nerve, the low contrast of images, and imaging noise. This study aimed to apply deep learning approaches to improve the accuracy of automatic segmentation of the median nerve in ultrasound images. METHODS In this study, we proposed an improved network called VGG16-UNet, which incorporates a contracting path and an expanding path. The contracting path is the VGG16 model with the 3 fully connected layers removed. The architecture of the expanding path resembles the upsampling path of U-Net. Moreover, attention mechanisms or/and residual modules were added to the U-Net and VGG16-UNet, which sequentially obtained Attention-UNet (A-UNet), Summation-UNet (S-UNet), Attention-Summation-UNet (AS-UNet), Attention-VGG16-UNet (A-VGG16-UNet), Summation-VGG16-UNet (S-VGG16-UNet), and Attention-Summation-VGG16-UNet (AS-VGG16-UNet). Each model was trained on the dataset of 910 median nerve images from 19 participants and tested on 207 frames from a new image sequence. The performance of the models was evaluated by metrics including Dice similarity coefficient (Dice), Jaccard similarity coefficient (Jaccard), Precision, and Recall. Based on the best segmentation results, we reconstructed a 3D median nerve image using the volume rendering method in the Visualization Toolkit (VTK) to assist in clinical nerve diagnosis. RESULTS The results of paired t-tests showed significant differences (P<0.01) in the metrics' values of different models. It showed that AS-UNet ranked first in U-Net models. The VGG16-UNet and its variants performed better than the corresponding U-Net models. Furthermore, the model's performance with the attention mechanism was superior to that with the residual module either based on U-Net or VGG16-UNet. The A-VGG16-UNet achieved the best performance (Dice =0.904±0.035, Jaccard =0.826±0.057, Precision =0.905±0.061, and Recall =0.909±0.061). Finally, we applied the trained A-VGG16-UNet to segment the median nerve in the image sequence, then reconstructed and visualized the 3D image of the median nerve. CONCLUSIONS This study demonstrates that the attention mechanism and residual module improve deep learning models for segmenting ultrasound images. The proposed VGG16-UNet-based models performed better than U-Net-based models. With segmentation, a 3D median nerve image can be reconstructed and can provide a visual reference for nerve diagnosis.
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Affiliation(s)
- Aiyue Huang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Medical Image Processing, Guangzhou, China
- Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China
| | - Li Jiang
- Department of Rehabilitation, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiangshan Zhang
- Department of Rehabilitation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qing Wang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Medical Image Processing, Guangzhou, China
- Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China
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Rudoler D, Kurdyak P, Gomes T, Huang A, Jones W, Littleford S, Paracha N, Fischer B. Evaluating the population-level effects of oxycodone restrictions on prescription opioid utilization in Ontario. Pharmacoepidemiol Drug Saf 2022; 31:769-778. [PMID: 35470515 DOI: 10.1002/pds.5442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/03/2021] [Revised: 03/11/2022] [Accepted: 04/12/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE To investigate the impact of restrictions on access to long acting oxycodone on prescription opioid use and opioid-related harms. METHODS Administrative health data from Ontario, Canada was used to measure differences in opioids dispensed and ED visits for opioid-related overdose, poisoning or substance use following provincial restrictions on access to publicly insured OxyContin (February 29, 2012) and OxyNeo (February 28, 2013). This study focused on the cohort of provincial drug insurance eligible people (people 65+ and select low-income populations) who were dispensed oxycodone prior to the restrictions. Difference-in-differences models with a propensity score matched comparison group of people who were dispensed non-oxycodone opioids were used to estimate the main effects. RESULTS In the six months following the delisting of OxyContin, MMEs per person per week for all opioids fell by an average of 7.5% in people dispensed oxycodone relative to the comparison group, and an average of 13.8% in chronic recipients of oxycodone. In the six months following the restrictions on OxyNeo, MMEs per person per week fell by an average of 3.1% in all people dispensed oxycodone, and 25.2% in chronic oxycodone recipients. The decline in oxycodone dispensing amongst chronic oxycodone recipients corresponded with an increase in dispensing of other opioid formulations, particularly hydromorphone and fentanyl. No important differences were observed for ED visits related to opioid poisoning, overdose, or substance use disorder. CONCLUSIONS Province-wide restrictions on access to long acting oxycodone had an impact on quantities of all opioids dispensed to chronic recipients of oxycodone, but small impacts on the full population of people dispensed oxycodone; the decline in use was partially offset by increases in use of other publicly-funded opioid formulations. This study suggests that policies limiting access to specific prescription opioids led to overall reductions in publicly-funded prescription opioid use, particularly in chronic oxycodone recipients, without immediate evidence of changes in opioid-related ED visits. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- D Rudoler
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada.,Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - P Kurdyak
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - T Gomes
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - A Huang
- ICES, Toronto, Ontario, Canada
| | - W Jones
- Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Suite 2400 515 W. Hastings Street, Vancouver, British Columbia, Canada
| | - S Littleford
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - N Paracha
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - B Fischer
- Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, New Zealand.,Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Suite 2400 515 W. Hastings Street, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of Toronto, 250 College Street 8th floor, Toronto, Ontario, Canada.,Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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25
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Briggs K, Corriea G, Tsai A, Zhang M, Tonini M, Wilker E, Davis C, Cottrell K, Maxwell J, Huang A. 24P Evidence for synergy between TNG908, an MTAPnull-selective PRMT5 inhibitor, and sotorasib in an MTAPnull/KRASG12C xenograft model. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.01.032] [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: 11/01/2022] Open
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26
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Keilty D, Khandwala M, Liu Z, Papioannou V, Bouffet E, Hodgson D, Yee R, Laperriere N, Ahmed S, Mabbott D, Cushing S, Ramaswamy V, Tabori U, Huang A, Bartels U, Tsang D. Hearing Loss After Radiation and Chemotherapy for Central Nervous System and Head and Neck Tumors in Children. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.655] [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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27
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Huang S, Niu Y, Liu X, Gu Z, Huang A, Wu J. Characteristics of malnutrition according to Global Leadership Initiative on Malnutrition criteria in non-surgical patients with irritable bowel disease. Nutrition 2021; 94:111514. [PMID: 34844157 DOI: 10.1016/j.nut.2021.111514] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Malnutrition is common in patients with inflammatory bowel disease (IBD). The Global Leadership Initiative on Malnutrition (GLIM) was proposed to assess the severity and characteristics of malnutrition. Thus, we aimed to use the latest consensus on the diagnosis of malnutrition, GLIM criteria, to evaluate malnutrition in patients with IBD. METHODS We performed a retrospective cohort study of 73 adult patients with IBD (48 with Crohn disease and 25 with ulcerative colitis). Demographic data, clinical characteristics, and nutrition status defined by Nutritional Risk Screening (NRS) 2002 and GLIM criteria were recorded at enrollment. RESULTS According to the GLIM criteria, 43 (58.90%) patients were identified with malnutrition, and the incidence of mild to moderate malnutrition and severe malnutrition was 28.77% (21 of 73 patients) and 30.14% (22 of 73 patients), respectively. The severity of malnutrition in patients with IBD increased with the cumulative number of phenotypic criteria they met (P < 0.01). The difference in the number of etiologic indicators was only identified between patients with severe malnutrition and those without malnutrition (P < 0.05). Patients with Crohns disease had a significantly higher rate of muscle mass loss than patients with ulcerative colitis (P = 0.038) but a lower incidence of reduced food intake or assimilation (P = 0.039). CONCLUSION The prevalence of malnutrition according to the GLIM criteria was high in non-surgical patients with IBD, and as the degree of malnutrition worsened, more phenotypes and etiologic types appeared. The phenotypic and etiologic characteristics of GLIM were different in patients with Crohn disease than in those with ulcerative colitis.
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Affiliation(s)
- Shanshan Huang
- Department of Clinical Nutrition, Huadong Hospital, affiliated to Fudan University, Shanghai, China; Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China
| | - Yang Niu
- Department of Clinical Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong
| | - Xiaowei Liu
- Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China
| | - Zhengye Gu
- Department of Clinical Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong
| | - Aiyue Huang
- Department of Clinical Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong
| | - Jiang Wu
- Department of Clinical Nutrition, Huadong Hospital, affiliated to Fudan University, Shanghai, China.
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Jacob L, Agari K, Wlodarczyk J, Huang A, Hammoudeh J. Maxillomandibular Development after Mandibular Distraction Osteogenesis in Isolated Pierre Robin Sequence Patients. J Oral Maxillofac Surg 2021. [DOI: 10.1016/j.joms.2021.08.087] [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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Jacob L, Agari K, Wlodarczyk J, Huang A, Hammoudeh J. Maxillomandibular Development after Mandibular Distraction Osteogenesis in Isolated Pierre Robin Sequence Patients. J Oral Maxillofac Surg 2021. [DOI: 10.1016/j.joms.2021.08.086] [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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Gao H, Ma X, Apple S, Cirrone G, Huang A, Kabariti S, Saad A, Yucel R, Gustafson D, Motov S. 50 Depression in Emergency Department Healthcare Workers During the COVID-19 Outbreak in Brooklyn, NY. Ann Emerg Med 2021. [PMCID: PMC8536266 DOI: 10.1016/j.annemergmed.2021.09.058] [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: 11/01/2022]
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31
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Li G, Zhao Y, Jiang Y, Yang Q, Huang A, Chen Y, Han D. 777P A prospective, single-arm, open-label study of camrelizumab, apatinib and nab-paclitaxel in patients with advanced cervical cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1219] [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] Open
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Shi JY, Yang Y, Huang A, Xu JX, Cheng Y, Li YK, Gu J. [A challenge for colorectal surgeons: pathogenesis, progression and management of the secondary tumors of the ovary]. Zhonghua Wei Chang Wai Ke Za Zhi 2021; 24:550-556. [PMID: 34148321 DOI: 10.3760/cma.j.issn.441530-20210506-00192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A common clinical problem encountered by colorectal surgeons is the secondary tumors of the ovary (STO), particularly in young female patients. Most STO are from the digestive tract, and the known possible metastatic mechanisms include lymphatic, hematogenous, and intraperitoneal spreading. The molecular and histopathological characteristics of STO from different sites are diverse. It is particularly important to correctly identify the origin and feature of STO, which should be clarified by combining medical history, histopathology, immunohistochemistry, molecular biology, imaging and other means. The prognosis of patients with STO is poor in general. Comprehensive therapies based on surgical resection can benefit some patients. There is no specific treatment for STO at present, but not giving up easily on these patients is the right choice that every surgeon should understand.
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Affiliation(s)
- J Y Shi
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Y Yang
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - A Huang
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - J X Xu
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Y Cheng
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Y K Li
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - J Gu
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China Department of Gastrointestinal Surgery, Peking University Shougang Hospital, Beijing 100144, China Peking-Tsinghua Center for Life Science, Beijing 100142, China
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Girard B, Abdellaoui M, de Saint-Sauveur G, Huang A, Lévy P. Erratum to “Blepharospasm, dry eye and extractable nuclear antigen antibodies” [J. Fr. Ophtal. 43 (7) (2020) e221–5. PII: S0181-5512(20)30230-8. doi:10.1016/j.jfo.2020.06.001]. J Fr Ophtalmol 2020; 43:1130-1131. [DOI: 10.1016/j.jfo.2020.10.001] [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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Kyaw T, Loveland P, Kanellakis P, Cao A, Huang A, Peter K, Toh B, Bobik A. Alarmin-activated B cells accelerate atherosclerosis after myocardial infarction via plasma cell-immunoglobulin dependent mechanisms. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3793] [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
Introduction
Myocardial infarction (MI) accelerates atherosclerosis and for years greatly increases the risk of recurrent cardiovascular events, such as stroke and MI. B cell-derived autoantibodies produced in response to MI also persist for years.
Purpose
We investigated the role of B cells in adaptive immune responses to MI.
Methods
We used an apolipoprotein-E-deficient (ApoE−/−) mouse model of MI-accelerated atherosclerosis to assess the importance of B cells using loss and gain of function approaches. In loss of function experiment, after inducing an MI we depleted B cells using an anti-CD20 antibody. Gain of function experiments involve transfers of purified MI-B cells from different donor mice, isolated one week after MI, into atherosclerotic ApoE−/− mice.
Results
Depletion of B cells in MI mice prevented immunoglobulin G accumulation in plaques and MI-induced acceleration of atherosclerosis. Adoptive transfer of wildtype MI-B cells into atherosclerotic ApoE−/− mice greatly increased IgG accumulation in plaque and accelerated atherosclerosis in recipient mice. Cytokines that promote humoral immunity were also greatly increased in B cells activated by MI. These cells formed germinal centres within the spleen where they differentiated into antibody-producing plasma cells. Transfer of MI-B cells deficient in Blimp-1, the transcriptional repressor that drives their terminal differentiation to antibody-producing plasma cells failed to accelerate atherosclerosis in recipient mice. Alarmins released from infarcted heart were responsible for activation of B cells via toll-like receptors; transfer of MI-B cells deficient in MyD88, the canonical adaptor protein for inflammatory signaling downstream of toll-like receptors, prevented acceleration of atherosclerosis in recipient mice.
Conclusion
Our data implicate early B cell activation and autoantibodies as a central cause for accelerated atherosclerosis post MI and identifies novel therapeutic strategies towards preventing recurrent cardiovascular events such as MI and stroke.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Health and Medical Research Council of Australia
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Affiliation(s)
- T Kyaw
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - P Loveland
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - P Kanellakis
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - A Cao
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - A Huang
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - K Peter
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - B.H Toh
- Monash University, Medicine, Melbourne, Australia
| | - A Bobik
- Baker Heart and Diabetes Institute, Melbourne, Australia
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Huang A, Liu A, Wlodarczyk J, Fahradyan A, Hammoudeh J, Urata M. How Far Is Far Enough: Long-Term Efficacy of Mandibular Distraction Osteogenesis in Treating OSA Infants with Micrognathia. J Oral Maxillofac Surg 2020. [DOI: 10.1016/j.joms.2020.07.153] [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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Girard BC, Abdellaoui M, de Saint Sauveur G, Huang A, Lévy P. [Blepharospasm, dry eye and extractable nuclear antigen antibodies (French translation of the article)]. J Fr Ophtalmol 2020; 43:691-696. [PMID: 32896450 DOI: 10.1016/j.jfo.2019.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/08/2019] [Revised: 11/06/2019] [Accepted: 11/13/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE The goal of this study is to determine a link between benign essential blepharospasm and Sjogren's syndrome by analyzing the presence of extractable nuclear antigens in this population. METHODS Seventy-two patients with benign essential blepharospasm (BEB) were included in this study. We eliminated patients with hemifacial spasm or blepharospasm secondary to corneal pathology. We collected the values of the Schirmer I test and the results of the anti-SSA and anti-SSB antibodies. RESULTS Our study included 72 patients (144 eyes) whose 62 women (86.1%). Mean age was 74.3 years±10.73. Average Schirmer I test was 3.14mm±4.00mm. Five women (8% of this female population) had positive anti-SSA and SSB antibodies. Their mean age was 65.66 years±13.24 whereas the negative antibody patients had an average age of 75.42±9.27. There was no significant difference between their Schimer I test and the Schirmer I of negative antibody population. CONCLUSION This study illustrates the possible association between the presence of Sjögren's syndrome and the occurrence of a BEB justifying the search for anti-SSA and anti SSB in blepharospasm patients.
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Affiliation(s)
- B C Girard
- Service d'ophtalmologie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75970 Paris cedex 20, France; UPMC Sorbonne université, Paris, France.
| | - M Abdellaoui
- Service d'ophtalmologie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75970 Paris cedex 20, France; UPMC Sorbonne université, Paris, France
| | - G de Saint Sauveur
- Service d'ophtalmologie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75970 Paris cedex 20, France; UPMC Sorbonne université, Paris, France
| | - A Huang
- Service d'ophtalmologie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75970 Paris cedex 20, France; UPMC Sorbonne université, Paris, France
| | - P Lévy
- Département de santé publique, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75970 Paris cedex 20, France; Inserm, Institut Pierre-Louis de Santé Publique, France; UPMC Sorbonne université, Paris, France
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Girard BC, Abdellaoui M, de Saint Sauveur G, Huang A, Lévy P. Blepharospasm, dry eye and extractable nuclear antigen antibodies. J Fr Ophtalmol 2020; 43:e211-e215. [PMID: 32532571 DOI: 10.1016/j.jfo.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/24/2020] [Revised: 04/29/2020] [Accepted: 05/29/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To study whether there is an association between benign essential blepharospasm and Sjögren's syndrome by analyzing the presence of antibodies to extractable nuclear antigens in this population. METHODS Seventy-two patients with benign essential blepharospasm (BEB) were included in this study. We excluded patients with hemifacial spasm or blepharospasm secondary to known corneal pathology. We recorded results of Schirmer I testing as well as levels of anti-SSA/Ro and anti-SSB/La antibodies. RESULTS Our study included 72 patients (144 eyes), of which 62 (86.1%) were women. The mean age was 74.3±10.73 years. The mean Schirmer I test result was 3.14±4.00mm. Five women (8% of this female population) were found to have positive anti-SSA/Ro and anti-SSB/La antibodies. Their mean age was 65.66±13.24 years, while the mean age of the antibody-negative patients was 75.42±9.27 years. There was no statistically significant difference between the Schirmer I tests of the antibody positive and negative patients. CONCLUSION This study demonstrates a possible association between Sjögren's syndrome and benign essential blepharospasm, justifying anti-SSA/Ro and anti-SSB/La testing in these patients.
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Affiliation(s)
- B C Girard
- Service d'ophtalmologie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de-la-Chine, 75970 Paris cedex 20, France; UPMC Sorbonne université, Paris, France.
| | - M Abdellaoui
- Service d'ophtalmologie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de-la-Chine, 75970 Paris cedex 20, France; UPMC Sorbonne université, Paris, France
| | - G de Saint Sauveur
- Service d'ophtalmologie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de-la-Chine, 75970 Paris cedex 20, France; UPMC Sorbonne université, Paris, France
| | - A Huang
- Service d'ophtalmologie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de-la-Chine, 75970 Paris cedex 20, France; UPMC Sorbonne université, Paris, France
| | - P Lévy
- Département de santé publique, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de-la-Chine, 75970 Paris cedex 20, France; INSERM, institut Pierre-Louis de santé publique, UPMC Sorbonne université, Paris, France
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Chang TC, Huang SH, Chao HY, Chen BL, Chen C, Chen CH, Chen TR, Chin CY, Chiu CP, Chiu FP, Chou J, Chyr CY, Chu SY, Hsiao SM, Hsieh YM, Huang A, Huang WI, Hung SS, Ko HC, Lin LP, Lin PY, Liu CB, Liu FC, Sheu YI, Shie JS, Tai TF, Tsai SJ, Wang SJ, Wen SC, Wong HC, Yan LP, Yeh T. Efficacy of a Latex Agglutination Test for Rapid Identification of Staphylococcus aureus: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/79.3.661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Fifteen laboratories completed a collaborative study comparing the efficacy of a latex agglutination kit (Aureus Test) with that of AOAC Official Method 987.09 (coagulase test for identification of Staphylococcus aureus). Each laboratory analyzed 240 strains of bacteria, including 160 isolates of S. aureus and 80 isolates of other bacteria. Upon receipt of cultures, collaborators subcultured each isolate on both tryptic soy agar (TSA) and Baird-Parker agar medium (BPA) to determine whether the growth medium has any effect on either method. For cultures grown on TSA, the latex test had sensitivity and specificity rates of 99.2 and 97.1 %, respectively, whereas the coagulase test had respective rates of 98.4 and 92.5%. For cultures able to grow on BPA, the latex test had sensitivity and specificity rates of 99.2 and 96.6%, respectively, while the coagulase test had respective rates of 98.3 and 91.3%. By using the McNemar pairwise comparison test of the 2 methods, the falsepositive and false-negative rates of the latex test were significantly lower (p < 0.01) than those of the coagulase test for strains grown either on TSA or BPA. The latex agglutination test for identification of S. aureus isolated from foods has been adopted by AOAC INTERNATIONAL.
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Affiliation(s)
- Tsung C Chang
- Food Industry Research and Development Institute, PO Box 246, Hsinchu 300, Taiwan, Republic of China
| | - Su H Huang
- Food Industry Research and Development Institute, PO Box 246, Hsinchu 300, Taiwan, Republic of China
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Yin WJ, Li LM, Wang L, Huang A, Qiao AX, Jia YT, Feng Y. [Correlation between BRAP expression and prognosis of patients with laryngeal squamous cell carcinoma]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2020; 33:1081-1084. [PMID: 31914300 DOI: 10.13201/j.issn.1001-1781.2019.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Indexed: 11/12/2022]
Abstract
Objective:To investigate the expression of BRCA1 associated protein(BRAP) and its correlations with clinicopathological features and prognosis of patients with laryngeal squamous cell carcinoma(LSCC). Method:The protein expression of BRAP in LSCC tissues and normal laryngeal tissues were assessed by immunohistochemistry and Western blot, and their correlations with clinicopathological features and prognosis were statistically analyzed. Result:The expression of BRAP in LSCC was significantly higher than that in normal laryngeal tissues(P<0.05). BRAP expression was significantly correlated with the TNM stage and lymph node metastasis(P<0.05). Kaplan-Meier survival analysis showed that LSCC patients with high BRAP expression had worse overall survival than those with low BRAP expression(P<0.01). Multivariate Cox proportional-hazards analysis showed that the high expression of BRAP protein was an important poor prognostic indicator of the patients. Conclusion:BRAP is related with the development of LSCC, and it may be used as an important prognostic biomarker for LSCC patients.
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Affiliation(s)
- W J Yin
- Department of Pathology,Shanxi Medical University,Taiyuan,030001,China
| | - L M Li
- Department of Pathology,Shanxi Medical University,Taiyuan,030001,China
| | - L Wang
- Department of Pathology,Shanxi Medical University,Taiyuan,030001,China
| | - A Huang
- Department of Otorhinolaryngology,the First People's Hospital of Jinzhong
| | - A X Qiao
- Department of Pathology,Shanxi Medical University,Taiyuan,030001,China
| | - Y T Jia
- Department of Otorhinolaryngology Head and Neck Surgery,the First Hospital of Shanxi Medical University
| | - Y Feng
- Department of Otorhinolaryngology Head and Neck Surgery,the First Hospital of Shanxi Medical University
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Ortega-Gutierrez S, Samaniego EA, Reccius A, Huang A, Zheng-Lin B, Masukar A, Marshall RS, Petersen NH. Changes on Dynamic Cerebral Autoregulation Are Associated with Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage. Acta Neurochir Suppl 2020; 127:149-153. [PMID: 31407076 DOI: 10.1007/978-3-030-04615-6_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Early identification of vasospasm prior to symptom onset would allow prevention of delayed cerebral ischemia (DCI) in aneurysmal subarachnoid hemorrhage (aSAH). Dynamic cerebral autoregulation (DCA) is a noninvasive means of assessing cerebral blood flow regulation by determining independence of low-frequency temporal oscillations of systemic blood pressure (BP) and cerebral blood flow velocities (CBFV). METHODS Eight SAH patients underwent prospectively a median of 7 DCA assessments consisting of continuous measurements of BCFV and BP. Transfer function analysis was applied to calculate average phase shift (PS) in low (0.07-0.2 Hz) frequency range for each hemisphere as continuous measure of DCA. Lower PS indicated poorer regulatory response. DCI was defined as a 2-point decrease in Glasgow Coma Score and/or infarction on CT. RESULTS Three subjects developed symptomatic vasospasm with median time-to-DCI of 9 days. DCI was significantly associated with lower PS over the entire recording period (Wald = 4.28; p = 0.039). Additionally, there was a significant change in PS over different recording periods after adjusting for DCI (Wald = 15.66; p = 0.001); particularly, a significantly lower mean PS day 3-5 after bleed (14.22 vs 27.51; p = 0.05). CONCLUSIONS DCA might be useful for early detection of symptomatic vasospasm. A larger cohort study of SAH patients is currently underway.
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Affiliation(s)
- S Ortega-Gutierrez
- Stroke Division, Neurointerventional Surgery Section, Departments of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa, IA, USA.
| | - E A Samaniego
- Stroke Division, Neurointerventional Surgery Section, Departments of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa, IA, USA
| | - A Reccius
- Department of Critical Care, Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - A Huang
- Department of Neurology, Columbia University, New York, NY, USA
| | - B Zheng-Lin
- Stroke Division, Neurointerventional Surgery Section, Departments of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa, IA, USA
| | - A Masukar
- Department of Neurology, Columbia University, New York, NY, USA
| | - R S Marshall
- Department of Neurology, Columbia University, New York, NY, USA
| | - N H Petersen
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
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Yu X, Xin M, Huang A, Chen L, Cai X, Shen J, Zou T, Yang T, Miao Y. Ginsenoside Rg2 Attenuates Ischemia/Reperfusion-induced Injury to Spinal Cord in Rats. Indian J Pharm Sci 2020. [DOI: 10.36468/pharmaceutical-sciences.spl.22] [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: 11/22/2022] Open
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Affiliation(s)
- A. Huang
- School of Mathematics and Physics, University of Queensland, St Lucia, Queensland, Australia
| | - A. S. I. Kim
- School of Mathematical and Physical Sciences, University of Technology Sydney, Broadway, New South Wales, Australia
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Bauml J, Yoon D, Yan P, Katz S, Jeffries S, Davis C, Aggarwal C, Cohen R, Marmarelis M, Singh A, Ciunci C, Wherry E, Albelda S, Langer C, Huang A. P2.04-02 Effect of Chemotherapy, Chemoimmunotherapy, and Immunotherapy on Parameters of T Cell Exhaustion in Metastatic Non-Small Cell Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1508] [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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Huang A, Mugharbil A, Anastasius M, Ghadiri S, Leipsic J, Elahi N, Brunham L, Pimstone S, Golmohammadzadeh M, Thompson CR, Argulian E, Narula J, Ahmadi A. P3432Coronary artery calcium score is of limited sensitivity in detecting subclinical atherosclerosis in young individuals with family history of coronary artery disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0306] [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
Introduction
Family history of premature coronary artery disease (CAD) is known to predispose individuals to adverse CAD events, often at a younger age. Current risk stratification strategy is suboptimal, as up to 50% of individuals were considered “low-risk” prior to their first presentation of myocardial infarction. Coronary artery calcium score (CACS) is a marker of atherosclerosis and provides incremental value in risk stratification. However, the utility of CACS may be limited in younger patients as they often have non-calcified atherosclerotic plaques. In this study, we evaluate the sensitivity of CACS in detecting subclinical atherosclerosis in different age groups.
Method
From 310 referrals to a specialized unit in the management of early atherosclerosis, 222 individuals with a family history of premature CAD (defined as CAD events in first-degree family members, male<55 and female<65) and aged between 35 and 55 were enrolled for assessment of their CAD risks. Individuals with possible, probably or definite familial hypercholesterolemia were excluded. In addition to clinical and risk factor evaluation, cardiac CT and CACS were performed in select individuals, at the discretion of the treating physician.
Results
Of the 141 (59% male, mean age 45.9±6.0 year) individuals that completed clinical evaluation, 65 (73% male, mean age 47.4±6.9 years) have subclinical atherosclerosis (defined by the presence of atherosclerotic plaques in any of the coronary artery segments in cardiac CT). Of them, 52 have CACS>0, giving an overall sensitivity of 80%. The breakdown by age group is shown in table 1. The sensitivity of CACS in detecting subclinical atherosclerosis is quite modest in younger individuals (60% in individuals <45 year-old) but improves with patient age (>85% in >45 years).
Table 1. Sensitivity of CACS in different age groups Age group True Positive Fast Negative Sensitivity N (CAC+ CTCA+) (CAC+ CTCA−) (%) <40 6 4 60 10 41–45 7 4 55 11 46–50 19 3 86 22 51–55 20 1 95 21
Conclusion
In younger individuals (<45 years) with family history of premature CAD, CACS is of limited sensitivity in detecting subclinical atherosclerosis, and should not be used to rule out CAD. Further studies are warranted.
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Affiliation(s)
- A Huang
- St Paul's Hospital, Vancouver, Canada
| | | | | | - S Ghadiri
- University of British Columbia, Vancouver, Canada
| | - J Leipsic
- St Paul's Hospital, Vancouver, Canada
| | - N Elahi
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - L Brunham
- University of British Columbia, Vancouver, Canada
| | - S Pimstone
- University of British Columbia, Vancouver, Canada
| | | | - C R Thompson
- University of British Columbia, Vancouver, Canada
| | - E Argulian
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - J Narula
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - A Ahmadi
- Icahn School of Medicine at Mount Sinai, New York, United States of America
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Ghadiri S, Leipsic J, Elahi N, Anastasius M, Huang A, Mugharbil A, Brunham L, Pimstone S, Golmohammadzadeh M, Thompson C, Argulian E, Narula J, Ahmadi A. P3412Risk factors, biomarkers and framingham risk estimate fail to identify presence of subclinical atherosclerosis in young individual with family history of premature coronary artery disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0286] [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
Introduction
Patients with family history of premature coronary artery disease (CAD) are at increased risk of CAD events at a younger age. Risk factor based approaches and clinical evaluation are most commonly used to assess these individuals. However, it has been recently shown that up to 50% of individual presenting with their first myocardial infarction (MI) were considered to be “low risk” prior to that event. MI is often a result of plaque rupture preceded by progression of subclinical atherosclerosis. Detection of subclinical atherosclerosis may therefore help target prevention of plaque progression. We assessed the value of clinical risk factor, biomarkers and Framingham Risk Score (FRS) in predicting subclinical atherosclerosis in individuals with a family history of premature CAD.
Methods
From 310 referrals, 222 individuals between the ages of 35 and 55 with a family history of premature CAD (CAD events in first-degree family members (male <55, female <65)) were enrolled for evaluation of risk of CAD. Those with familial hypercholesteremia (possible, probable or definite) were excluded. Patients underwent clinical and risk factor evaluations as well as Cardiac CT or Calcium Score (CS) to assess presence of subclinical / clinical atherosclerosis at the discretion of the treating physician.
Results
In this pilot, 141 individuals (59% male, mean age 45.9±6.0 years) completed evaluation, and 65 (46%) had evidence of subclinical atherosclerosis on CT coronary angiography or CT calcium score with a mean segment involvement score (SIS) of 2.8 and mean CS of 152, putting them above the 80th percentile for their age and sex. Aside from male sex, age, and smoking history, other traditional risk factors and biomarkers including diabetes mellitus, hypertension, total cholesterol, LDL-C, HDL-C and Cholesterol/HDL-C were not significantly different between those with or without subclinical atherosclerosis (Table 1).
Table 1
Conclusion
In young individuals with a family history of premature CAD, risk factors, biomarkers, and FRS failed to identify individuals with premature, subclinical atherosclerosis in this pilot study. Detection of subclinical atherosclerosis and early implementation of treatment with the aim of stabilizing plaques and stopping progression might prove vital in reducing events in these individuals. Further studies are warranted.
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Affiliation(s)
- S Ghadiri
- University of British Columbia, Vancouver, Canada
| | - J Leipsic
- University of British Columbia, Vancouver, Canada
| | - N Elahi
- Wesleyan University, Middletown, United States of America
| | - M Anastasius
- University of British Columbia, Vancouver, Canada
| | - A Huang
- University of British Columbia, Vancouver, Canada
| | - A Mugharbil
- University of British Columbia, Vancouver, Canada
| | - L Brunham
- University of British Columbia, Vancouver, Canada
| | - S Pimstone
- University of British Columbia, Vancouver, Canada
| | | | - C Thompson
- University of British Columbia, Vancouver, Canada
| | - E Argulian
- Mount Sinai School of Medicine, New York, United States of America
| | - J Narula
- Mount Sinai School of Medicine, New York, United States of America
| | - A Ahmadi
- Mount Sinai School of Medicine, New York, United States of America
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Huang A, Nardone B, West D, Colavincenzo M. 674 Hair loss and psychoactive medications: Stimulants and antidepressants: A retrospective analysis from the RADAR (Research on Adverse Drug events And Reports) Program. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.750] [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: 10/27/2022]
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Huang A, Delozier S, Lauderdale CJ, Zhao S, Clayton DB, Pope JC, Tanaka ST, Adams MC, Shannon CN, Brock JW, Thomas JC. Do repeat ultrasounds affect orchiectomy rate in patients with testicular torsion treated at a pediatric institution? J Pediatr Urol 2019; 15:179.e1-179.e5. [PMID: 30704855 DOI: 10.1016/j.jpurol.2018.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Testicular torsion is a urological emergency; as the testicular salvage rate decreases with time, prompt intervention is required to restore the blood flow. Interhospital transfers and ultrasound examinations, while clinically essential to proper treatment and diagnosis, may adversely affect outcomes by delaying surgical intervention. Patients transferred to another institution for treatment of testicular torsion may experience a further time delay by undergoing two ultrasound examinations: one at the initial admitting institution and one at the receiving institution. To the knowledge of the authors, no study has yet explored the time delays and outcomes associated with these repeat ultrasounds. OBJECTIVE The objective was to investigate the impact of repeat ultrasound imaging on time to treatment and patient outcomes in patients with testicular torsion. STUDY DESIGN A retrospective chart review of 133 patients, aged 0-20 years, treated at the authors' institution for testicular torsion was conducted. Neonate patients and patients who did not receive ultrasound were excluded. Demographic and clinical variables were collected from the electronic medical record. Pearson Chi-squared and t-tests were used for univariate comparisons, and multivariate logistic regression analysis was performed to measure the relationships between variables. RESULTS Forty-nine percent of patients were primary patients, and 51% were transfer patients. Fifty-two percent of transfer patients received repeat ultrasounds. In comparison to salvaged patients, those who underwent orchiectomy experienced a greater delay between presentation at the institution and surgical intervention (229 min vs 177 min, p = 0.048). The transfer status does not appear to be related to the outcome, i.e. orchiectomy versus salvage. Patients who underwent orchiectomy were more likely than salvaged patients to have received repeat ultrasounds (p = 0.008). Repeat ultrasound patients had three times the likelihood of orchiectomy of single ultrasound patients. In a subset analysis of transfer patients, repeat ultrasound patients were more likely than single ultrasound patients to receive an orchiectomy (p = 0.03). DISCUSSION In agreement with previous studies, patients who underwent orchiectomy were found to experience greater treatment delays and trend toward transfer. Specifically, repeat ultrasound and time between presentation and intervention appear to influence patient outcomes. The effect of repeat ultrasound on outcomes appears to be independent of the transfer status. The study was limited by its retrospective nature and small sample size. CONCLUSION The analysis suggests that efforts to prevent repeat ultrasounds and minimize the time between presentation and intervention would improve patient outcomes. It is proposed that standardized clinical decision-making procedures, such as the TWIST scoring system, be incorporated into hospital protocols.
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Affiliation(s)
- A Huang
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way Nashville, TN 37232, USA.
| | - S Delozier
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way Nashville, TN 37232, USA
| | - C J Lauderdale
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way Nashville, TN 37232, USA
| | - S Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End, Suite 1100, Nashville, TN 37203, USA
| | - D B Clayton
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way Nashville, TN 37232, USA; Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 4102, Nashville, TN 37232-9820, USA
| | - J C Pope
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way Nashville, TN 37232, USA; Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 4102, Nashville, TN 37232-9820, USA
| | - S T Tanaka
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way Nashville, TN 37232, USA; Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 4102, Nashville, TN 37232-9820, USA
| | - M C Adams
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way Nashville, TN 37232, USA; Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 4102, Nashville, TN 37232-9820, USA
| | - C N Shannon
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way Nashville, TN 37232, USA; Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Doctors' Office Tower, Suite 9226, 2200 Children's Way, Nashville, TN 37232-9557, USA
| | - J W Brock
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way Nashville, TN 37232, USA; Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 4102, Nashville, TN 37232-9820, USA
| | - J C Thomas
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way Nashville, TN 37232, USA; Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 4102, Nashville, TN 37232-9820, USA
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Jagannathan N, Hajduk J, Sohn L, Huang A, Sawardekar A, Albers B, Bienia S, De Oliveira GS. Randomized equivalence trial of the King Vision aBlade videolaryngoscope with the Miller direct laryngoscope for routine tracheal intubation in children <2 yr of age. Br J Anaesth 2018; 118:932-937. [PMID: 28549081 DOI: 10.1093/bja/aex073] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2017] [Indexed: 11/14/2022] Open
Abstract
Background. We conducted a randomized equivalence trial to compare direct laryngoscopy using a Miller blade (DL) with the King Vision videolaryngoscope (KVL) for routine tracheal intubation. We hypothesized that tracheal intubation times with DL would be equivalent to the KVL in children <2 yr of age. Methods. Two hundred children were randomly assigned to tracheal intubation using DL or KVL. The primary outcome was the median difference in the total time for successful tracheal intubation. Secondary outcomes assessed were tracheal intubation attempts, time to best glottic view, time for tracheal tube entry, percentage of glottic opening score, airway manoeuvres needed, and complications. Results. The median difference between the groups was 5.7 s, with an upper 95% confidence interval of 7.5 s, which was less than our defined equivalence time difference of 10 s. There were no differences in the number of tracheal intubation attempts and the time to best glottic view [DL median 5.3 (4.1-7.6) s vs KVL 5.0 (4.0-6.3) s; P =0.19]. The percentage of glottic opening score was better when using the KVL [median 100 (100-100) vs DL median 100 (90-100); P <0.0001]. Use of DL was associated with greater need for airway manoeuvres during tracheal intubation (33 vs 7%; P <0.001). Complications did not differ between devices. Conclusions. In children <2 yr of age, the KVL was associated with equivalent times for routine tracheal intubation when compared with the Miller blade. Clinical trial registration NCT02590237.
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Affiliation(s)
- N Jagannathan
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 19, Chicago, IL, USA
| | - J Hajduk
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 19, Chicago, IL, USA
| | - L Sohn
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 19, Chicago, IL, USA
| | - A Huang
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 19, Chicago, IL, USA
| | - A Sawardekar
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 19, Chicago, IL, USA
| | - B Albers
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 19, Chicago, IL, USA
| | - S Bienia
- Department of Anesthesiology, Massachusetts General Hospital Boston, MA, USA
| | - G S De Oliveira
- Department of Anesthesiology Feinberg School of Medicine, Northwestern University, 303 East Chicago Avenue, Chicago, IL 60611, USA
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Huang A, Strombotne KL, Horner E, Lapham SJ. ADOLESCENT COGNITIVE PREDICTORS OF ALZHEIMER’S DISEASE AND RELATED DISORDERS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Huang
- American Institutes for Research, Washington, District of Columbia, United States
| | | | - E Horner
- American Institutes for Research, Washington, DC, USA
| | - S J Lapham
- American Institutes for Research, Washington, DC, USA
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Chapman B, Huang A, Horner E, Peters K, Sempeles E, Roberts B, Lapham S. INTERNAL REPLICATION STRATEGIES FOR (MODERATELY) LARGE SAMPLES: CROSS-VALIDATION TECHNIQUES IN PROJECT TALENT. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B Chapman
- Departments of Psychiatry and Public Health Sciences, URMC, Rochester, New York, United States
| | - A Huang
- American Institutes for Research, Washington, DC, USA
| | - E Horner
- American Institutes for Research, Washington, DC, USA
| | - K Peters
- American Institutes for Research, Washington, DC, USA
| | - E Sempeles
- American Institutes for Research, Washington, DC, USA
| | - B Roberts
- University of Illinois, Champaign, IL, USA
| | - S Lapham
- American Institutes for Research, Washington, DC, USA
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