1
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Gururaja Rao S, Lam A, Seeley S, Park J, Aruva S, Singh H. The BK Ca (slo) channel regulates the cardiac function of Drosophila. Physiol Rep 2024; 12:e15996. [PMID: 38561252 PMCID: PMC10984821 DOI: 10.14814/phy2.15996] [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] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
The large conductance, calcium, and voltage-active potassium channels (BKCa) were originally discovered in Drosophila melanogaster as slowpoke (slo). They are extensively characterized in fly models as ion channels for their roles in neurological and muscular function, as well as aging. BKCa is known to modulate cardiac rhythm and is localized to the mitochondria. Activation of mitochondrial BKCa causes cardioprotection from ischemia-reperfusion injury, possibly via modulating mitochondrial function in adult animal models. However, the role of BKCa in cardiac function is not well-characterized, partially due to its localization to the plasma membrane as well as intracellular membranes and the wide array of cells present in mammalian hearts. Here we demonstrate for the first time a direct role for BKCa in cardiac function and cardioprotection from IR injury using the Drosophila model system. We have also discovered that the BKCa channel plays a role in the functioning of aging hearts. Our study establishes the presence of BKCa in the fly heart and ascertains its role in aging heart function.
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Affiliation(s)
- Shubha Gururaja Rao
- Department of Pharmaceutical and Biomedical SciencesThe Raabe College of Pharmacy, Ohio Northern UniversityAdaOhioUSA
- Department of Physiology and Cell BiologyThe Ohio State UniversityColumbusOhioUSA
| | - Alexander Lam
- Department of Physiology and Cell BiologyThe Ohio State UniversityColumbusOhioUSA
| | - Sarah Seeley
- Department of Pharmaceutical and Biomedical SciencesThe Raabe College of Pharmacy, Ohio Northern UniversityAdaOhioUSA
| | - Jeniffer Park
- Department of Physiology and Cell BiologyThe Ohio State UniversityColumbusOhioUSA
| | - Shriya Aruva
- Department of Physiology and Cell BiologyThe Ohio State UniversityColumbusOhioUSA
| | - Harpreet Singh
- Department of Physiology and Cell BiologyThe Ohio State UniversityColumbusOhioUSA
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2
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Zhou AL, Wu X, Youm J, Heller MB, Lam A. Cost-Effectiveness of Drug-Coated Balloon Angioplasty versus Plain Old Balloon Angioplasty for Arteriovenous Fistula Stenosis. Cardiovasc Intervent Radiol 2023; 46:1221-1230. [PMID: 36977902 DOI: 10.1007/s00270-023-03403-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/23/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVE To compare the cost-effectiveness of drug-coated balloon angioplasty (DCB) versus plain old balloon angioplasty (POBA) for treatment of arteriovenous fistula (AVF) stenosis. METHODS A Markov model was created to compare DCB versus POBA for AVF stenosis over a 2-year time horizon from a United States payer's perspective. Probabilities related to complications, restenosis, retreatment, and all-cause mortality were obtained from published literature. Costs were calculated using Medicare reimbursement rates and data from published cost analyses, inflation-adjusted to 2021. Health outcomes were measured with quality-adjusted life years (QALY). Probabilistic and deterministic sensitivity analyses were performed with a willingness-to-pay threshold of $100,000/QALY. RESULTS Base case calculation showed better quality-of-life outcomes but increased cost with POBA compared to DCB, with an incremental cost-effectiveness ratio of $27,413/QALY, making POBA the more cost-effective strategy in the base case model. Sensitivity analyses showed that DCB becomes cost-effective if the 24-month mortality rate after DCB is no more than 3.4% higher than that after POBA. In secondary analyses where mortality rates were equalized, DCB was more cost-effective than POBA until its additional cost reached more than $4213 per intervention. CONCLUSION When modeled from a payer's perspective over 2 years, the cost utility of DCB versus POBA varies with mortality outcomes. POBA is cost-effective if 2-year all-cause mortality after DCB is greater than 3.4% higher than after POBA. If 2-year mortality after DCB is less than 3.4% higher than after POBA, DCB is cost-effective until its additional cost per procedure exceeds $4213 more than POBA. LEVEL OF EVIDENCE IV HISTORICALLY CONTROLLED STUDY.: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Alice L Zhou
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
| | - Xiao Wu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Jiwon Youm
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Michael B Heller
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Alexander Lam
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
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3
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Lam A, Selvarajah D, Htike SS, Chan S, Lalloo S, Lock G, Redmond K, Leggett D, Mews P. The efficacy of postoperative middle meningeal artery embolization on chronic subdural hematoma - A multicentered randomized controlled trial. Surg Neurol Int 2023; 14:168. [PMID: 37292400 PMCID: PMC10246309 DOI: 10.25259/sni_208_2023] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 04/25/2023] [Indexed: 06/10/2023] Open
Abstract
Background Middle meningeal artery (MMA) embolization has recently emerged as a potential treatment for chronic subdural hematoma (cSDH). Numerous retrospective studies have suggested that it can potentially reduce the risk of hematoma recurrence following surgical evacuation. We have conducted a randomized controlled trial to investigate the effectiveness of postoperative MMA embolization in reducing recurrence rate, residual hematoma thickness as well as improving functional outcome. Methods Patients aged 18 or above were recruited. Following evacuation through burr hole or craniotomy, patients were randomly allocated to undergo either MMA embolization or standard care (monitoring). The primary outcome was symptomatic recurrence requiring redo evacuation. Secondary outcomes include residual hematoma thickness and modified Rankin Scale (mRS) at 6 weeks and 3 months. Results Thirty-six patients (41 cSDHs) were recruited between April 2021 and September 2022. Seventeen patients (19 cSDHs) were allocated to the embolization group and 19 patients (22 cSDHs) were in the control group. No symptomatic recurrence was observed in the treatment group while 3 control patients (15.8%) underwent repeat surgery for symptomatic recurrence, however, it was not statistically significant (P = 0.234). Furthermore, there was no significant difference in residual hematoma thickness at 6 weeks or 3 months between the two groups. All patients in the embolization group had a good functional outcome (mRS 0-1) at 3 months, which was significantly higher than the 53% observed in the control group. No complications related to MMA embolization were reported. Conclusion Further study with larger sample size is required to evaluate the efficacy of MMA embolization.
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Affiliation(s)
- Alexander Lam
- Department of Neurosurgery, Princess Alexandra Hospital, Woolloongabba, Australia
| | | | - Soe San Htike
- Department of Neurosurgery, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Sophia Chan
- Department of Neurosurgery, Princess Alexandra Hospital, Woolloongabba, Australia
| | | | - Gregory Lock
- Department of Radiology, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Kendal Redmond
- Department of Radiology, Princess Alexandra Hospital, Woolloongabba, Australia
| | - David Leggett
- Department of Radiology, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Peter Mews
- Department of Neurosurgery, Canberra Hospital, Garran, Australia
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4
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Massouh A, Kwan SW, Fidelman N, Higgins M, Abujudeh H, Charalel RA, Guimaraes MS, Gupta A, Lam A, Majdalany BS, Patel PJ, Stadtlander KS, Stillwell T, Teo EYL, Tong RT, Kapoor BS. ACR Appropriateness Criteria® Central Venous Access Device and Site Selection. J Am Coll Radiol 2023; 20:S3-S19. [PMID: 37236750 DOI: 10.1016/j.jacr.2023.02.021] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
The use of central venous access devices is ubiquitous in both inpatient and outpatient settings, whether for critical care, oncology, hemodialysis, parenteral nutrition, or diagnostic purposes. Radiology has a well-established role in the placement of these devices due to demonstrated benefits of radiologic placement in multiple clinical settings. A wide variety of devices are available for central venous access and optimal device selection is a common clinical challenge. Central venous access devices may be nontunneled, tunneled, or implantable. They may be centrally or peripherally inserted by way of veins in the neck, extremities, or elsewhere. Each device and access site presents specific risks that should be considered in each clinical scenario to minimize the risk of harm. The risk of infection and mechanical injury should be minimized in all patients. In hemodialysis patients, preservation of future access is an additional important consideration. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Alan Massouh
- Research Author, University of Utah, Salt Lake City, Utah.
| | - Sharon W Kwan
- University of Utah, Salt Lake City, Utah; and JACR editorial board
| | - Nicholas Fidelman
- Panel Chair, University of California San Francisco, San Francisco, California
| | - Mikhail Higgins
- Panel Vice-Chair, Boston University School of Medicine, Boston, Massachusetts
| | - Hani Abujudeh
- Detroit Medical Center, Tenet Healthcare and Envision Radiology Physician Services, Detroit, Michigan
| | - Resmi A Charalel
- Weill Cornell Medicine, New York, New York; and SIR Quality Data Analytics Committee Co-Chair
| | | | - Amit Gupta
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Alexander Lam
- University of California, San Francisco, San Francisco, California
| | | | - Parag J Patel
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Terri Stillwell
- University of Michigan, Ann Arbor, Michigan; Infectious Diseases Society of America; PIDS Education Committee; SHEA Education Committee; and Panelist, IDSA
| | - Elrond Y L Teo
- Piedmont Atlanta Hospital, Atlanta, Georgia; Society of Critical Care Medicine
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Wu X, Heller M, Lokken R, Fidelman N, Lam A. Abstract No. 264 Socioeconomic and Survival Analysis of Radioembolization in Patients with Intrahepatic Cholangiocarcinoma: A Propensity Score Adjusted Analysis. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.329] [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: 02/27/2023] Open
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6
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Wu X, Heller M, Lokken RP, Fidelman N, Lam A. Socioeconomic and Survival Analysis of Radioembolization in Patients with Intrahepatic Cholangiocarcinoma: A Propensity Score-Adjusted Study. J Vasc Interv Radiol 2023; 34:815-823.e1. [PMID: 36693521 DOI: 10.1016/j.jvir.2023.01.014] [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] [Received: 08/31/2022] [Revised: 12/19/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To determine whether transarterial radioembolization (TARE) is associated with longer survival of patients with intrahepatic cholangiocarcinoma (ICC) and whether access to TARE is influenced by socioeconomic factors. MATERIALS AND METHODS Retrospective review of patients with ICC in the National Cancer Database from 2004 to 2018 was performed with Cox regression analysis to identify predictors of survival. Overall survival (OS) was estimated using the Kaplan-Meier method. Socioeconomic factors were compared between 2 groups using the Wilcoxon rank-sum test and χ2 test. Propensity score-matched cohorts were created between patients with ICC who did and did not undergo TARE. RESULTS The number of patients receiving TARE for ICC increased over time from 1 in 2004 to 210 in 2018. Patients in the TARE group were more likely to be White (87.9% vs 84.3%; P = .012) and less likely to be Hispanic/Latino (7.7% vs 11.0%; P = .009). Fewer patients who underwent TARE were uninsured (0.9% vs 2.8%; P = .012). Older age, male sex, non-White race, higher tumor grade size, and stage, earlier year of diagnosis, lack of treatment with surgery or systemic therapy, and presence of lymphatic or vascular invasion exhibited significant associations with decreased survival (P < .05 for all). Patients who underwent TARE had longer survival in both unadjusted and adjusted cohorts, with an OS of 17.5 months (vs 7.2 months in the non-TARE group) after propensity matching. CONCLUSIONS Patients with ICC who had undergone TARE experienced significantly longer survival than that experienced by those who had not after adjusting for measurable confounders. Significant socioeconomic disparities in access to TARE remain.
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Affiliation(s)
- Xiao Wu
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Michael Heller
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - R Peter Lokken
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Nicholas Fidelman
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Alexander Lam
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.
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7
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Selvarajah D, Lam A, Fadia M, McDowell D. Adult pilomyxoid astrocytoma presenting in the temporal lobe. Heliyon 2023; 9:e12909. [PMID: 36685361 PMCID: PMC9853359 DOI: 10.1016/j.heliyon.2023.e12909] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 12/08/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
Pilomyxoid astrocytoma (PMA) is a rare variant of astrocytoma that is usually present in the hypothalamic and chiasmatic areas in the paediatric population. PMA shares many similar histopathological features to Pilocytic astrocytoma (PA), with some notable differences in its radiological and histopathological findings. On the contrary, PMA has been reported to behave more aggressively in its clinical progression than PA. Here, we describe a rare case of PMA in a 25-year-old female involving the temporal lobe, presenting with recurrent partial seizures. To our knowledge, this is the first reported case of PMA presenting in the temporal lobe in an adult female with an atypical location of the tumour, uncommon age group, and unusual radiological features being unique in this case report.
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Affiliation(s)
- Denesh Selvarajah
- Medical Officer, Department of Neurosurgery, The Canberra Hospital; MChD, Australia,Corresponding author. Resident Medical Officer, Department of Neurosurgery The Canberra Hospital, Yamba Dr, Garran ACT 2605 Australia.
| | - Alexander Lam
- Neurosurgical Registrar, Department of Neurosurgery, The Canberra Hospital; MChD, Australia
| | - Mitali Fadia
- Consultant Pathologist, Department of Pathology, The Canberra Hospital; FRCPA, Australia
| | - David McDowell
- Consultant Neurosurgeon, Head of Department, Department of Neurosurgery, The Canberra Hospital; FRACS, Australia
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8
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Shreve LA, Lam A, Badin D, Nelson K, Katrivesis J, Fernando D, Abi-Jaoudeh N. Changes in perfusion angiography after IVC filter placement and retrieval. Medicine (Baltimore) 2022; 101:e31600. [PMID: 36550909 PMCID: PMC9771224 DOI: 10.1097/md.0000000000031600] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Inferior vena cava (IVC) filters are posited to effect flow dynamics, causing turbulence, vascular remodeling and eventual thrombosis; however, minimal data exists evaluating hemodynamic effects of IVC filters in vivo. The purpose of this study was to determine differences in hemodynamic flow parameters acquired with two-dimension (2D)-perfusion angiography before and after IVC filter placement or retrieval. 2D-perfusion images were reconstructed retrospectively from digital subtraction angiography from a cohort of 37 patients (13F/24M) before and after filter placement (n = 18) or retrieval (n = 23). Average dwell time was 239.5 ± 132.1 days. Changes in the density per pixel per second within a region of interest (ROI) were used to calculate contrast arrival time (AT), time-to-peak (TTP), wash-in-rate (WIR), and mean transit time (MTT). Measurements were obtained superior to, inferior to, and within the filter. Differences in hemodynamic parameters before and after intervention were compared, as well as correlation between parameters versus filter dwell time. A P value with Bonferroni correction of <.004 was considered statistically significant. After placement, there was no difference in any 2D-perfusion variable. After retrieval, ROIs within and inferior to the filter showed a significantly shorter TTP (1.7 vs 1.4 s, P = .004; 1.5 vs 1.3 s, P = .001, respectively) and MTT (1.7 vs 1.4 s, P = .003; 1.5 vs 1.2 s, P = .002, respectively). Difference in variables showed no significant correlation when compared to dwell time. 2D-perfusion angiography is feasible to evaluate hemodynamic effects of IVC filters in vivo. TTP and MTT within and below the filter after retrieval were significantly changed, without apparent correlation to dwell time, suggesting a functional hemodynamic delay secondary to filter presence.
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Affiliation(s)
- Lauren A. Shreve
- Department of Radiological Sciences, University of Pennsylvania, Philadelphia, PA, USA
- *Correspondence: Lauren Shreve, Department of Radiological Sciences, University of Pennsylvania, 3400 Spruce Street, 1 Silverstein Suite 130, Philadelphia, PA, 19104. (e-mail: )
| | - Alexander Lam
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Dylan Badin
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA
| | - Kari Nelson
- Department of Radiology, Vascular and Interventional Radiology, Saddleback Memorial Medical Center, Laguna Hills, CA, USA
| | - James Katrivesis
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA
| | - Dayantha Fernando
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA
| | - Nadine Abi-Jaoudeh
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA
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9
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Lam A, Kim YJ, Fidelman N, Higgins M, Cash BD, Charalel RA, Guimaraes MS, Kwan SW, Patel PJ, Plett S, Scali ST, Stadtlander KS, Stoner M, Tong R, Kapoor BS. ACR Appropriateness Criteria® Radiologic Management of Mesenteric Ischemia: 2022 Update. J Am Coll Radiol 2022; 19:S433-S444. [PMID: 36436968 DOI: 10.1016/j.jacr.2022.09.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Mesenteric ischemia is a serious medical condition characterized by insufficient vascular supply to the small bowel. In the acute setting, endovascular interventions, including embolectomy, transcatheter thrombolysis, and angioplasty with or without stent placement, are recommended as initial therapeutic options. For nonocclusive mesenteric ischemia, transarterial infusion of vasodilators, such as papaverine or prostaglandin E1, is the recommended initial treatment. In the chronic setting, endovascular means of revascularization, including angioplasty and stent placement, are generally recommend, with surgical options, such as bypass or endarterectomy, considered alternative options. Although the diagnosis of median arcuate ligament syndrome remains controversial, diagnostic angiography can be helpful in rendering a diagnosis, with the preferred treatment option being a surgical release. Systemic anticoagulation is recommended as initial therapy for venous mesenteric ischemia with acceptable rates of recanalization. If anticoagulation fails, transcatheter thrombolytic infusion can be considered with possible adjunctive placement of a transjugular intrahepatic portosystemic shunt to augment antegrade flow. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Alexander Lam
- University of California, San Francisco, San Francisco, California.
| | - Yoon-Jin Kim
- Research Author, University of California, San Francisco, San Francisco, California
| | - Nicholas Fidelman
- Panel Chair, University of California, San Francisco, San Francisco, California
| | - Mikhail Higgins
- Panel Vice-Chair, Boston University School of Medicine, Boston, Massachusetts
| | - Brooks D Cash
- Chief of Gastroenterology, Hepatology, and Nutrition Division, University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | | | - Marcelo S Guimaraes
- Division Chief Pediatric Radiology, Medical University of South Carolina, Charleston, South Carolina
| | | | - Parag J Patel
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sara Plett
- Department of Radiology Chair, Sonoran Crossing Medical Center, Southwest Medical Imaging, Scottsdale, Arizona
| | - Salvatore T Scali
- University of Florida, Gainesville, Florida; Society for Vascular Surgery; SVS PSO VQI EVAR Registry Chair
| | | | - Michael Stoner
- Chief, Division of Vascular Surgery, Vice-Chair, Clinical Operations, University of Rochester Medical Center, Rochester, New York; Society for Vascular Surgery
| | - Ricky Tong
- Main Line Health, Bryn Mawr, Pennsylvania; Peer Review Committee
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Rashed AN, Mohamud N, Lam A, Hamadallah H, Terry D, Tomlin S. Community pharmacy role in children's health in England: Experiences and opinions of parents and young people. Health Soc Care Community 2022; 30:2362-2371. [PMID: 35315159 DOI: 10.1111/hsc.13786] [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: 11/09/2020] [Revised: 12/25/2021] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
Little is known about the reason behind the underutilisation of community pharmacy (CP) for children. This study explored the experiences, barriers and recommendations of parents/carers and young people regarding their use of CP services for children. Two-stage facilitated, structured, audio-recorded interviews were conducted at each of four CPs in London, England, between May and November 2019 [1 month in each CP]. Parents/carers or young persons (aged 16-18 years) who visited CP for a child-related matter were invited to participate. Interviews were transcribed verbatim. Data were analysed both quantitatively and qualitatively, using thematic analysis to identify themes. In total, 249 (58.2% of 428 eligible) customers agreed to participate and completed the two interviews. Out of these, 82.3% (205/249) reported positive experiences with the CP. The general practitioner (GP) was the preferred healthcare provider for minor ailments (44.6%,111/249), while 35.7% (89/249) would choose CP. Eighty-two participants (33%) visited an Emergency Department in the last 12 months, with 13.4% (11/82) of them visited for cold and cough reasons. Where a child was present with parents/carer (128/249), there was a low level of interaction between children and pharmacists (13.3%, 17/128). Lack of awareness about the CP services provided for children and privacy were among the barriers identified by participants. Advertising of CP services and creating a child-friendly environment were recommendations suggested by participants. The findings of this paper show that CP remains an underutilised health service for children by parents/carers and young persons. More work is needed to increase public awareness of the roles of CP in children's health and well-being.
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Affiliation(s)
- Asia N Rashed
- Institute of Pharmaceutical Science, King's College London, London, UK
- Evelina Pharmacy, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nadiya Mohamud
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Alexander Lam
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Hanaa Hamadallah
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - David Terry
- Academic Practice Unit, Life & Health Sciences, Aston University, Birmingham, UK
| | - Stephen Tomlin
- Pharmacy Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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Lam A, Jankovic L, Aharonyan L, McGroarty K, Prince M, Morris L, Stang C, Berdahl C, Torbati S. 95 A Tender-Loving-Care Volunteer Program to Provide Non-Clinical, Supportive Interventions to Older Adults in the Emergency Department. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.118] [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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12
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Sanghvi S, Szteyn K, Ponnalagu D, Sridharan D, Lam A, Hansra I, Chaudhury A, Majumdar U, Kohut A, Rao S, Khan M, Garg V, Singh H. Abstract P1050: Activation Of Bk
Ca
Channel Increases Myocardial Infarction After Ischemia-Reperfusion Injury In Neonatal Hearts. Circ Res 2022. [DOI: 10.1161/res.131.suppl_1.p1050] [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: 11/16/2022]
Abstract
Large-conductance calcium and voltage-activated potassium channels (BK
Ca
) are heterogeneously expressed in a wide array of cells. In adult ventricular cardiomyocytes, activation of mitochondrial BK
Ca
channels is implicated in cardioprotection against ischemia-reperfusion (IR) injury. However, plasma membrane BK
Ca
channel activity has never been detected in adult ventricular cardiomyocytes. In this study, we report the presence of the BK
Ca
channel in the plasma membrane and mitochondria of neonatal murine and rodent cardiomyocytes. In neonatal cardiomyocyte (NCM), whole-cell potassium currents measured were sensitive to iberiotoxin (IbTx), suggesting the presence of BK
Ca
channels in the plasma membrane. Moreover, the open probability of single-channel recording decreased in presence of IbTx by 46+5% (n=10) and 32+5% (n=10) for rats and mice, respectively.
Ex vivo
studies with isolated neonatal hearts (p6) subjected to ischemia and post-conditioned with NS1619 during reoxygenation increased (58+3% as opposed to 48+5% for control, n>5 pups) the myocardial infarction whereas IbTx reduced (32+2%) the infarct size. In agreement, isolated NCM also presented increased apoptosis on treatment with NS1619 during hypoxia-reoxygenation (HR), whereas IbTx reduced TUNEL positive cells. In NCMs, activation of BK
Ca
channels increased the intracellular reactive oxygen species post HR injury. Electrophysiological characterization of NCMs indicated that NS1619 increased the beat period, field, and action potential duration, and decreased the conduction velocity and spike amplitude. In contrast, IbTx had no impact on the electrophysiological properties of NCMs. Taken together, our data established that inhibition of plasma membrane BK
Ca
channels in the neonates protects the heart/cardiomyocytes from IR injury. Furthermore, the functional disparity observed towards the cardioprotective activity of BK
Ca
channels in adults compared to neonatal heart could be attributed to their differential localization.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Vidu Garg
- Nationwide Children's Hosp, Columbus, OH
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13
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Gorantla V, Heller M, Wu X, Lam A. Abstract No. 224 Comparison of outcomes in patients with biliary obstruction undergoing endoscopic retrograde cholangiopancreatography with biliary stenting versus percutaneous transhepatic biliary drainage. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.305] [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: 10/18/2022] Open
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14
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Zhou A, Wu X, Youm J, Heller M, Lam A. Abstract No. 203 Drug-coated balloon angioplasty versus conventional balloon angioplasty for arteriovenous fistula stenosis: a cost effectiveness study. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.284] [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: 10/18/2022] Open
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15
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Tanner H, Goulouti E, Lam A, Elchinova E, Nozica N, Servatius H, Noti F, Seiler J, Baldinger SH, Haeberlin A, Franzeck F, Asatryan B, Reichlin T, Roten L. Gender gap in study inclusion: Insights from the STAR-FIB cohort study. Europace 2022. [DOI: 10.1093/europace/euac053.153] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Swiss National Science Foundation Swiss Heart Foundation
Background
The underrepresentation of women in cardiovascular clinical trials is well described but cannot be fully explained by sex-specific differences in the prevalence of cardiovascular diseases. Data on potential sex- and gender-related differences in study exclusion reasons are scarce.
The STAR-FIB cohort study aimed to estimate the age and sex-specific prevalence of screening-detected atrial fibrillation (AF) in 800 hospitalized patients aged 65-84 years using serial seven-day ECGs. Recruitment for study inclusion was stratified by sex (female/male, as stated in the patient’s records) and age (four age bands, ≥65 to <70, ≥70 to <75, ≥75 to <80, and ≥80 to <85 years), and was truncated for each subgroup after the inclusion of 100 participants.
Purpose
To assess sex and gender differences in patient recruitment for inclusion in the STAR-FIB cohort study.
Methods
A screening log containing sex-category, age, and reasons for exclusion was maintained. Exclusion criteria are shown in the figure. For the purpose of the present study, an explorative analysis of all exclusion criteria with respect to sex category was done.
Results
Overall, 11’470 patients were identified for eligibility, 795 patients (49% women; mean age 75 years) were enrolled, and 10’675 patients (52% women vs. 48% men, p =0.13) were not enrolled. The two major exclusion reasons were unwillingness to participate, which was more frequent in women (27.9% of women vs. 18.4% of men, p < 0.01), and the presence of clinical AF, which was more prevalent in men (27.1% of men vs. 20.5 % of women, p < 0.01). A detailed analysis of all exclusion criteria analysed by sex category is provided in the figure.
Conclusions
Clinical AF was more frequent in men, in accordance with the well described sex-driven (biological) higher prevalence of AF in men. In contrast, we found a higher percentage of women unwilling to participate in this study, which may represent a more gender-based (sociocultural) phenomenon. A further exploration of these findings should be performed and may help to identify and potentially overcome modifiable obstacles for study participation.
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Affiliation(s)
- H Tanner
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - E Goulouti
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - A Lam
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - E Elchinova
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - N Nozica
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - H Servatius
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - F Noti
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - J Seiler
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - SH Baldinger
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - A Haeberlin
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - F Franzeck
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - B Asatryan
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - T Reichlin
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - L Roten
- Bern University Hospital, Cardiology, Bern, Switzerland
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16
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Goulouti E, Lam A, Nozica N, Elchinova E, Spirito A, Servatius H, Noti F, Seiler J, Baldinger S, Haeberlin A, Babken A, Franzeck F, Tanner H, Reichlin T, Roten L. Incidental arrhythmias during atrial fibrillation screening in a hospital-based patient population. Europace 2022. [DOI: 10.1093/europace/euac053.032] [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: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Screening for atrial fibrillation may reveal other, incidental arrhythmias of relevance. We sought to describe such incidental arrhythmias in the prospective STARFIB cohort study, which screened for silent atrial fibrillation in hospitalized patients aged 65-84 years.
Method
Patients included in the STARFIB cohort study had up to three 7-day Holter ECGs, performed in two-month intervals. We analysed all the 7-day Holter ECGs of study participants for the presence of one of the following incidental arrhythmias: 1) sick-sinus-syndrome (SSS), defined as sinus arrest of ≥3 seconds duration; 2) second or higher degree atrioventricular block (AVB); 3) sustained atrial tachycardia of ≥30 seconds duration (AT); and 4) sustained ventricular tachycardia of ≥30 seconds duration (VT).
Results
A total of 2’077 Holter ECGs were performed in 794 patients (mean age 74.7 years; 49% females), resulting in a mean cumulative duration of an analyzable ECG signal of 414±136 hours per patient. We found incidental arrhythmias in 94 patients (11.8%). Among these were SSS in 14 patients (1.8%), AVB in 41 (5.2%), AT in 41 (5.2%), and VT in two (0.3%). The median pause duration in SSS was 4 seconds and SSS resulted in pacemaker implantation in one patient with a pause of 9 seconds duration. The most severe type of AVB found per patient was second degree AVB type Wenkebach in 23 patients (2.9%), second degree AVB type Mobitz or 2:1 AV conduction in 10 patients (1.3%) and complete AVB in 8 (1%; maximum pause 18 seconds). AVB led to pacemaker implantation in 9 patients (1.1%). The median duration and heart rate of AT was 2.2 minutes and 144 bpm, respectively. Initiation of betablocker therapy was recommended in 3 patients (0.4%) due to symptomatic AT. The duration and heart rate of VT was 3 minutes at 216 bpm in one patient and 38 seconds at 150 bpm in another. The former patient with VT experienced syncope and an ICD was implanted, whereas in the latter the betablocker dose was increased. One patient died from a non-cardiac cause during a Holter ECG, which showed progressive bradycardia and finally asystole.
Conclusion
Incidental arrhythmias were frequently discovered during screening for atrial fibrillation and resulted in device therapy in 1.4% of our cohort patients.
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Affiliation(s)
- E Goulouti
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - A Lam
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - N Nozica
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - E Elchinova
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - A Spirito
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - H Servatius
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - F Noti
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - J Seiler
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - S Baldinger
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - A Haeberlin
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - A Babken
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - F Franzeck
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - H Tanner
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - T Reichlin
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - L Roten
- Bern University Hospital, Inselspital, Bern, Switzerland
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17
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Vassilev S, Sue Y, Lim Z, Sivalingam J, Lam A, Ho V, Renia L, Malleret B, Reuveny S, Oh S. iPSC: SELECTION OF O-VE IPSC CLONES FOR HIGH-DENSITY RED BLOOD CELL PRODUCTION IN A SCALABLE PERFUSION BIOREACTOR SYSTEM. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00390-5] [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: 11/03/2022]
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18
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Sanghvi S, Szteyn K, Ponnalagu D, Sridharan D, Lam A, Hansra I, Chaudhury A, Majumdar U, Kohut AR, Gururaja Rao S, Khan M, Garg V, Singh H. Inhibition of BK Ca channels protects neonatal hearts against myocardial ischemia and reperfusion injury. Cell Death Dis 2022; 8:175. [PMID: 35393410 PMCID: PMC8989942 DOI: 10.1038/s41420-022-00980-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/15/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022]
Abstract
BKCa channels are large-conductance calcium and voltage-activated potassium channels that are heterogeneously expressed in a wide array of cells. Activation of BKCa channels present in mitochondria of adult ventricular cardiomyocytes is implicated in cardioprotection against ischemia-reperfusion (IR) injury. However, the BKCa channel’s activity has never been detected in the plasma membrane of adult ventricular cardiomyocytes. In this study, we report the presence of the BKCa channel in the plasma membrane and mitochondria of neonatal murine and rodent cardiomyocytes, which protects the heart on inhibition but not activation. Furthermore, K+ currents measured in neonatal cardiomyocyte (NCM) was sensitive to iberiotoxin (IbTx), suggesting the presence of BKCa channels in the plasma membrane. Neonatal hearts subjected to IR when post-conditioned with NS1619 during reoxygenation increased the myocardial infarction whereas IbTx reduced the infarct size. In agreement, isolated NCM also presented increased apoptosis on treatment with NS1619 during hypoxia and reoxygenation, whereas IbTx reduced TUNEL-positive cells. In NCMs, activation of BKCa channels increased the intracellular reactive oxygen species post HR injury. Electrophysiological characterization of NCMs indicated that NS1619 increased the beat period, field, and action potential duration, and decreased the conduction velocity and spike amplitude. In contrast, IbTx had no impact on the electrophysiological properties of NCMs. Taken together, our data established that inhibition of plasma membrane BKCa channels in the NCM protects neonatal heart/cardiomyocytes from IR injury. Furthermore, the functional disparity observed towards the cardioprotective activity of BKCa channels in adults compared to neonatal heart could be attributed to their differential localization.
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Affiliation(s)
- Shridhar Sanghvi
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Molecular Cellular and Developmental Biology, The Ohio State University, Columbus, OH, USA
| | - Kalina Szteyn
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Devasena Ponnalagu
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Divya Sridharan
- Department of Emergency Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Alexander Lam
- Department of Internal Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Inderjot Hansra
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ankur Chaudhury
- Department of Internal Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Uddalak Majumdar
- Center for Cardiovascular Research and The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Andrew R Kohut
- Department of Internal Medicine, Drexel University College of Medicine, Philadelphia, PA, USA.,Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shubha Gururaja Rao
- Department of Pharmaceutical and Biomedical Sciences, The Raabe College of Pharmacy, Ohio Northern University, Ada, OH, USA
| | - Mahmood Khan
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Emergency Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Vidu Garg
- Center for Cardiovascular Research and The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Harpreet Singh
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA. .,Department of Molecular Cellular and Developmental Biology, The Ohio State University, Columbus, OH, USA.
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19
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Shen R, Wang YM, Cheung CY, Tang FY, Lam A, Tham CC, Chan PP. Relationship between macular intercapillary area measured by optical coherence tomography angiography and central visual field sensitivity in normal tension glaucoma. Br J Ophthalmol 2022; 107:816-822. [PMID: 35110277 DOI: 10.1136/bjophthalmol-2021-319923] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/20/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE To investigate the relationship of macular intercapillary area (ICA) with macular ganglion cell-inner plexiform layer (GCIPL) thickness and central visual field sensitivity (CVFS) in normal tension glaucoma (NTG). METHODS Seventy-eight early NTG eyes, 33 moderate-to-severe NTG eyes and 75 normal control eyes were cross-sectional evaluated. All participants underwent swept-source optical coherence tomography angiography (OCT-A; DRI-OCT, Topcon, Tokyo, Japan). A customised MATLAB program was used to quantify macular OCT-A metrics at central 3×3 mm macular region including vascular density (VD), foveal avascular zone (FAZ) area, 10 largest ICA including FAZ area (ICA10_IncFAZ) and excluding FAZ area (ICA10_ExcFAZ). Generalised estimating equation regression models were performed to determine the relationships of OCT-A vascular metrics with GCIPL thickness in the macular region and CVFS. RESULTS NTG eyes had lower global VD, larger ICA10_IncFAZ, and larger ICA10_ExcFAZ than normal controls (all p≤0.016). In the multivariable analyses, decreased VD (β=-0.304, p=0.006) and increased ICA (β=-0.231 for ICA10_IncFAZ and β=-0.259 for ICA10_ExcFAZ, all p≤0.042) were significantly associated with decreased GCIPL thickness in early NTG eyes but not in moderate-to-severe NTG eyes. ICA enlargement was associated with CVFS in early NTG eyes (β=-0.310, p=0.009), while VD was associated with CVFS in moderate-to-severe NTG eyes (β=-0.272, p=0.038). CONCLUSION ICA enlargement could be a potentially important disease marker of early NTG as reflected by its association with GCIPL thinning and decrease CVFS specifically for early NTG eyes.
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Affiliation(s)
- Ruyue Shen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Yu Meng Wang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Fang Yao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Alexander Lam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China .,Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong, China
| | - Poemen PuiMan Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China .,Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong, China
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20
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Pride T, Lam A, Swansburg J, Seno M, Lowe MB, Bomfim E, Toombs E, Marsan S, LoRusso J, Roy J, Gurr E, LaFontaine J, Paul J, Burack JA, Mushquash C, Stewart SH, Wendt DC. Trauma-informed Approaches to Substance Use Interventions with Indigenous Peoples: A Scoping Review. J Psychoactive Drugs 2021; 53:460-473. [PMID: 34895091 DOI: 10.1080/02791072.2021.1992047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Indigenous Peoples experience disproportionately higher rates of problematic substance use. These problems are situated in a context of individual and intergenerational trauma from colonization, residential schools, and racist and discriminatory practices, policies, and services. Therefore, substance use interventions need to adopt a trauma-informed approach. We aimed to synthesize and report the current literature exploring the intersection of trauma and substance use interventions for Indigenous Peoples. Fourteen databases were searched using keywords for Indigenous Peoples, trauma, and substance use. Of the 1373 sources identified, 117 met inclusion criteria. Literature on trauma and substance use with Indigenous Peoples has increased in the last 5 years (2012-2016, n = 29; 2017-2021, n = 48), with most literature coming from the United States and Canada and focusing on historical or intergenerational trauma. Few articles focused on intersectional identities such as 2SLGBTQIA+ (n = 4), and none focused on veterans. There were limited sources (n = 25) that reported specific interventions at the intersection of trauma and substance use. These sources advocate for multi-faceted, trauma-informed, and culturally safe interventions for use with Indigenous Peoples. This scoping review illuminates gaps in the literature and highlights a need for research reporting on trauma-informed interventions for substance use with Indigenous Peoples.
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Affiliation(s)
- T Pride
- Faculty of Health, Dalhousie University, Halifax, Canada
| | - A Lam
- Centre de Recherche du Chum, Université de Montréal, Montreal, Canada
| | - J Swansburg
- Centre de Recherche du Chum, Université de Montréal, Montreal, Canada.,Psychology and Neuroscience, Dalhousie University, Halifax, Canada
| | - M Seno
- Centre de Recherche du Chum, Université de Montréal, Montreal, Canada.,Psychology and Neuroscience, Dalhousie University, Halifax, Canada.,Maastricht University, Psychology and Neuroscience, Maastricht, The Netherlands
| | - M B Lowe
- Health and Human Performance, Dalhousie University, Halifax, Canada
| | - E Bomfim
- Educational and Counselling Psychology, McGill University, Montreal, Canada.,Psychology, Concordia University, Montreal, Canada
| | - E Toombs
- Psychology, Lakehead University, Thunder Bay, Canada
| | - S Marsan
- Family and Emergency Medicine, Université de Montréal, Montreal, Canada
| | - J LoRusso
- Psychology and Neuroscience, Dalhousie University, Halifax, Canada
| | - J Roy
- Social Work, McGill University, Montreal, Canada
| | - E Gurr
- Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - J LaFontaine
- Integrated Studies in Education, McGill University, Montreal, Canada
| | - J Paul
- Psychology and Neuroscience, Dalhousie University, Halifax, Canada
| | - J A Burack
- Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - C Mushquash
- Psychology, Lakehead University, Thunder Bay, Canada
| | - S H Stewart
- Psychology and Neuroscience, Dalhousie University, Halifax, Canada.,Psychiatry, Dalhousie University, Halifax, Canada
| | - D C Wendt
- Educational and Counselling Psychology, McGill University, Montreal, Canada
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21
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Wittmer S, Chollet L, Baldinger S, Servatius H, Seiler J, Madaffari A, Kueffer T, Muehl A, Asatryan B, Lam A, Noti F, Haeberlin A, Roten L, Tanner H, Reichlin T. Impact of clinical risk factor profile vs. atrial fibrillation phenotype on outcome after pulmonary vein isolation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0373] [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
Aims
Catheter ablation for atrial fibrillation (AF) is increasingly performed. Both clinical risk factors as well as the AF phenotype have been shown to influence ablation outcomes. The inter-relationship of the two however is incompletely understood.
Methods
In a retrospective analysis of a prospective registry of patients undergoing a first pulmonary vein isolation, the association of 8 predefined clinical risk factors (age >70 years, female gender, hypertension, BMI >30 kg/m2, coronary artery disease, heart failure, chronic kidney disease (CKD; eGFR<60ml/min/1.73m2) and diabetes mellitus) and the AF phenotype (paroxysmal vs. persistent AF) were assessed as well as their impact on AF recurrence during follow-up.
Results
Overall, 715 patients were enrolled (median age 63 years, 27% females, 69% paroxysmal AF). The prevalence of obesity, hypertension, heart failure and CKD was significantly higher in persistent AF, while female gender was more prevalent in paroxysmal AF. After 2 years of follow-up, overall freedom from recurrence was 46%, and was higher in paroxysmal AF compared to persistent AF (54.1% vs. 29.1%, p<0.001). Of the clinical risk factors, obesity (p=0.02), CKD (p=0.01) and heart failure (p=0.01) were significantly associated with lower arrhythmia-free survival, and there was a trend for hypertension and coronary artery disease (both p<0.2). A risk score composed of those 5 factors was associated with recurrences in patients with paroxysmal AF (p=0.04, Figure 1), but not in those with persistent AF (p=0.85, Figure 2).
Conclusion
Clinical risk factors predict outcome after pulmonary vein isolation in patients with paroxysmal, but not persistent AF. This is likely due to a strong association of those risk factors with the occurrence of persistent AF.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- S Wittmer
- Inselspital - University of Bern, Bern, Switzerland
| | - L Chollet
- Inselspital - University of Bern, Bern, Switzerland
| | - S Baldinger
- Inselspital - University of Bern, Bern, Switzerland
| | - H Servatius
- Inselspital - University of Bern, Bern, Switzerland
| | - J Seiler
- Inselspital - University of Bern, Bern, Switzerland
| | - A Madaffari
- Inselspital - University of Bern, Bern, Switzerland
| | - T Kueffer
- Inselspital - University of Bern, Bern, Switzerland
| | - A Muehl
- Inselspital - University of Bern, Bern, Switzerland
| | - B Asatryan
- Inselspital - University of Bern, Bern, Switzerland
| | - A Lam
- Inselspital - University of Bern, Bern, Switzerland
| | - F Noti
- Inselspital - University of Bern, Bern, Switzerland
| | - A Haeberlin
- Inselspital - University of Bern, Bern, Switzerland
| | - L Roten
- Inselspital - University of Bern, Bern, Switzerland
| | - H Tanner
- Inselspital - University of Bern, Bern, Switzerland
| | - T Reichlin
- Inselspital - University of Bern, Bern, Switzerland
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22
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Mikael A, Yufa A, Gochi A, Fawibe O, Maley M, Lam A, Lara G, Andacheh I. Application of the VORTEC Technique in Creating a Proximal Inflow Conduit in the Circumferentially-Calcified or "Lead-Pipe" Aorta. Ann Vasc Surg 2021; 79:432-436. [PMID: 34644645 DOI: 10.1016/j.avsg.2021.07.026] [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: 12/08/2020] [Revised: 07/10/2021] [Accepted: 07/20/2021] [Indexed: 11/01/2022]
Abstract
A heavily calcified or "lead-pipe" aorta can present many challenges to any surgeon. There is higher risk of vessel wall rupture or disruption, distal embolization, and prolonged ischemia time of visceral organs due to longer clamp times. Hybrid revascularization techniques, which were originally described in visceral revascularization during complex aortic procedures, can be potentially utilized for lower extremity bypasses. These techniques, such as "VORTEC," are well-studied and have been shown to have similar patency rates as traditional bypass grafts with the added benefit of decreased ischemia time and lower levels of acute kidney injury and visceral organ ischemia. This allows VORTEC and other similar hybrid techniques to be utilized as options when traditional vessel control cannot be safely achieved during distal revascularization procedures, as we describe in our patient.
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Affiliation(s)
- Amarseen Mikael
- Department of Surgery, Riverside Community Hospital, Riverside, CA; University of California, Riverside School of Medicine, Riverside, CA.
| | - Ann Yufa
- Albert Einstein Medical Center, Philadelphia, PA
| | - Andrea Gochi
- University of California, Riverside School of Medicine, Riverside, CA
| | - Oluwatosin Fawibe
- Department of Surgery, Riverside Community Hospital, Riverside, CA; University of California, Riverside School of Medicine, Riverside, CA
| | - Manda Maley
- Albert Einstein Medical Center, Philadelphia, PA
| | | | - Gustavo Lara
- Department of Surgery, Riverside Community Hospital, Riverside, CA; University of California, Riverside School of Medicine, Riverside, CA
| | - Iden Andacheh
- Department of Surgery, Riverside Community Hospital, Riverside, CA; University of California, Riverside School of Medicine, Riverside, CA
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23
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Goodman S, Bagai A, Tan M, Andrade J, Spindler C, Malek-Marzban P, Har B, Yip A, Paniagua M, Elbarouni B, Bainey K, Paradis J, Maranda R, Cantor W, Doucet M, Khan R, Eisenberg M, Dery J, Schwalm J, Madan M, Lam A, Hameed A, Noronha L, Cieza T, Matteau A, Roth S, So D, Lavi S, Glanz A, Gao D, Tahiliani R, Welsh R, Kim H, Robinson S, Daneault B, Chong A, Le May M, Ahooja V, Gregoire J, Nadeau P, Laksman Z, Heilbron B, Bonakdar H, Yung D, Yan A. ANTITHROMBOTIC THERAPIES IN CANADIAN ATRIAL FIBRILLATION PATIENTS WITH CONCOMITANT CORONARY ARTERY DISEASE: INSIGHTS FROM THE CONNECT AF+PCI-I AND -II PROGRAMS. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.030] [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] Open
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Oh S, Lam A, Sivalingam J, Lim Z, Loh Y, Reuveny S, Malleret B. Generation of high densities of universal O-ve red blood cells from human induced pluripotent stem cells in bioreactors. Cytotherapy 2021. [DOI: 10.1016/s1465324921002760] [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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25
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Lam A, Jayaraman P, Tong G, Ho V, Reuveny S, Oh S. Directed differentiation of pluripotent stem cells toward retinal pigment epithelium lineage by crispr activation. Cytotherapy 2021. [DOI: 10.1016/s1465324921004758] [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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26
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Li F, Lin F, Gao K, Cheng W, Song Y, Liu Y, Wang YM, Lam A, Tham CC, Cheung C, Zhang X, Zangwill LM. Association of foveal avascular zone area withstructural and functional progression in glaucoma patients. Br J Ophthalmol 2021; 106:1245-1251. [PMID: 33827858 DOI: 10.1136/bjophthalmol-2020-318065] [Citation(s) in RCA: 12] [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: 09/28/2020] [Revised: 02/02/2021] [Accepted: 03/07/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND To investigate whether quantitative optical coherence tomography angiography (OCTA) metrics of the superficial/deep macular retina and optic disc are associated with glaucoma progression risk. METHODS A total of 238 eyes from 119 patients with open angle glaucoma or ocular hypertension, and no history of systemic hypertension or diabetes mellitus were included. All participants underwent OCTA imaging with a swept-source OCT (DRI-OCT 1, Topcon, Japan). OCTA metrics of superficial capillary plexus (SCP) and deep capillary plexus (DCP) in the macular region, and radial peripapillary capillary network of the optic disc were measured by a customised MATLAB program to obtain foveal avascular zone (FAZ) area, FAZ circularity and capillary density of SCP/DCP, and capillary density of the peripapillary region. Relationships between baseline OCTA metrics, visual field (VF) metrics, intraocular pressure fluctuation and risk of glaucoma progression were analysed with the Cox proportional hazards model. A frailty model was used to adjust for intereye correlation. RESULTS During a mean follow-up duration of 29.39 months (range 12-56 months), 50, 48 and 16 eyes were determined to have retinal nerve fibre layer (RNFL), ganglion cell-inner plexiform layer (GC-IPL) and VF progression respectively. FAZ area per SD increase at baseline were significantly associated with both RNFL thinning (HR 1.73 95% CI 1.04 to 2.90); p=0.036) and GC-IPL thinning (HR 2.62, 95% CI 1.59 to 4.31; p<0.001), after adjusting for age, axial length and other potential confounding factors. VF progression was associated with age (HR 1.05, 95% CI 1.02 to 1.08; p<0.001) and mean deviation value (HR 0.91, 95% CI 0.84 to 0.98; p=0.010), but not with any OCTA metrics. CONCLUSION Enlarged FAZ area measured by OCTA was associated with a higher risk of RNFL and GC-IPL thinning associated with glaucoma, but not with functional deterioration in glaucoma.
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Affiliation(s)
- Fei Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Fengbin Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Kai Gao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Weijing Cheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yunhe Song
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yuhong Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yu Meng Wang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alexander Lam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Carol Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Linda M Zangwill
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, La Jolla, California, USA
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Lee AY, Lam A, Hicks RM, Isikbay M, Heller MB, Sugi MD, Behr S, Kohi MP. Visceral Aneurysm Formation and Intraabdominal Hemorrhage Associated with Immune Checkpoint Inhibitor Therapy. J Vasc Interv Radiol 2020; 32:151-152. [PMID: 33277167 DOI: 10.1016/j.jvir.2020.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Andrew Y Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave., Suite M-361, San Francisco, CA 94143
| | - Alexander Lam
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave., Suite M-361, San Francisco, CA 94143
| | - Robert M Hicks
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave., Suite M-361, San Francisco, CA 94143
| | - Masis Isikbay
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave., Suite M-361, San Francisco, CA 94143
| | - Michael B Heller
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave., Suite M-361, San Francisco, CA 94143
| | - Mark D Sugi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave., Suite M-361, San Francisco, CA 94143
| | - Spencer Behr
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave., Suite M-361, San Francisco, CA 94143
| | - Maureen P Kohi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave., Suite M-361, San Francisco, CA 94143
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Lin TPH, Wang YM, Ho K, Wong CYK, Chan PP, Wong MOM, Chan NCY, Tang F, Lam A, Leung DYL, Wong TY, Cheng CY, Cheung CY, Tham CC. Global assessment of arteriolar, venular and capillary changes in normal tension glaucoma. Sci Rep 2020; 10:19222. [PMID: 33154407 PMCID: PMC7644687 DOI: 10.1038/s41598-020-75784-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/12/2020] [Indexed: 01/31/2023] Open
Abstract
Microcirculatory insufficiency has been hypothesized in glaucoma pathogenesis. There is a scarcity of data to comprehensively examine the changes in retinal microvasculature and its role in normal tension glaucoma (NTG). We conducted a cross-sectional case-control study and included 168 eyes from 100 NTG patients and 68 healthy subjects. Quantitative retinal arteriolar and venular metrics were measured from retinal photographs using a computer-assisted program. Radial peripapillary capillary network was imaged with OCT-A and quantitative capillary metrics (circumpapillary vessel density (cpVD) and circumpapillary fractal dimension (cpFD)) were measured with a customized MATLAB program. We found that NTG was associated with decreased arteriolar and venular tortuosity, arteriolar branching angle, cpVD and cpFD. Decreased venular caliber, arteriolar and venular branching angles, cpVD and cpFD were associated with thinner average RNFL thickness. Decreased arteriolar and venular branching angles, cpVD and cpFD were also associated with worse standard automated perimetry measurements (mean deviation and visual field index). Compared with retinal arteriolar and venular metrics, regression models based on OCT-A capillary metrics consistently showed stronger associations with NTG and structural and functional measurements in NTG. We concluded that NTG eyes showed generalized microvascular attenuations, in which OCT-A capillary metrics attenuations were more prominent and strongly associated with NTG.
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Affiliation(s)
- Timothy P H Lin
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Yu Meng Wang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Kevin Ho
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Cherie Y K Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Hong Kong, China
| | - Poemen P Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Hong Kong, China
| | - Mandy O M Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Hong Kong, China
| | - Noel C Y Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology, Prince of Wales Hospital, Hong Kong, China
| | - Fangyao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Alexander Lam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Dexter Y L Leung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Singapore
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Hong Kong, China
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Lam A, Schwertner A, Katrivesis J, Fernando D, Nelson K, Abi-Jaoudeh N. Atherectomy with balloon angioplasty compared to balloon angioplasty alone for the treatment of chronic limb threatening ischemia: A national surgical quality improvement program database analysis. Vascular 2020; 28:747-755. [PMID: 33045944 DOI: 10.1177/1708538120932713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/16/2022]
Abstract
OBJECTIVES To compare perioperative outcomes related to atherectomy with percutaneous transluminal angioplasty versus percutaneous transluminal angioplasty alone for the treatment of lower extremity chronic limb threatening ischemia using a national patient database. METHODS Patients with chronic limb threatening ischemia treated with atherectomy and percutaneous transluminal angioplasty or percutaneous transluminal angioplasty alone from 2011 to 2016 in the National Surgical Quality Improvement Program database were identified. Primary outcomes were major adverse limb events (30-day untreated loss of patency, major reintervention, major amputation) and major adverse cardiac events (cardiac arrest, composite outcome of myocardial infarction or stroke). Secondary outcomes included 30-day mortality, length of stay, and any unplanned readmission within 30 days. Multivariate regression analyses were performed to determine independent predictors of outcome. Propensity score matched cohort analysis was performed. A p-value <0.05 was considered statistically significant. Subgroup analyses of femoropopliteal and infrapopliteal interventions were performed. RESULTS In total, 2636 (77.2%) patients were treated with percutaneous transluminal angioplasty and 778 (22.8%) were treated with atherectomy and percutaneous transluminal angioplasty. Multivariate analyses of the unadjusted cohort revealed no significant differences in major adverse cardiac events or major adverse limb events between the two groups (p-value >0.05). Subgroup analysis of femoropopliteal interventions demonstrated a significantly decreased likelihood of untreated loss of patency in 30 days in the atherectomy group compared to the percutaneous transluminal angioplasty group (1.1% vs. 2.7%, respectively; p-value = 0.034), which persisted on propensity score matched analysis (1.1% vs. 3.1%, respectively; p-value = 0.026). CONCLUSION Atherectomy with balloon angioplasty of femoropopliteal disease provides a significant decrease in untreated loss of patency compared to balloon angioplasty alone.
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Affiliation(s)
- Alexander Lam
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, School of Medicine, San Francisco, CA, USA
| | - Adam Schwertner
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, School of Medicine, San Francisco, CA, USA
| | - James Katrivesis
- Department of Radiological Sciences, University of California, Irvine, School of Medicine, Orange, CA, USA
| | - Dayantha Fernando
- Department of Radiological Sciences, University of California, Irvine, School of Medicine, Orange, CA, USA
| | - Kari Nelson
- Department of Radiological Sciences, University of California, Irvine, School of Medicine, Orange, CA, USA
| | - Nadine Abi-Jaoudeh
- Department of Radiological Sciences, University of California, Irvine, School of Medicine, Orange, CA, USA
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Sinha S, Lazar A, Lam A, Anderson EM, Chen LM, Hsu ICJ, Yoshida EJ. Adjuvant radiation followed by chemotherapy is associated with improved overall survival in endometrial cancer. Gynecol Oncol 2020; 159:30-35. [PMID: 32811681 DOI: 10.1016/j.ygyno.2020.07.098] [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: 05/30/2020] [Accepted: 07/23/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Although multimodality therapy has been shown to improve outcomes for patients with high-risk endometrial carcinoma, optimal type and timing of adjuvant therapies is unknown. METHODS Patients with stage I-IVA endometrial carcinoma diagnosed from 2004 to 2015, and treated with surgery, chemotherapy, and radiation were identified in the National Cancer Database. Adjuvant treatment was categorized as sequential radiation followed by chemotherapy (RT-CT), concurrent chemoradiation (CCRT, RT and CT started within 7 days), or sequential chemotherapy followed by radiation (CT-RT). Analysis for propensity score matched (PSM) cohorts comparing RT-CT to CCRT and CT-RT groups was additionally performed. RESULTS A total of 17,070 patients were identified, including 12,402 (72.7%) treated with RT-CT, 2,153 (12.6%) with CCRT, and 2,515 (14.7%) with CT-RT. Median follow-up was 44.3 months. Five-year overall-survival (OS) by adjuvant treatment regimen was 77.3% (95% CI 76.4%-78.2%), 74.3% (95% CI 72.0%-76.3%), and 74.4% (95% CI 72.5%-76.3%), respectively (p < .001). When unmatched cohorts were stratified by stage, adjuvant RT-CT was associated with improved OS in stage I and III patients. A similar survival advantage associated with RT-CT was observed in PSM cohorts comparing RT-CT group to CCRT/CT-RT group (5-year OS 77.4% vs 74.2%, p = .001). However, the difference in OS was significant only among stage III patients (RT-CT 73.9% compared to CCRT/CT-RT 69.7%, p =.002). CONCLUSION Our findings suggest survival benefit with adjuvant RT-CT compared to CT-RT or CCRT in patients undergoing trimodality therapy for endometrial cancer. This survival benefit may be limited to stage III patients.
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Affiliation(s)
- Sumi Sinha
- Department of Radiation Oncology, University of California San Francisco, 1600 Divisadero St, Suite H1031, San Francisco, CA 94115, USA.
| | - Ann Lazar
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, San Francisco, CA, USA.
| | - Alexander Lam
- Department of Radiology, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Eric M Anderson
- Department of Radiation Oncology, Cedars-Sinai Medical Center, North Tower LL, 8700 Beverly Blvd, Los Angeles, CA 90048, USA.
| | - Lee-May Chen
- Division of Gynecologic Oncology, University of California San Francisco, 1825 4th St, San Francisco, CA 94115, USA.
| | - I-Chow J Hsu
- Department of Radiation Oncology, University of California San Francisco, 1600 Divisadero St, Suite H1031, San Francisco, CA 94115, USA.
| | - Emi J Yoshida
- Department of Radiation Oncology, University of California San Francisco, 1600 Divisadero St, Suite H1031, San Francisco, CA 94115, USA.
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31
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Raab S, Roten L, Branca M, Nozica N, Wilhelm M, De Marchi S, Brugger N, Elchinova E, Seiler J, Asatryan B, Tanner H, Baldinger SH, Lam A, Reichlin T, Servatius H. P311Hypertrophic cardiomyopathy and other forms of left ventricular hypertrophy. The P wave can make the difference. Europace 2020. [DOI: 10.1093/europace/euaa162.180] [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: 11/14/2022] Open
Abstract
Abstract
Background
Structural disarray of hypertrophied myocytes and interstitial fibrosis characterize hypertrophic cardiomyopathy (HCM). These morphological changes also affect atrial myocytes and, together with hemodynamic alterations because of HCM, may lead to atrial cardiomyopathy.
Purpose
To investigate the incremental value of P-wave parameters to differentiate left ventricular hypertrophy (LVH) because of HCM from LVH in hypertensive heart disease (HHD) and athletes heart.
Methods
In a prospective study, we compared electrocardiographic (including signal-averaged ECG of the P wave) and echocardiographic data of patients with HCM, HHD and athletes heart. We developed a predictive model with a simple scoring system to identify HCM.
Results
We compared data of 27 patients with HCM (70% males, 49.8 ± 14.5 years), 324 patients with HHD (52% males, 74.8 ± 5.5 years), and 215 subjects with athletes heart (72% males, 42.3 ± 7.5). The table shows the significant differences among the 3 groups. We included the following parameters into a predictive score to differentiate HCM from other forms of LVH: QRS width (>88ms = 1 point), P-wave integral (>688µVs = 1 point) and septum thickness (>12mm = 2 points). A score >2 (Youden index 0.626) correctly classified HCM in 81% of the cases with a sensitivity and specificity of 82% an 81%, respectively.
Conclusion Differentiation of HCM from other forms of LVH is improved by including atrial parameters. A simple scoring system including septum thickness, QRS width and P wave integral allowed identification of patients with HCM with a sensitivity and specificity of >80%. This score needs to be validated prospectively.
Table 1 HCM HHD Athletes P-value HCM vs HHD* HCM vs Athletes* 95%-CI P-value 95%-CI P-value P-wave duration [ms] 152.7 ± 25.8 143.9 ± 16.5 133.5 ± 14.2 <0.001 -16.9 -24.6 to -9.1 <0.001 -16.3 -22.7 to -9.9 <0.001 P-wave integral [µVs] 850.4 ± 272.4 672.0 ± 235.4 773.1 ± 260.1 <0.001 -198.6 -320.8 to -76.3 0.002 -68.2 -169.7 to 33.2 0.187 QRS [ms] 110.3 ± 27.3 96.9 ± 20.3 95.1 ± 9.8 <0.001 -16.4 -24.7 to -8.1 <0.001 -13.8 -20.8 to -6.9 <0.001 QTc [ms] 447.9 ± 27.2 438.6 ± 24.5 414.0 ± 22.9 <0.001 -21.1 -32.7 to -9.5 <0.001 -30.8 -40.5 to -21.2 <0.001 LVMMI [g/m2] 153.6 ± 55.5 133.5 ± 30.3 98.6 ± 19.7 <0.001 -15.3 -29.7 to -0.9 0.038 -56.1 -67.7 to -44.6 <0.001 IVS [ms] 16.8 ± 4.2 11.8 ± 2.2 10.3 ± 1.5 <0.001 -5.2 -6.3 to -4.1 <0.001 -6.4 -7.3 to -5.6 <0.001 LAVI [ml/m2] 43.2 ± 13.9 30.5 ± 9.7 30.8 ± 9.5 <0.001 -14.6 -20.0 to -9.3 <0.001 -12.2 -16.6 to -7.9 <0.001 The table shows the study result after univariate and multivariate (*; adjusting for age and sex) analysis.
Abstract Figure 1
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Affiliation(s)
- S Raab
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - L Roten
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - M Branca
- CTU Bern, University of Bern, Bern, Switzerland
| | - N Nozica
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - M Wilhelm
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - S De Marchi
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - N Brugger
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - E Elchinova
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - J Seiler
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - B Asatryan
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - H Tanner
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - S H Baldinger
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - A Lam
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - T Reichlin
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - H Servatius
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
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Maurhofer J, Tanner H, Haeberlin A, Noti F, Seiler J, Baldinger SH, Roten L, Lam A, Asatryan B, Nozica N, Franzeck F, Kueffer T, Reichlin T, Servatius H. P1492Comparison of the long-term performance of the quadripolar IS-4 and the bipolar IS-1 left ventricular lead for cardiac resynchronization therapy. Europace 2020. [DOI: 10.1093/europace/euaa162.179] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The implantation of left ventricular (LV) leads for cardiac resynchronization therapy (CRT) and the management of lead-related complications can be challenging. The introduction of the quadripolar IS-4 LV lead may have facilitated the implantation procedure and may have reduced lead-related complications. Data of long-term follow-up (FU) comparing the IS-4 lead with the IS-1 LV lead are rare and conflicting.
PURPOSE
Comparison of lead-related complications and all-cause mortality between CRT patients who received an IS-4 or an IS-1 LV lead in the long-term FU.
METHODS
Adults with an indication for a CRT-Defibrillator or CRT-Pacemaker, a successful endovascular IS-4 or IS-1 LV lead implantation, and a minimal FU of three years were included in this retrospective study. The combined primary endpoint was freedom from lead-related complications defined as (i) occurrence of persisting high pacing threshold (>2.75V/0.4ms), (ii) unresolved phrenic nerve stimulation, (iii) LV lead dislodgement/disruption, (iv) the necessity of re-interventions affecting the LV lead, and (v) LV lead deactivation/explantation. Secondary endpoints were all singular complications and all-cause mortality.
RESULTS
Eligible for the study were 133 patients (IS-4 n = 66; IS-1 n = 67) with a mean FU of 4.03 ± 1.93 years. Baseline characteristics of both patient groups did not differ significantly. Freedom from lead-related complications was higher in patients with an IS-4 lead as compared to an IS-1 lead (Figure 1; 87.9% vs. 65.7%; p = 0.002). The secondary outcomes showed a higher rate of LV lead dislodgement/disruption (4.5% vs. 17.9%; p = 0.015) in the IS-1 patient group and more patients suffered from unresolved phrenic nerve stimulation with an IS-1 lead (3.0% vs. 13.4%; p = 0.029). LV lead deactivation/explantation during FU and LV lead-related re-interventions were fewer in case of an IS-4 lead (4.5% vs 22.4%; p = 0.003; 6.1% vs. 17.9%; p = 0.036, respectively). The rate of persisting high pacing thresholds and all-cause mortality did not differ (4.5% vs. 9.0%; p = 0.492; 22.7% vs 25.4%; p = 0.721, respectively).
CONCLUSION
The quadripolar IS-4 LV lead showed in this retrospective study a better long-term performance than the bipolar IS-1 lead.
Abstract Figure 1
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Affiliation(s)
- J Maurhofer
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - H Tanner
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - A Haeberlin
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - F Noti
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - J Seiler
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - S H Baldinger
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - L Roten
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - A Lam
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - B Asatryan
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - N Nozica
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - F Franzeck
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - T Kueffer
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - T Reichlin
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - H Servatius
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
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Burke C, Kohlbrenner R, Fidelman N, Heller M, Kolli K, Lam A, Lehrman E, Lokken R, Taylor A, Kumar V, Conrad M, Kohi M. 3:54 PM Abstract No. 105 Percutaneous transhepatic biliary drain placement for reduction of hyperbilirubinemia in malignant biliary obstruction: a bridge to chemotherapy or a bridge to nowhere? J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.134] [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: 10/25/2022] Open
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Bennett R, Abi-Jaoudeh N, Rupasinghe M, Javan H, Lam A, Nelson K. Abstract No. 487 Role of time-resolved magnetic resonance angiography in appropriate diagnosis of patients with Klippel-Trenaunay syndrome. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.548] [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] Open
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Bennett R, Abi-Jaoudeh N, Rupasinghe M, Javan H, Lam A, Nelson K. 3:54 PM Abstract No. 181 Technical and clinical success of endovenous ablation and sclerotherapy in Klippel-Trenaunay syndrome. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.218] [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] Open
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Tang FY, Chan EO, Sun Z, Wong R, Lok J, Szeto S, Chan JC, Lam A, Tham CC, Ng DS, Cheung CY. Clinically relevant factors associated with quantitative optical coherence tomography angiography metrics in deep capillary plexus in patients with diabetes. Eye Vis (Lond) 2020; 7:7. [PMID: 32025523 PMCID: PMC6996172 DOI: 10.1186/s40662-019-0173-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 12/30/2019] [Indexed: 01/04/2023]
Abstract
Background To test clinically relevant factors associated with quantitative artifact-free deep capillary plexus (DCP) metrics in patients with diabetes mellitus (DM). Methods 563 eligible eyes (221 with no diabetic retinopathy [DR], 135 with mild DR, 130 with moderate DR, and 77 with severe DR) from 334 subjects underwent optical coherence tomography-angiography (OCT-A) with a swept-source OCT (Triton DRI-OCT, Topcon, Inc., Tokyo, Japan). Strict criteria were applied to exclude from analysis those DCP images with artifacts and of poor quality, including projection artifacts, motion artifacts, blurriness, signal loss, B-scan segmentation error, or low-quality score. A customized MATLAB program was then used to quantify DCP morphology from the artifact-free DCP images by calculating three metrics: foveal avascular zone (FAZ), vessel density (VD), and fractal dimension (FD). Results 166 (29.5%) eyes were excluded after quality control, leaving in the analysis 397 eyes (170 with no DR, 101 with mild DR, 90 with moderate DR, 36 with severe DR) from 250 subjects. In the multiple regression models, larger FAZ area was associated with more severe DR (β = 0.687; p = 0.037), shorter axial length (AL) (β = − 0.171; p = 0.003), thinner subfoveal choroid thickness (β = − 0.122; p = 0.031), and lower body mass index (BMI) (β = − 0.090; p = 0.047). Lower VD was associated with more severe DR (β = − 0.842; p = 0.001), shorter AL (β = 0.107; p = 0.039), and poorer visual acuity (VA) (β = − 0.133; p = 0.021). Lower FD was associated with more severe DR (β = − 0.891; p < 0.001) and with older age (β = − 0.142; p = 0.004). Conclusions Quantitative artifact-free DCP metrics are associated with VA, DR severity, AL, subfoveal choroidal thickness, age, and BMI in diabetic patients. The effects of ocular and systemic factors should be considered for meaningful interpretations of DCP changes in DM patients.
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Affiliation(s)
- Fang Yao Tang
- 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Kowloon, China
| | - Erica O Chan
- 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Kowloon, China
| | - Zihan Sun
- 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Kowloon, China
| | - Raymond Wong
- 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Kowloon, China.,2Hong Kong Eye Hospital, Hong Kong Special Administrative Region, Kowloon, China
| | - Jerry Lok
- 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Kowloon, China.,2Hong Kong Eye Hospital, Hong Kong Special Administrative Region, Kowloon, China
| | - Simon Szeto
- 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Kowloon, China.,2Hong Kong Eye Hospital, Hong Kong Special Administrative Region, Kowloon, China
| | - Jason C Chan
- 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Kowloon, China.,2Hong Kong Eye Hospital, Hong Kong Special Administrative Region, Kowloon, China
| | - Alexander Lam
- 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Kowloon, China
| | - Clement C Tham
- 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Kowloon, China
| | - Danny S Ng
- 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Kowloon, China
| | - Carol Y Cheung
- 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Kowloon, China.,3CUHK Eye Centre, Hong Kong Eye Hospital, 147K Argyle Street, Kln, Kowloon, Hong Kong China
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Corfield B, Lam A. 21. Giant inflammatory polyposis in a patient with ulcerative colitis: A case report. Pathology 2020. [DOI: 10.1016/j.pathol.2020.01.022] [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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Wasserman M, Ouslander JG, Lam A, Wolk AG, Morley JE, von Preyss-Friedman S, Marco N, Nazir A, Haimowitz D, Bessey F. Editorial: Diagnostic Testing for SARS-Coronavirus-2 in the Nursing Facility: Recommendations of a Delphi Panel of Long-Term Care Clinicians. J Nutr Health Aging 2020; 24:538-443. [PMID: 32510102 PMCID: PMC7262162 DOI: 10.1007/s12603-020-1401-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 01/12/2023]
Abstract
With the COVID-19 pandemic progressing, guidance on strategies to mitigate its devastating effects in nursing facilities (NFs) is critical to preventing additional tragic outcomes. Asymptomatic spread of COVID-19 from nursing facility staff and residents is a major accelerator of infection. Facility-wide point-prevalence testing is an emerging strategy in disease mitigation. Because time is not available to await the results of randomized controlled trials before implementing strategies in this high-risk setting, an expert Delphi panel composed of experienced long-term care medicine professionals has now met to provide testing guidance for SARS-Coronavirus-2 to NFs. After many email and telephone discussions, the panel responded to a questionnaire that included six different scenarios, based on varying availability of Polymerase Chain Reaction (RT-PCR) testing and personal protective equipment (PPE). The panel endorsed facility-wide testing of staff and residents without dissent when diagnostic RT-PCR was available. While the panel recognized the limitations of RT-PCR testing, it strongly recommended this testing for both staff and residents in NFs that were either COVID-19 naive or had limited outbreaks. There was also consensus on testing residents with atypical symptoms in a scenario of limited testing capability. The panel favored testing every 1 to 2 weeks if testing was readily available, reducing the frequency to every month as community prevalence declined or as the collection of additional data further informed clinical critical thinking and decision-making. The panel recognized that frequent testing would have consequences in terms of potential staff shortages due to quarantine after positive tests and increased PPE use. However, the panel felt that not testing would allow new clusters of infection to form. The resulting high mortality rate would outweigh the potential negative consequences of testing. The panel also recognized the pandemic as a rapidly evolving crisis, and that new science and increasing experience might require an updating of its recommendations. The panel hopes that its recommendations will be of value to the long-term care industry and to policy makers as we work together to manage through this challenging and stressful time.
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Affiliation(s)
- M Wasserman
- Michael Wasserman, MD, CMD, California Association of Long Term Care Medicine, 295 Mesa Ave., Newbury Park, CA 91320, , Ph. 720-412-5202
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Lam A, D'Rozario A, McKinnon A, Phillips C, Grunstein R, Naismith S. Delineating the role of osa on mild cognitive impairment profiles and memory recall performance in older adults at-risk of dementia. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.583] [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: 10/25/2022]
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Anwander M, Kueffer T, Branca M, Sweda R, Nozica N, Asatryan B, Lam A, Baldinger S, Haeberlin A, Seiler J, Servatius H, Tanner H, Reichlin T, Roten L, Noti F. P2855Unexpectedly high rate of lead failure of the Microport (formerly Sorin/Livanova) Beflex and Vega pacemaker electrodes: A single centre experience. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Pacing leads remain the weak link of current pacemaker systems. Various differences in design and material exist among companies. Lead performance is mainly assessed via post-marketing studies of the manufacturing companies. Reliable independent reports are rare. We aimed to study the early and long-term performance of the Microport (formerly Sorin/Livanova) Beflex and Vega leads at our centre, for which a lead survival >99% at 3 years has been reported by the company.
Method
In this single centre, retrospective study we analysed the performance of all right ventricular Microport pacemaker leads implanted at our centre between January 2014 and January 2018. Only first pacemaker implants were considered. Lead failure was defined as any lead issue requiring reintervention during follow-up (dislocation, perforation, electrical abnormalities such as lead noise or excessively high thresholds).
Results
A total of 271 Microport right ventricular pacing leads were implanted (233 Beflex and 38 Vega leads). Mean patient age was 76±13.1 years (66% men). Dual chamber pacemakers were implanted in 162 patients (60%) and single chamber in 109 (40%). Mean threshold at implant was 0.6V/0.5ms (range 0.3–1.2V), mean R wave 13.2 mV (range 1.5–30mV) and mean impedance 816 Ohm (range 469–1639 Ohm). Patients without available follow-up information were excluded (N=18, 6.6%). The remaining 253 patients (93.4%) were analysed. Median follow-up was 1.26 years, IQR [25%=0.91 and 75%=2.24]. We observed a total of 25 lead failures (10%). Lead dislocation occurred in 2 cases (0.8%), lead perforation in 5 cases (2%), electrical abnormalities in 6 cases (2.4%) and excessively high threshold in 12 cases (4.8%; mean voltage 4V, range 2–7.5V; mean pulse width 0.75ms, range 0.35–1ms). Yearly incidence of lead failure per 100 leads was 6.1% (95%-CI [4.09–8.98] with a failure rate of 12.74% at 3 year in Kaplan-Meier analysis (Figure).
Figure 1
Conclusion
We found an unexpectedly high rate of lead failure of the Microport Beflex and Vega pacing leads at our centre. The two main reasons for premature lead failure were excessively high thresholds as well as electrical abnormalities during follow-up. Comparison of lead performance with other centres and against other leads are needed to further assess the magnitude of the problem.
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Affiliation(s)
- M Anwander
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - T Kueffer
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - M Branca
- University of Bern, Bern, Switzerland
| | - R Sweda
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - N Nozica
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - B Asatryan
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - A Lam
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - S Baldinger
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - A Haeberlin
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - J Seiler
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - H Servatius
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - H Tanner
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - T Reichlin
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - L Roten
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - F Noti
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
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Nozica N, Asatryan B, Noti F, Baldinger SH, Lam A, Haeberlin A, Servatius HS, Seiler J, Schwitz F, Tanner H, Wustmann KB, Delacretaz E, Schwerzmann M, Reichlin T, Roten L. P1007Efficacy and safety of atrial ablation procedures in patients with complete d-TGA and atrial switch at a Swiss tertiary center. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0599] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Patients with complete transposition of the great arteries (d-TGA) and atrial switch face a high lifetime risk of arrhythmias. Interventions in these patients are challenging because of their particular anatomy. Reports on ablation procedures in this patient population are scarce and missing for Switzerland.
Method
We retrospectively analyzed all ablation procedures performed in the above-mentioned population at a Swiss tertiary care center.
Results
Among 73 d-TGA pts. (71% male; N=37 Senning; N=36 Mustard) followed at our center, 17 ablations were performed in 11 pts. (15%; one ablation in 8 pts., two in 2 pts. and five in 1 patient). Median age at first ablation was 34 years (range 15–49 years). A total of 17 different intra-atrial reentry tachycardias (IART) and 3 AVNRT were targeted. Of the IART, 10 were cavotricuspid isthmus (CTI)-dependent and 7 were not. In two procedures (12%) only the systemic venous (SV) baffle was accessed for ablation. In 15 procedures (88%), ablation was performed within the pulmonary venous (PV) baffle. Access to the PV baffle was retrograde via the aorta in 6 cases (35%), via a baffle leak in 3 (18%) and via baffle puncture in 6 (35%). All procedures with retrograde approach to the PV baffle or with SV baffle only ablation were performed up to January 2012 and all remaining procedures afterwards. The 3 pts. requiring repeat procedures had retrograde or SV baffle approaches initially, and one additional ablation via baffle puncture was successful. The CTI was targeted in 10 pts. (91%) and ablation was finally successful in all with bidirectional block demonstrated in 8 pts. The coronary sinus was found to drain into the SV baffle in 5 pts. (46%) and useful for assessment of CTI block. The seven CTI-independent IART were scar-related micro-reentries. Ablation of all 3 AVNRTs was successful after one procedure without recurrence. Slow pathway ablation was performed in the SV baffle in two and in the PV baffle in one case (Figure). After a median follow-up of 7 months (range 2–186 months) 9 pts. are without recurrence and in 2 pts. rare self-limited arrhythmias still occur. No procedural complications occurred.
Conclusion
Arrhythmias in patients with complete d-TGA and atrial switch are mainly CTI-dependent IART or scar-related micro-reentries, and a few patients also have AVNRT. Ablation of these arrhythmias is safe and successful if PV baffle access is achieved via a baffle leak or baffle puncture.
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Affiliation(s)
- N Nozica
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - B Asatryan
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - F Noti
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - S H Baldinger
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - A Lam
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - A Haeberlin
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - H S Servatius
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - J Seiler
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - F Schwitz
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - H Tanner
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - K B Wustmann
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - E Delacretaz
- Clinique Cecil de recherche cardio-vasculaire, Lausanne, Switzerland
| | - M Schwerzmann
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - T Reichlin
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - L Roten
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
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Sacher F, Roumegou P, Duchateau J, Derval N, Denis A, Pambrun T, Escande W, Takigawa M, Lam A, Andre C, Chauvel R, Hocini M, Haissaguerre M, Jais P, Cochet H. 5201Intra-cardiac thrombus in patients undergoing ventricular tachycardia ablation. a computed tomographic scan study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0059] [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: 11/13/2022] Open
Abstract
Abstract
Background
Embolic event is one of the complications of VT ablation. This may be due to the presence of intra-cardiac thrombus before ablation. However, there is no clear consensus on how to rule out thrombus before the procedure.
Objective
We sought to examine the prevalence and risk factors of intra-cardiac thrombus with cardiac computed tomographic (CT) scan in patients undergoing scar-related VT ablation.
Methods
In absence of contra-indication, all patients undergoing scar-related VT ablation at our institution underwent contrast-enhanced cardiac CT within one week before ablation. 324 consecutive patients (292 male, 59±16 yo) have been included in this study. The etiology was ischemic cardiomyopathy (CMP) (n=191), arrhythmogenic right ventricular CMP (ARVC) (n=37), congenital CMP (n=11) or other CMP (n=85). LVEF was <40% in 154 patients (48%).
Results
Intra-cardiac thrombus was diagnosed in 29 (9%) patients: in the left atrium (n=8), in the right atrium (n=1), in the left ventricle (n=15), in the right ventricle (n=3), in right and left atrium (n=1), and in left atrium and right ventricle (n=1). Moreover in 2, a bilateral pulmonary embolism was identified. The population with thrombus was older (65±12 vs 58±16 years, p=0,005), with more permanent atrial fibrillation (AF) (28% vs 8%; p=0.005). Patients with left ventricular (LV) aneurysm were at higher risk of thrombus 50% vs 3% (p<0.001). The average CHADSVASC score was similar for both groups (2,5 vs 2,1; p=0.179). After matching for age and sex, only ischemic CMP and LV aneurysm were risk factors for thrombus. Because of arrhythmic storm, ablation was performed by epicardial approach only, in 5 patients with intra-ventricular thrombus and by retroaortic approach only, in 2 patients with LAA thrombus. No embolic event occurred during these procedures.
Conclusion
CT scans help eliminating intra-cardiac thrombus before VT ablation procedure. A high proportion of thrombus (9%) was identified. Whereas LV thrombus should systematically be ruled out before scar related VT ablation, in patients with AF, a LAA thrombus should also be eliminated as well as RV thrombus in patients with ARVC.
Acknowledgement/Funding
ANR-10-IAHU-04
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Affiliation(s)
- F Sacher
- Bordeaux University Hospital and IHU LIRYC, Bordeaux-Pessac, France
| | - P Roumegou
- Bordeaux University Hospital and IHU LIRYC, Bordeaux-Pessac, France
| | - J Duchateau
- Bordeaux University Hospital and IHU LIRYC, Bordeaux-Pessac, France
| | - N Derval
- Bordeaux University Hospital and IHU LIRYC, Bordeaux-Pessac, France
| | - A Denis
- Bordeaux University Hospital and IHU LIRYC, Bordeaux-Pessac, France
| | - T Pambrun
- Bordeaux University Hospital and IHU LIRYC, Bordeaux-Pessac, France
| | - W Escande
- Bordeaux University Hospital and IHU LIRYC, Bordeaux-Pessac, France
| | - M Takigawa
- Bordeaux University Hospital and IHU LIRYC, Bordeaux-Pessac, France
| | - A Lam
- Bordeaux University Hospital and IHU LIRYC, Bordeaux-Pessac, France
| | - C Andre
- Bordeaux University Hospital and IHU LIRYC, Bordeaux-Pessac, France
| | - R Chauvel
- Bordeaux University Hospital and IHU LIRYC, Bordeaux-Pessac, France
| | - M Hocini
- Bordeaux University Hospital and IHU LIRYC, Bordeaux-Pessac, France
| | - M Haissaguerre
- Bordeaux University Hospital and IHU LIRYC, Bordeaux-Pessac, France
| | - P Jais
- Bordeaux University Hospital and IHU LIRYC, Bordeaux-Pessac, France
| | - H Cochet
- Bordeaux University Hospital and IHU LIRYC, Bordeaux-Pessac, France
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Lam A, Yoshida EJ, Bui K, Katrivesis J, Fernando D, Nelson K, Abi-Jaoudeh N. Demographic and facility volume related outcomes in radiofrequency ablation for early-stage hepatocellular carcinoma. HPB (Oxford) 2019; 21:849-856. [PMID: 30518497 DOI: 10.1016/j.hpb.2018.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Received: 08/05/2018] [Revised: 10/13/2018] [Accepted: 10/18/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND To evaluate outcomes related to disparities in facility volume and patient demographics in patients with early-stage hepatocellular carcinoma (HCC) treated with radiofrequency ablation (RFA). METHODS This is a retrospective study of patients with stage I/II HCC treated with RFA in the National Cancer Database. Independent contributors to overall survival were determined with Cox regression analysis. The Kaplan-Meier method and log-rank analyses were used to estimate overall survival and compare survival curves. A propensity score matched cohort analysis was performed. P-values < 0.05 were considered statistically significant. RESULTS In total, 2911 patients were included. Stage II disease (p-value = 0.006), increasing alpha fetoprotein (p-value = 0.007), and increasing bilirubin (p-value < 0.001) were associated with worse survival. Improved survival was seen in patients treated at high-volume centers (p-value = 0.004), which persisted following propensity score adjustment (p-value = 0.003). Asian race was associated with significantly improved survival (p-value < 0.001), while governmental insurance was associated with a significant decrease in survival (p-value < 0.001). CONCLUSION Treatment at a high-volume center and Asian race were significantly associated with improved survival following RFA for early-stage HCC. Governmental insurance, increasing alpha fetoprotein, increasing bilirubin, and higher disease stage were significantly associated with worse survival.
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Affiliation(s)
- Alexander Lam
- University of California, Irvine School of Medicine, Department of Radiological Sciences, 101 The City Drive South, Orange, CA 92868, USA.
| | - Emi J Yoshida
- University of California, San Francisco School of Medicine, Department of Radiation Oncology, 1600 Divisadero Street, San Francisco, CA 94143, USA
| | - Kevin Bui
- University of California, Irvine School of Medicine, Department of Radiological Sciences, 101 The City Drive South, Orange, CA 92868, USA
| | - James Katrivesis
- University of California, Irvine School of Medicine, Department of Radiological Sciences, 101 The City Drive South, Orange, CA 92868, USA
| | - Dayantha Fernando
- University of California, Irvine School of Medicine, Department of Radiological Sciences, 101 The City Drive South, Orange, CA 92868, USA
| | - Kari Nelson
- University of California, Irvine School of Medicine, Department of Radiological Sciences, 101 The City Drive South, Orange, CA 92868, USA
| | - Nadine Abi-Jaoudeh
- University of California, Irvine School of Medicine, Department of Radiological Sciences, 101 The City Drive South, Orange, CA 92868, USA
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Cabral M, Garçon G, Touré A, Diop C, Lam A, Fall M, Bouhsina S, Dewaele D, Cazier F, Tall-Dia A, Shirali P, Diouf A, Courcot D, Verdin A. Évaluation des atteintes néphroniques chez des adultes riverains d’une décharge à ciel ouvert. Toxicologie Analytique et Clinique 2019. [DOI: 10.1016/j.toxac.2019.03.104] [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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Touré A, Cabral M, Dioum MD, Touré NN, Lam A, Ba F, Diop C, Diouf A, Malisch M, Fall M. Les polluants organiques persistants dans le lait maternel : évaluation des facteurs favorisant l’exposition au Sénégal. Toxicologie Analytique et Clinique 2019. [DOI: 10.1016/j.toxac.2019.03.129] [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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Abstract
Angiomatoid fibrous histiocytoma (AFH) is a rare and slow-growing soft tissue lesion that typically arises in the extremities of young patients. Microscopically, AFH is characterized by pseudovascular, blood-filled spaces that are surrounded by a multinodular proliferation of spindle and/or round cells and lymphoid cuffs. However, there is a wide morphological spectrum, including a myxoid variant. Examples with a prominent myxoid matrix are rare and may pose great diagnostic difficulty. Specific gene fusions have been found to play a significant role in AFH tumorigenesis. Gene fusions of Ewing sarcoma breakpoint region 1 (EWSR1) with members of the cAMP response element-binding protein family (CREB) of transcription factors (CREB1, activating transcription factor 1 (ATF1), and cAMP response element modulator (CREM)) have been described in histopathologically diverse mesenchymal neoplasms such as AFH, hyalinising clear cell carcinomas of salivary glands, primary pulmonary myxoid sarcoma, and clear cell sarcoma. Classically, EWSR1-CREB is known to be the prominent gene fusion in AFH. Recently, a small series of intracranial mesenchymal tumors with EWSR1-CREB family gene fusions has been reported. These tumors seem to show histologic, immunophenotypic, and cytogenic features similar to those observed in the myxoid variant of AFH; therefore, there is a debate on whether these tumors merely represent a variant of AFH or a novel entity. This case report is of a 58-year-old woman presenting with the first episode of generalized seizure due to an extra-axial lesion with homogenous contrast enhancement in the right parietal lobe, which was initially diagnosed as a World Health Organization (WHO) grade I meningioma. Following a series of pathological investigations, the diagnosis of an intracranial myxoid variant of AFH was made. This case report illustrates the need to consider the myxoid variant of intracranial AFH in the differential diagnosis of meningioma-like tumors. A high index of suspicion is required if the meningioma behaves abnormally with a much higher recurrence rate.
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Affiliation(s)
| | | | | | - Gabriel Lee
- Neurosurgery, Sir Charles Gairdner Hospital, Perth, AUS
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Lam A, Yoshida EJ, Bui K, Katrivesis J, Fernando D, Nelson K, Abi-Jaoudeh N. Patient and Facility Demographics Related Outcomes in Early-Stage Non-Small Cell Lung Cancer Treated with Radiofrequency Ablation: A National Cancer Database Analysis. J Vasc Interv Radiol 2018; 29:1535-1541.e2. [PMID: 30293735 DOI: 10.1016/j.jvir.2018.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/23/2018] [Accepted: 06/11/2018] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To determine facility and patient demographics associated with survival in early-stage non-small cell lung cancer (NSCLC) treated with radiofrequency (RF) ablation. MATERIALS AND METHODS The National Cancer Database was queried for cases of stage 1a NSCLC treated with RF ablation without chemotherapy or radiotherapy from 2004 to 2014. High-volume centers (HVCs) were defined as the top 95th percentile of facilities by number of procedures performed. Overall survival (OS) was estimated with the Kaplan-Meier method, and comparisons between survival curves were performed with the log-rank test. Propensity score-matched cohort analysis was performed. P values less than .05 were considered statistically significant. RESULTS In the final cohort, 967 cases were included. Estimated median survival and follow-up were 33.1 and 62.5 months, respectively. Of 305 facilities, 15 were determined to be HVCs, treating 13 or more patients from 2004 to 2014. A total of 335 cases (34.6%) were treated at HVCs. On multivariate Cox regression analysis, treatment at an HVC was independently associated with improved OS (hazard ratio [HR] = 0.766; P = .006). After propensity score adjustment, 1-, 3-, and 5-year OS was 89.8%, 51.2%, and 27.7%, respectively, for patients treated at HVCs, compared to 85.2%, 41.5%, and 19.6%, respectively, for patients treated at non-HVCs (P = .015). Increasing age (HR = 1.012; P = .013) and higher T-classification (HR = 1.392; P < .001) were independently associated with worse OS. CONCLUSION Patients with early-stage NSCLC treated with RF ablation at HVCs experienced a significant increase in OS, suggesting regionalization of lung cancer management as a means of improving outcomes.
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Affiliation(s)
- Alexander Lam
- Department of Radiological Sciences, University of California, Irvine School of Medicine, Orange, CA, 92868.
| | - Emi J Yoshida
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kevin Bui
- Department of Radiological Sciences, University of California, Irvine School of Medicine, Orange, CA, 92868
| | - James Katrivesis
- Department of Radiological Sciences, University of California, Irvine School of Medicine, Orange, CA, 92868
| | - Dayantha Fernando
- Department of Radiological Sciences, University of California, Irvine School of Medicine, Orange, CA, 92868
| | - Kari Nelson
- Department of Radiological Sciences, University of California, Irvine School of Medicine, Orange, CA, 92868
| | - Nadine Abi-Jaoudeh
- Department of Radiological Sciences, University of California, Irvine School of Medicine, Orange, CA, 92868
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Chambers D, Kumar A, Feng L, Hargreaves I, Lam A, Manzur A, Muntoni F, Sewry C, Poulton J, Phadke R. MITOCHONDRIAL DISEASES (Posters). Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.223] [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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50
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Mercure JF, Lam A, Billington S, Pollitt H. Integrated assessment modelling as a positive science: private passenger road transport policies to meet a climate target well below 2 ∘C. Clim Change 2018; 151:109-129. [PMID: 30930506 PMCID: PMC6404732 DOI: 10.1007/s10584-018-2262-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/20/2018] [Indexed: 05/30/2023]
Abstract
Transport generates a large and growing component of global greenhouse gas emissions contributing to climate change. Effective transport emissions reduction policies are needed in order to reach a climate target well below 2 ∘C. Representations of technology evolution in current integrated assessment models (IAM) make use of systems optimisations that may not always provide sufficient insight on consumer response to realistic policy packages for extensive use in policy-making. Here, we introduce FTT: transport, an evolutionary technology diffusion simulation model for road transport technology, as an IAM sub-component, which features sufficiently realistic features of consumers and of existing technological trajectories that enables to simulate the impact of detailed climate policies in private passenger road transport. Integrated to the simulation-based macroeconometric IAM E3ME-FTT, a plausible scenario of transport decarbonisation is given, defined by a detailed transport policy package, that reaches sufficient emissions reductions to achieve the 2 ∘C target of the Paris Agreement.
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Affiliation(s)
- J.-F. Mercure
- Department of Environmental Science, Radboud University, PO Box 9010, 6500 GL Nijmegen, The Netherlands
- Cambridge Centre for Environment, Energy and Natural Resource Governance (C-EENRG), University of Cambridge, The David Attenborough Building, Pembroke Street, Cambridge, CB2 3QZ UK
- Cambridge Econometrics Ltd, Covent Garden, Cambridge, CB1 2HT UK
| | - A. Lam
- Cambridge Centre for Environment, Energy and Natural Resource Governance (C-EENRG), University of Cambridge, The David Attenborough Building, Pembroke Street, Cambridge, CB2 3QZ UK
- Department of Economics, Faculty of Social Sciences, Humanities and Social Science Building, University of Macau, E21, Avenida da Universidade, Taipa, Macau, China
| | - S. Billington
- Cambridge Econometrics Ltd, Covent Garden, Cambridge, CB1 2HT UK
| | - H. Pollitt
- Cambridge Econometrics Ltd, Covent Garden, Cambridge, CB1 2HT UK
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