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Capdevila J, Hernando J, Teule A, Lopez C, Garcia-Carbonero R, Benavent M, Custodio A, Garcia-Alvarez A, Cubillo A, Alonso V, Carmona-Bayonas A, Alonso-Gordoa T, Crespo G, Jimenez-Fonseca P, Blanco M, Viudez A, La Casta A, Sevilla I, Segura A, Llanos M, Landolfi S, Nuciforo P, Manzano JL. Durvalumab plus tremelimumab for the treatment of advanced neuroendocrine neoplasms of gastroenteropancreatic and lung origin. Nat Commun 2023; 14:2973. [PMID: 37221181 DOI: 10.1038/s41467-023-38611-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 05/10/2023] [Indexed: 05/25/2023] Open
Abstract
Single immune checkpoint blockade in advanced neuroendocrine neoplasms (NENs) shows limited efficacy; dual checkpoint blockade may improve treatment activity. Dune (NCT03095274) is a non-randomized controlled multicohort phase II clinical trial evaluating durvalumab plus tremelimumab activity and safety in advanced NENs. This study included 123 patients presenting between 2017 and 2019 with typical/atypical lung carcinoids (Cohort 1), G1/2 gastrointestinal (Cohort 2), G1/2 pancreatic (Cohort 3) and G3 gastroenteropancreatic (GEP) (Cohort 4) NENs; who progressed to standard therapies. Patients received 1500 mg durvalumab and 75 mg tremelimumab for up to 13 and 4 cycles (every 4 weeks), respectively. The primary objective was the 9-month clinical benefit rate (CBR) for cohorts 1-3 and 9-month overall survival (OS) rate for Cohort 4. Secondary endpoints included objective response rate, duration of response, progression-free survival according to irRECIST, overall survival, and safety. Correlation of PD-L1 expression with efficacy was exploratory. The 9-month CBR was 25.9%/35.5%/25% for Cohorts 1, 2, and 3 respectively. The 9-month OS rate for Cohort 4 was 36.1%, surpassing the futility threshold. Benefit in Cohort 4 was observed regardless of differentiation and Ki67 levels. PD-L1 combined scores did not correlate with treatment activity. Safety profile was consistent with that of prior studies. In conclusion, durvalumab plus tremelimumab is safe in NENs and shows modest survival benefit in G3 GEP-NENs; with one-third of these patients experiencing a prolonged OS.
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Affiliation(s)
- J Capdevila
- Medical Oncology Department, Vall Hebron University Hospital, Vall Hebron Institute of Oncology (VHIO), Barcelona, Spain.
- Medical Oncology Department, IOB-Quiron-Teknon, Barcelona, Spain.
| | - J Hernando
- Medical Oncology Department, Vall Hebron University Hospital, Vall Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - A Teule
- Medical Oncology Department, Institut Català d'Oncologia (ICO) - IDIBELL L'Hospitalet del Llobregat, L'Hospitalet de Llobregat, Spain
| | - C Lopez
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - R Garcia-Carbonero
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Imas12, UCM, CNIO, Madrid, Spain
| | - M Benavent
- Medical Oncology Department, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - A Custodio
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - A Garcia-Alvarez
- Medical Oncology Department, Vall Hebron University Hospital, Vall Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - A Cubillo
- Medical Oncology Department, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - V Alonso
- Medical Oncology Department, Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria de Aragón (IISA), Zaragoza, Spain
| | - A Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain
| | - T Alonso-Gordoa
- Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - G Crespo
- Medical Oncology Department, Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - P Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - M Blanco
- Medical Oncology Department, Hospital Universitario Gregorio Marañon, Madrid, Spain
| | - A Viudez
- Medical Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - A La Casta
- Medical Oncology Department, Hospital Universitario Donostia, San Sebastián, Spain
| | - I Sevilla
- Medical Oncology Department, Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain
| | - A Segura
- Medical Oncology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - M Llanos
- Medical Oncology Department, Hospital Universitario de Canarias, San Cristobal de la Laguna, Spain
| | - S Landolfi
- Pathology Department, Vall Hebron University Hospital, CIBERONC, Barcelona, Spain
| | - P Nuciforo
- Molecular Oncology Group. Vall Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - J L Manzano
- Medical Oncology Department, Institut Català d'Oncologia (ICO) - Badalona, Hospital Germans Trias i Pujol, Badalona, Spain
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Bagel A, Delignette-Muller ML, Lopez C, Michel V, Sergentet D, Douellou T. Strain- and serotype-dependent affinity of Shiga toxin-producing Escherichia coli for bovine milk fat globules. J Dairy Sci 2022; 105:8688-8704. [PMID: 36175225 DOI: 10.3168/jds.2022-21840] [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: 01/18/2022] [Accepted: 07/01/2022] [Indexed: 11/19/2022]
Abstract
Shiga toxin-producing Escherichia coli (STEC) are widely detected in raw milk products intended for human consumption. Although STEC are a worldwide public health problem, the pathogenicity of STEC in cheese remains unclear. In fact, bacterial association with compounds in raw milk cheeses could reduce their pathogenicity. A previous study showed the association of 2 STEC strains with raw milk cream in a natural creaming assay. Different concentrations of each strain were required to saturate the cream. In this study, we hypothesized that all STEC strains could be associated with milk fat globules (MFG) in raw milk and that the bacterial load required for saturation of the cream is serotype dependent. We evaluated the affinity of STEC strains belonging to the O157:H7, O26:H11, and O103:H2 serotypes for bovine raw milk cream and analyzed saturation of the cream layer by natural creaming assay. We used 12 STEC strains and 3 strains belonging to another pathotype to assess the effects of serotypes on this phenomenon. We performed sucrose density gradient centrifugation assays with 2 STEC model strains to confirm the results obtained by natural creaming. The localization of STEC within MFG-enriched creams was observed by confocal and electron microscopy. We recovered approximately 10 times more STEC from the cream layer after natural creaming than from raw bovine milk. The concentration of STEC required to saturate the cream layer (the saturation concentration) was estimated for each strain by nonlinear regression, highlighting a strain and serotype effect. Moreover, the concentration of STEC in the cream was milk fat level dependent. However, even in nonsaturating conditions, a high level of STEC was still present in the aqueous phase, after fat separation. Thus, natural creaming should not be used as the sole preventive measure to remove STEC from naturally contaminated raw milk. The results of our study suggest that cream saturation is a complex mechanism, most likely involving specific interactions between STEC and raw MFG.
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Affiliation(s)
- A Bagel
- Bacterial Opportunistic Pathogens and Environment Research Group, Université de Lyon, UMR 5557 Ecologie Microbienne Lyon, National Center of Scientific Research, VetAgro Sup, 69280 Marcy-l'Etoile, France
| | - M-L Delignette-Muller
- Laboratoire de Biométrie et Biologie Evolutive, UMR 5558, Université de Lyon, VetAgro Sup, National Center of Scientific Research, 69622 Villeurbanne, France
| | - C Lopez
- INRAE, UR BIA, F-44316, Nantes, France
| | - V Michel
- Actalia, 74800 La Roche-sur-Foron, France
| | - D Sergentet
- Bacterial Opportunistic Pathogens and Environment Research Group, Université de Lyon, UMR 5557 Ecologie Microbienne Lyon, National Center of Scientific Research, VetAgro Sup, 69280 Marcy-l'Etoile, France; VetAgro Sup-Campus Vétérinaire, Laboratoire d'Etudes des Microorganismes Alimentaires Pathogènes-French National Reference Laboratory for Escherichia coli including Shiga toxin-producing E. coli (NRL-STEC), Université de Lyon, 69280, Marcy-l'Etoile, France.
| | - T Douellou
- Bacterial Opportunistic Pathogens and Environment Research Group, Université de Lyon, UMR 5557 Ecologie Microbienne Lyon, National Center of Scientific Research, VetAgro Sup, 69280 Marcy-l'Etoile, France
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Proietti M, Romiti GF, Vitolo M, Harrison SL, Lane DA, Fauchier L, Marin F, Näbauer M, Potpara TS, Dan GA, Maggioni AP, Cesari M, Boriani G, Lip GYH, Ekmekçiu U, Paparisto V, Tase M, Gjergo H, Dragoti J, Goda A, Ciutea M, Ahadi N, el Husseini Z, Raepers M, Leroy J, Haushan P, Jourdan A, Lepiece C, Desteghe L, Vijgen J, Koopman P, Van Genechten G, Heidbuchel H, Boussy T, De Coninck M, Van Eeckhoutte H, Bouckaert N, Friart A, Boreux J, Arend C, Evrard P, Stefan L, Hoffer E, Herzet J, Massoz M, Celentano C, Sprynger M, Pierard L, Melon P, Van Hauwaert B, Kuppens C, Faes D, Van Lier D, Van Dorpe A, Gerardy A, Deceuninck O, Xhaet O, Dormal F, Ballant E, Blommaert D, Yakova D, Hristov M, Yncheva T, Stancheva N, Tisheva S, Tokmakova M, Nikolov F, Gencheva D, Shalganov T, Kunev B, Stoyanov M, Marchov D, Gelev V, Traykov V, Kisheva A, Tsvyatkov H, Shtereva R, Bakalska-Georgieva S, Slavcheva S, Yotov Y, Kubíčková M, Marni Joensen A, Gammelmark A, Hvilsted Rasmussen L, Dinesen P, Riahi S, Krogh Venø S, Sorensen B, Korsgaard A, Andersen K, Fragtrup Hellum C, Svenningsen A, Nyvad O, Wiggers P, May O, Aarup A, Graversen B, Jensen L, Andersen M, Svejgaard M, Vester S, Hansen S, Lynggaard V, Ciudad M, Vettus R, Muda P, Maestre A, Castaño S, Cheggour S, Poulard J, Mouquet V, Leparrée S, Bouet J, Taieb J, Doucy A, Duquenne H, Furber A, Dupuis J, Rautureau J, Font M, Damiano P, Lacrimini M, Abalea J, Boismal S, Menez T, Mansourati J, Range G, Gorka H, Laure C, Vassalière C, Elbaz N, Lellouche N, Djouadi K, Roubille F, Dietz D, Davy J, Granier M, Winum P, Leperchois-Jacquey C, Kassim H, Marijon E, Le Heuzey J, Fedida J, Maupain C, Himbert C, Gandjbakhch E, Hidden-Lucet F, Duthoit G, Badenco N, Chastre T, Waintraub X, Oudihat M, Lacoste J, Stephan C, Bader H, Delarche N, Giry L, Arnaud D, Lopez C, Boury F, Brunello I, Lefèvre M, Mingam R, Haissaguerre M, Le Bidan M, Pavin D, Le Moal V, Leclercq C, Piot O, Beitar T, Martel I, Schmid A, Sadki N, Romeyer-Bouchard C, Da Costa A, Arnault I, Boyer M, Piat C, Fauchier L, Lozance N, Nastevska S, Doneva A, Fortomaroska Milevska B, Sheshoski B, Petroska K, Taneska N, Bakrecheski N, Lazarovska K, Jovevska S, Ristovski V, Antovski A, Lazarova E, Kotlar I, Taleski J, Poposka L, Kedev S, Zlatanovik N, Jordanova S, Bajraktarova Proseva T, Doncovska S, Maisuradze D, Esakia A, Sagirashvili E, Lartsuliani K, Natelashvili N, Gumberidze N, Gvenetadze R, Etsadashvili K, Gotonelia N, Kuridze N, Papiashvili G, Menabde I, Glöggler S, Napp A, Lebherz C, Romero H, Schmitz K, Berger M, Zink M, Köster S, Sachse J, Vonderhagen E, Soiron G, Mischke K, Reith R, Schneider M, Rieker W, Boscher D, Taschareck A, Beer A, Oster D, Ritter O, Adamczewski J, Walter S, Frommhold A, Luckner E, Richter J, Schellner M, Landgraf S, Bartholome S, Naumann R, Schoeler J, Westermeier D, William F, Wilhelm K, Maerkl M, Oekinghaus R, Denart M, Kriete M, Tebbe U, Scheibner T, Gruber M, Gerlach A, Beckendorf C, Anneken L, Arnold M, Lengerer S, Bal Z, Uecker C, Förtsch H, Fechner S, Mages V, Martens E, Methe H, Schmidt T, Schaeffer B, Hoffmann B, Moser J, Heitmann K, Willems S, Willems S, Klaus C, Lange I, Durak M, Esen E, Mibach F, Mibach H, Utech A, Gabelmann M, Stumm R, Ländle V, Gartner C, Goerg C, Kaul N, Messer S, Burkhardt D, Sander C, Orthen R, Kaes S, Baumer A, Dodos F, Barth A, Schaeffer G, Gaertner J, Winkler J, Fahrig A, Aring J, Wenzel I, Steiner S, Kliesch A, Kratz E, Winter K, Schneider P, Haag A, Mutscher I, Bosch R, Taggeselle J, Meixner S, Schnabel A, Shamalla A, Hötz H, Korinth A, Rheinert C, Mehltretter G, Schön B, Schön N, Starflinger A, Englmann E, Baytok G, Laschinger T, Ritscher G, Gerth A, Dechering D, Eckardt L, Kuhlmann M, Proskynitopoulos N, Brunn J, Foth K, Axthelm C, Hohensee H, Eberhard K, Turbanisch S, Hassler N, Koestler A, Stenzel G, Kschiwan D, Schwefer M, Neiner S, Hettwer S, Haeussler-Schuchardt M, Degenhardt R, Sennhenn S, Steiner S, Brendel M, Stoehr A, Widjaja W, Loehndorf S, Logemann A, Hoskamp J, Grundt J, Block M, Ulrych R, Reithmeier A, Panagopoulos V, Martignani C, Bernucci D, Fantecchi E, Diemberger I, Ziacchi M, Biffi M, Cimaglia P, Frisoni J, Boriani G, Giannini I, Boni S, Fumagalli S, Pupo S, Di Chiara A, Mirone P, Fantecchi E, Boriani G, Pesce F, Zoccali C, Malavasi VL, Mussagaliyeva A, Ahyt B, Salihova Z, Koshum-Bayeva K, Kerimkulova A, Bairamukova A, Mirrakhimov E, Lurina B, Zuzans R, Jegere S, Mintale I, Kupics K, Jubele K, Erglis A, Kalejs O, Vanhear K, Burg M, Cachia M, Abela E, Warwicker S, Tabone T, Xuereb R, Asanovic D, Drakalovic D, Vukmirovic M, Pavlovic N, Music L, Bulatovic N, Boskovic A, Uiterwaal H, Bijsterveld N, De Groot J, Neefs J, van den Berg N, Piersma F, Wilde A, Hagens V, Van Es J, Van Opstal J, Van Rennes B, Verheij H, Breukers W, Tjeerdsma G, Nijmeijer R, Wegink D, Binnema R, Said S, Erküner Ö, Philippens S, van Doorn W, Crijns H, Szili-Torok T, Bhagwandien R, Janse P, Muskens A, van Eck M, Gevers R, van der Ven N, Duygun A, Rahel B, Meeder J, Vold A, Holst Hansen C, Engset I, Atar D, Dyduch-Fejklowicz B, Koba E, Cichocka M, Sokal A, Kubicius A, Pruchniewicz E, Kowalik-Sztylc A, Czapla W, Mróz I, Kozlowski M, Pawlowski T, Tendera M, Winiarska-Filipek A, Fidyk A, Slowikowski A, Haberka M, Lachor-Broda M, Biedron M, Gasior Z, Kołodziej M, Janion M, Gorczyca-Michta I, Wozakowska-Kaplon B, Stasiak M, Jakubowski P, Ciurus T, Drozdz J, Simiera M, Zajac P, Wcislo T, Zycinski P, Kasprzak J, Olejnik A, Harc-Dyl E, Miarka J, Pasieka M, Ziemińska-Łuć M, Bujak W, Śliwiński A, Grech A, Morka J, Petrykowska K, Prasał M, Hordyński G, Feusette P, Lipski P, Wester A, Streb W, Romanek J, Woźniak P, Chlebuś M, Szafarz P, Stanik W, Zakrzewski M, Kaźmierczak J, Przybylska A, Skorek E, Błaszczyk H, Stępień M, Szabowski S, Krysiak W, Szymańska M, Karasiński J, Blicharz J, Skura M, Hałas K, Michalczyk L, Orski Z, Krzyżanowski K, Skrobowski A, Zieliński L, Tomaszewska-Kiecana M, Dłużniewski M, Kiliszek M, Peller M, Budnik M, Balsam P, Opolski G, Tymińska A, Ozierański K, Wancerz A, Borowiec A, Majos E, Dabrowski R, Szwed H, Musialik-Lydka A, Leopold-Jadczyk A, Jedrzejczyk-Patej E, Koziel M, Lenarczyk R, Mazurek M, Kalarus Z, Krzemien-Wolska K, Starosta P, Nowalany-Kozielska E, Orzechowska A, Szpot M, Staszel M, Almeida S, Pereira H, Brandão Alves L, Miranda R, Ribeiro L, Costa F, Morgado F, Carmo P, Galvao Santos P, Bernardo R, Adragão P, Ferreira da Silva G, Peres M, Alves M, Leal M, Cordeiro A, Magalhães P, Fontes P, Leão S, Delgado A, Costa A, Marmelo B, Rodrigues B, Moreira D, Santos J, Santos L, Terchet A, Darabantiu D, Mercea S, Turcin Halka V, Pop Moldovan A, Gabor A, Doka B, Catanescu G, Rus H, Oboroceanu L, Bobescu E, Popescu R, Dan A, Buzea A, Daha I, Dan G, Neuhoff I, Baluta M, Ploesteanu R, Dumitrache N, Vintila M, Daraban A, Japie C, Badila E, Tewelde H, Hostiuc M, Frunza S, Tintea E, Bartos D, Ciobanu A, Popescu I, Toma N, Gherghinescu C, Cretu D, Patrascu N, Stoicescu C, Udroiu C, Bicescu G, Vintila V, Vinereanu D, Cinteza M, Rimbas R, Grecu M, Cozma A, Boros F, Ille M, Tica O, Tor R, Corina A, Jeewooth A, Maria B, Georgiana C, Natalia C, Alin D, Dinu-Andrei D, Livia M, Daniela R, Larisa R, Umaar S, Tamara T, Ioachim Popescu M, Nistor D, Sus I, Coborosanu O, Alina-Ramona N, Dan R, Petrescu L, Ionescu G, Popescu I, Vacarescu C, Goanta E, Mangea M, Ionac A, Mornos C, Cozma D, Pescariu S, Solodovnicova E, Soldatova I, Shutova J, Tjuleneva L, Zubova T, Uskov V, Obukhov D, Rusanova G, Soldatova I, Isakova N, Odinsova S, Arhipova T, Kazakevich E, Serdechnaya E, Zavyalova O, Novikova T, Riabaia I, Zhigalov S, Drozdova E, Luchkina I, Monogarova Y, Hegya D, Rodionova L, Rodionova L, Nevzorova V, Soldatova I, Lusanova O, Arandjelovic A, Toncev D, Milanov M, Sekularac N, Zdravkovic M, Hinic S, Dimkovic S, Acimovic T, Saric J, Polovina M, Potpara T, Vujisic-Tesic B, Nedeljkovic M, Zlatar M, Asanin M, Vasic V, Popovic Z, Djikic D, Sipic M, Peric V, Dejanovic B, Milosevic N, Stevanovic A, Andric A, Pencic B, Pavlovic-Kleut M, Celic V, Pavlovic M, Petrovic M, Vuleta M, Petrovic N, Simovic S, Savovic Z, Milanov S, Davidovic G, Iric-Cupic V, Simonovic D, Stojanovic M, Stojanovic S, Mitic V, Ilic V, Petrovic D, Deljanin Ilic M, Ilic S, Stoickov V, Markovic S, Kovacevic S, García Fernandez A, Perez Cabeza A, Anguita M, Tercedor Sanchez L, Mau E, Loayssa J, Ayarra M, Carpintero M, Roldán Rabadan I, Leal M, Gil Ortega M, Tello Montoliu A, Orenes Piñero E, Manzano Fernández S, Marín F, Romero Aniorte A, Veliz Martínez A, Quintana Giner M, Ballesteros G, Palacio M, Alcalde O, García-Bolao I, Bertomeu Gonzalez V, Otero-Raviña F, García Seara J, Gonzalez Juanatey J, Dayal N, Maziarski P, Gentil-Baron P, Shah D, Koç M, Onrat E, Dural IE, Yilmaz K, Özin B, Tan Kurklu S, Atmaca Y, Canpolat U, Tokgozoglu L, Dolu AK, Demirtas B, Sahin D, Ozcan Celebi O, Diker E, Gagirci G, Turk UO, Ari H, Polat N, Toprak N, Sucu M, Akin Serdar O, Taha Alper A, Kepez A, Yuksel Y, Uzunselvi A, Yuksel S, Sahin M, Kayapinar O, Ozcan T, Kaya H, Yilmaz MB, Kutlu M, Demir M, Gibbs C, Kaminskiene S, Bryce M, Skinner A, Belcher G, Hunt J, Stancombe L, Holbrook B, Peters C, Tettersell S, Shantsila A, Lane D, Senoo K, Proietti M, Russell K, Domingos P, Hussain S, Partridge J, Haynes R, Bahadur S, Brown R, McMahon S, Y H Lip G, McDonald J, Balachandran K, Singh R, Garg S, Desai H, Davies K, Goddard W, Galasko G, Rahman I, Chua Y, Payne O, Preston S, Brennan O, Pedley L, Whiteside C, Dickinson C, Brown J, Jones K, Benham L, Brady R, Buchanan L, Ashton A, Crowther H, Fairlamb H, Thornthwaite S, Relph C, McSkeane A, Poultney U, Kelsall N, Rice P, Wilson T, Wrigley M, Kaba R, Patel T, Young E, Law J, Runnett C, Thomas H, McKie H, Fuller J, Pick S, Sharp A, Hunt A, Thorpe K, Hardman C, Cusack E, Adams L, Hough M, Keenan S, Bowring A, Watts J, Zaman J, Goffin K, Nutt H, Beerachee Y, Featherstone J, Mills C, Pearson J, Stephenson L, Grant S, Wilson A, Hawksworth C, Alam I, Robinson M, Ryan S, Egdell R, Gibson E, Holland M, Leonard D, Mishra B, Ahmad S, Randall H, Hill J, Reid L, George M, McKinley S, Brockway L, Milligan W, Sobolewska J, Muir J, Tuckis L, Winstanley L, Jacob P, Kaye S, Morby L, Jan A, Sewell T, Boos C, Wadams B, Cope C, Jefferey P, Andrews N, Getty A, Suttling A, Turner C, Hudson K, Austin R, Howe S, Iqbal R, Gandhi N, Brophy K, Mirza P, Willard E, Collins S, Ndlovu N, Subkovas E, Karthikeyan V, Waggett L, Wood A, Bolger A, Stockport J, Evans L, Harman E, Starling J, Williams L, Saul V, Sinha M, Bell L, Tudgay S, Kemp S, Brown J, Frost L, Ingram T, Loughlin A, Adams C, Adams M, Hurford F, Owen C, Miller C, Donaldson D, Tivenan H, Button H, Nasser A, Jhagra O, Stidolph B, Brown C, Livingstone C, Duffy M, Madgwick P, Roberts P, Greenwood E, Fletcher L, Beveridge M, Earles S, McKenzie D, Beacock D, Dayer M, Seddon M, Greenwell D, Luxton F, Venn F, Mills H, Rewbury J, James K, Roberts K, Tonks L, Felmeden D, Taggu W, Summerhayes A, Hughes D, Sutton J, Felmeden L, Khan M, Walker E, Norris L, O’Donohoe L, Mozid A, Dymond H, Lloyd-Jones H, Saunders G, Simmons D, Coles D, Cotterill D, Beech S, Kidd S, Wrigley B, Petkar S, Smallwood A, Jones R, Radford E, Milgate S, Metherell S, Cottam V, Buckley C, Broadley A, Wood D, Allison J, Rennie K, Balian L, Howard L, Pippard L, Board S, Pitt-Kerby T. Epidemiology and impact of frailty in patients with atrial fibrillation in Europe. Age Ageing 2022; 51:6670566. [PMID: 35997262 DOI: 10.1093/ageing/afac192] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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: 03/17/2022] [Revised: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. OBJECTIVES We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients. METHODS A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. RESULTS Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. CONCLUSIONS In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.
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Affiliation(s)
- Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Translational and Precision Medicine, Sapienza - University of Rome, Italy
| | - Marco Vitolo
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Francisco Marin
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBER-CV, Murcia, Spain
| | - Michael Näbauer
- Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Center of Serbia, Belgrade, Serbia
| | - Gheorghe-Andrei Dan
- University of Medicine, 'Carol Davila', Colentina University Hospital, Bucharest, Romania
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Lopez C, Vaivre-Douret L. Effect of the vision suppression on the graphomotor gesture in school aged children typically developed and with handwriting disorders. Eur Psychiatry 2022. [PMCID: PMC9567823 DOI: 10.1192/j.eurpsy.2022.1939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The knowledge aboutthe integration of letter motor programs during learning to write support the idea of an interdependence of visual and kinesthetic controls to direct the strokes. Objectives The objective of our study is to analyze the effect of the vision suppression both on the postural-gestural organization and on the spatial/temporal/kinematic parameters in a prescriptural task. Methods 35 school aged children with handwriting disorders (HD group) aged 6-11 years and 35 matched typical children were included in the study. They performed a prescriptural task of copying a cycloid line of loops, carried out under two conditions, with open eyes versus closed eyes. Postural-gestural measures were recorded with two video cameras allowing 2D reconstruction of the gesture. Spatial/temporal/kinematic measures were recorded with a digital pen. Results The HD group showed a significantly poorer postural control and an improvement in the spatial/temporal/kinematic parameters of the loops when they closed their eyes compared to eyes open. In typical group, the postural-gestural organization became significantly more mature but with no significant influence on the spatial/temporal/kinematic parameters of the loops. Conclusions HDs could be partly explained by a deficit in the processing of proprioceptive/kinesthetic feedback and a disruptive effect of the visual control on the quality of the prescriptural drawings. The ability to direct the strokes would remain dependent on sensory feedbacks, themselves insufficiently efficient, which would lead to difficulties in reaching a proactive control of handwriting. These results should be able to enhance clinical practices and to contribute to clinical decision making processes for handwriting disorders remediation. Disclosure No significant relationships.
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Roca Lecumberri A, Gelabert E, Torres Giménez A, Solé E, Andrés-Perpiñá S, Roda E, Lopez C, Naranjo C, Garcia-Esteve L. Unplanned Pregnancy in women with mental disorder. Eur Psychiatry 2022. [PMCID: PMC9566928 DOI: 10.1192/j.eurpsy.2022.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Few studies have investigated the level of planning of pregnancy among women with mental disorder and associated risk factors.
Objectives
The purpose of this study was to determine the associated factors to UP and psychopathological consequences.
Methods
A cross sectional study was conducted at the Perinatal Mental Health Unit of the Hospital Clínic in Barcelona. The total sample comprised 675 consecutive pregnant women with diagnosis of mental disorder (DSM-IV criteria), seen between January 2006 and December 2018. Clinical, psychometric and socio-demographic variables were collected at the first visit. Pregnancy planning was assessed by a question “Was this pregnancy planned?” with three possible answers: 1) Yes, it was planned and has been well received; 2) No, it was not planned but it has been well received; and 3) No, it was an accident. Response 1 was coded as “planned pregnancy” and responses 2 and 3 as “Unplanned Pregnancy”.
Results
38.4% of the sample had an UP. Younger age, lower levels of education, Latin-American population, multiparity, financials problems and poor relationship with the partner were associated with UP in women with mental disorder. The mean EPDS and STAI scores and the presence of self-harming thoughts were significantly higher in women with UP.
Conclusions
UP was associated with more depressive and anxious symptoms and more self-harming thoughts. It is necessary to promote reproductive health care for women with mental disorders and to take into account their reproductive life plan, especially in those with risk factors described.
Disclosure
No significant relationships.
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Zhao L, Asis-Cruz JD, Feng X, Wu Y, Kapse K, Largent A, Quistorff J, Lopez C, Wu D, Qing K, Meyer C, Limperopoulos C. Automated 3D Fetal Brain Segmentation Using an Optimized Deep Learning Approach. AJNR Am J Neuroradiol 2022; 43:448-454. [PMID: 35177547 PMCID: PMC8910820 DOI: 10.3174/ajnr.a7419] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/06/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE MR imaging provides critical information about fetal brain growth and development. Currently, morphologic analysis primarily relies on manual segmentation, which is time-intensive and has limited repeatability. This work aimed to develop a deep learning-based automatic fetal brain segmentation method that provides improved accuracy and robustness compared with atlas-based methods. MATERIALS AND METHODS A total of 106 fetal MR imaging studies were acquired prospectively from fetuses between 23 and 39 weeks of gestation. We trained a deep learning model on the MR imaging scans of 65 healthy fetuses and compared its performance with a 4D atlas-based segmentation method using the Wilcoxon signed-rank test. The trained model was also evaluated on data from 41 fetuses diagnosed with congenital heart disease. RESULTS The proposed method showed high consistency with the manual segmentation, with an average Dice score of 0.897. It also demonstrated significantly improved performance (P < .001) based on the Dice score and 95% Hausdorff distance in all brain regions compared with the atlas-based method. The performance of the proposed method was consistent across gestational ages. The segmentations of the brains of fetuses with high-risk congenital heart disease were also highly consistent with the manual segmentation, though the Dice score was 7% lower than that of healthy fetuses. CONCLUSIONS The proposed deep learning method provides an efficient and reliable approach for fetal brain segmentation, which outperformed segmentation based on a 4D atlas and has been used in clinical and research settings.
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Affiliation(s)
- L Zhao
- From the Department of Diagnostic Imaging and Radiology (L.Z., J.D.A.-C., Y.W., K.K., A.L., J.Q., C. Lopez, C. Limperopoulos), Developing Brain Institute, Children's National, Washington, DC
- Department of Biomedical Engineering (L.Z., D.W.), Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, China
| | - J D Asis-Cruz
- From the Department of Diagnostic Imaging and Radiology (L.Z., J.D.A.-C., Y.W., K.K., A.L., J.Q., C. Lopez, C. Limperopoulos), Developing Brain Institute, Children's National, Washington, DC
| | - X Feng
- Department of Biomedical Engineering (X.F., C.M.), University of Virginia, Charlottesville, Virginia
| | - Y Wu
- From the Department of Diagnostic Imaging and Radiology (L.Z., J.D.A.-C., Y.W., K.K., A.L., J.Q., C. Lopez, C. Limperopoulos), Developing Brain Institute, Children's National, Washington, DC
| | - K Kapse
- From the Department of Diagnostic Imaging and Radiology (L.Z., J.D.A.-C., Y.W., K.K., A.L., J.Q., C. Lopez, C. Limperopoulos), Developing Brain Institute, Children's National, Washington, DC
| | - A Largent
- From the Department of Diagnostic Imaging and Radiology (L.Z., J.D.A.-C., Y.W., K.K., A.L., J.Q., C. Lopez, C. Limperopoulos), Developing Brain Institute, Children's National, Washington, DC
| | - J Quistorff
- From the Department of Diagnostic Imaging and Radiology (L.Z., J.D.A.-C., Y.W., K.K., A.L., J.Q., C. Lopez, C. Limperopoulos), Developing Brain Institute, Children's National, Washington, DC
| | - C Lopez
- From the Department of Diagnostic Imaging and Radiology (L.Z., J.D.A.-C., Y.W., K.K., A.L., J.Q., C. Lopez, C. Limperopoulos), Developing Brain Institute, Children's National, Washington, DC
| | - D Wu
- Department of Biomedical Engineering (L.Z., D.W.), Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, China
| | - K Qing
- Department of Radiation Oncology (K.Q.), City of Hope National Center, Duarte, California
| | - C Meyer
- Department of Biomedical Engineering (X.F., C.M.), University of Virginia, Charlottesville, Virginia
| | - C Limperopoulos
- From the Department of Diagnostic Imaging and Radiology (L.Z., J.D.A.-C., Y.W., K.K., A.L., J.Q., C. Lopez, C. Limperopoulos), Developing Brain Institute, Children's National, Washington, DC
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7
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Basu S, Pradhan S, Barnett S, Mikkelsen M, Kapse K, Murnick J, Quistorff J, Lopez C, du Plessis A, Limperopoulos C. Regional Differences in Gamma-Aminobutyric Acid and Glutamate Concentrations in the Healthy Newborn Brain. AJNR Am J Neuroradiol 2022; 43:125-131. [PMID: 34764083 PMCID: PMC8757541 DOI: 10.3174/ajnr.a7336] [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: 06/14/2021] [Accepted: 09/10/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Gamma-aminobutyric acid and glutamate system disruptions may underlie neonatal brain injury. However, in vivo investigations are challenged by the need for special 1H-MR spectroscopy sequences for the reliable measurement of the neurotransmitters in this population. We used J-edited 1H-MR spectroscopy (Mescher-Garwood point-resolved spectroscopy) to quantify regional in vivo gamma-aminobutyric acid and glutamate concentrations during the early postnatal period in healthy neonates. MATERIALS AND METHODS We prospectively enrolled healthy neonates and acquired Mescher-Garwood point-resolved spectroscopy spectra on a 3T MR imaging scanner from voxels located in the cerebellum, the right basal ganglia, and the right frontal lobe. CSF-corrected metabolite concentrations were compared for regional variations and cross-sectional temporal trends with advancing age. RESULTS Fifty-eight neonates with acceptable spectra acquired at postmenstrual age of 39.1 (SD, 1.3) weeks were included for analysis. Gamma-aminobutyric acid (+ macromolecule) (2.56 [SD, 0.1]) i.u., glutamate (3.80 [SD, 0.2]), Cho, and mIns concentrations were highest in the cerebellum, whereas NAA (6.72 [SD, 0.2]), NAA/Cho, Cr/Cho, and Glx/Cho were highest in the basal ganglia. Frontal gamma-aminobutyric acid (1.63 [SD, 0.1]), Glx (4.33 [SD, 0.3]), Cr (3.64 [SD, 0.2]), and Cho concentrations were the lowest among the ROIs. Glx, NAA, and Cr demonstrated a significant adjusted increase with postmenstrual age (β = 0.2-0.35), whereas gamma-aminobutyric acid and Cho did not. CONCLUSIONS We report normative regional variations and temporal trends of in vivo gamma-aminobutyric acid and glutamate concentrations reflecting the functional and maturational status of 3 distinct brain regions of the neonate. These measures will serve as important normative values to allow early detection of subtle neurometabolic alterations in high-risk neonates.
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Affiliation(s)
- S.K. Basu
- From the Department of Neonatology (S.K.B.),Developing Brain Institute (S.K.B., S.P., S.D.B., K.J.K., J.L.Q., C.A.L., C.L.),George Washington University School of Medicine (S.K.B. S.P., S.D.B., J.M., A.J.d.P., C.L.), Washington, DC
| | - S. Pradhan
- Developing Brain Institute (S.K.B., S.P., S.D.B., K.J.K., J.L.Q., C.A.L., C.L.),George Washington University School of Medicine (S.K.B. S.P., S.D.B., J.M., A.J.d.P., C.L.), Washington, DC
| | - S.D. Barnett
- Developing Brain Institute (S.K.B., S.P., S.D.B., K.J.K., J.L.Q., C.A.L., C.L.),George Washington University School of Medicine (S.K.B. S.P., S.D.B., J.M., A.J.d.P., C.L.), Washington, DC
| | - M. Mikkelsen
- Department of Radiology (M.M., J.M.), Weill Cornell Medicine, New York, New York
| | - K.J. Kapse
- Developing Brain Institute (S.K.B., S.P., S.D.B., K.J.K., J.L.Q., C.A.L., C.L.)
| | - J. Murnick
- George Washington University School of Medicine (S.K.B. S.P., S.D.B., J.M., A.J.d.P., C.L.), Washington, DC,Department of Radiology (M.M., J.M.), Weill Cornell Medicine, New York, New York
| | - J.L. Quistorff
- Developing Brain Institute (S.K.B., S.P., S.D.B., K.J.K., J.L.Q., C.A.L., C.L.)
| | - C.A. Lopez
- Developing Brain Institute (S.K.B., S.P., S.D.B., K.J.K., J.L.Q., C.A.L., C.L.)
| | - A.J. du Plessis
- Fetal Medicine Institute (A.J.d.P.), Children’s National Hospital, Washington, DC,George Washington University School of Medicine (S.K.B. S.P., S.D.B., J.M., A.J.d.P., C.L.), Washington, DC
| | - C. Limperopoulos
- Developing Brain Institute (S.K.B., S.P., S.D.B., K.J.K., J.L.Q., C.A.L., C.L.),Division of Diagnostic Imaging and Radiology (C.L.),George Washington University School of Medicine (S.K.B. S.P., S.D.B., J.M., A.J.d.P., C.L.), Washington, DC
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Kerr M, Dennis KMJH, Carr CA, Fuller W, Berridge G, Rohling S, Aitken CL, Lopez C, Fischer R, Miller JJ, Clarke K, Tyler DJ, Heather LC. Diabetic mitochondria are resistant to palmitoyl CoA inhibition of respiration, which is detrimental during ischemia. FASEB J 2021; 35:e21765. [PMID: 34318967 PMCID: PMC8662312 DOI: 10.1096/fj.202100394r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/24/2021] [Accepted: 06/14/2021] [Indexed: 01/07/2023]
Abstract
The bioactive lipid intermediate palmitoyl CoA (PCoA) can inhibit mitochondrial ADP/ATP transport, though the physiological relevance of this regulation remains unclear. We questioned whether myocardial ischemia provides a pathological setting in which PCoA regulation of ADP/ATP transport would be beneficial, and secondly, whether the chronically elevated lipid content within the diabetic heart could make mitochondria less sensitive to the effects of PCoA. PCoA acutely decreased ADP‐stimulated state 3 respiration and increased the apparent Km for ADP twofold. The half maximal inhibitory concentration (IC50) of PCoA in control mitochondria was 22 µM. This inhibitory effect of PCoA on respiration was blunted in diabetic mitochondria, with no significant difference in the Km for ADP in the presence of PCoA, and an increase in the IC50 to 32 µM PCoA. The competitive inhibition by PCoA was localised to the phosphorylation apparatus, particularly the ADP/ATP carrier (AAC). During ischemia, the AAC imports ATP into the mitochondria, where it is hydrolysed by reversal of the ATP synthase, regenerating the membrane potential. Addition of PCoA dose‐dependently prevented this wasteful ATP hydrolysis for membrane repolarisation during ischemia, however, this beneficial effect was blunted in diabetic mitochondria. Finally, using 31P‐magnetic resonance spectroscopy we demonstrated that diabetic hearts lose ATP more rapidly during ischemia, with a threefold higher ATP decay rate compared with control hearts. In conclusion, PCoA plays a role in protecting mitochondrial energetics during ischemia, by preventing wasteful ATP hydrolysis. However, this beneficial effect is blunted in diabetes, contributing to the impaired energy metabolism seen during myocardial ischemia in the diabetic heart.
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Affiliation(s)
- M Kerr
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - K M J H Dennis
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - C A Carr
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - W Fuller
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - G Berridge
- Target Discovery Institute, University of Oxford, Oxford, UK
| | - S Rohling
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - C L Aitken
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - C Lopez
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - R Fischer
- Target Discovery Institute, University of Oxford, Oxford, UK
| | - J J Miller
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK.,Department of Physics, University of Oxford, Oxford, UK.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - K Clarke
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - D J Tyler
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK.,Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - L C Heather
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
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Lopez C, Frechon P, Seizeur R, Emery E, Pelissou-Guyotat I, Proust F, Thines L, Gaberel T, Magro E. What is the role of neurosurgeons in the current management of intracranial aneurysm in France? An analysis of professional practices. Neurochirurgie 2021; 68:16-20. [PMID: 34246662 DOI: 10.1016/j.neuchi.2021.06.013] [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: 02/15/2021] [Revised: 06/27/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
STUDY DESIGN Retrospective observational survey-based study. INTRODUCTION In France, intracranial aneurysm (IA) patients are managed by neurosurgeons and by interventional neuroradiologists. The growth of endovascular treatment led us to reflect on the role of neurosurgeons in the management of patients with IA. The present study aimed to highlight the current organization of IA management in France. METHOD A 60-question survey was sent to the neurosurgeons in 34 hospitals managing IA patients. Thirty-three questions dealt with standards of care, follow-up procedures and the involvement of the specific specialist. RESULTS Twenty-seven centers (79.4%) responded to the survey. A Vascular Multidisciplinary Discussion Team was organized, including both surgeons and neuroradiologists, in 92% of responding centers. There were department protocols in 66% of centers, a local registry in 33% and clinical trials in IA in 60%. Patients with unruptured IA were first seen by a neurosurgeon or by an interventional neuroradiologist, with different practices. For ruptured IA, the neurosurgeons were contacted first in 93% of cases, and were systematically involved in initial intensive care unit management. The patients were hospitalized in the neurosurgery department in 89% of the centers. The neurosurgeons took care of initial follow-up in 85% of the centers, and of lifetime follow-up in 36%. In most centers, radiological monitoring of IA was based on MRI angiography for patients who were embolized or under surveillance, and on CT angiography after microsurgery. CONCLUSION Despite the growth of endovascular treatments, the present survey and the literature highlight a major role of neurosurgeons in treatment, follow-up and care coordination.
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Affiliation(s)
- C Lopez
- Department of Neurosurgery, CHRU de la Cavale Blanche, Boulevard Tanguy-Prigent, 29609 Brest cedex, France.
| | - P Frechon
- CHU Caen, Department of Neurosurgery, Caen University Hospital, Avenue de la Côte de Nacre, 14033 Caen, France
| | - R Seizeur
- Department of Neurosurgery, CHRU de la Cavale Blanche, Boulevard Tanguy-Prigent, 29609 Brest cedex, France; Université de Bretagne Occidentale, INSERM, UMR 1101, LaTIM, Laboratoire de Traitement de l'Information Médicale, 29200 Brest, France
| | - E Emery
- CHU Caen, Department of Neurosurgery, Caen University Hospital, Avenue de la Côte de Nacre, 14033 Caen, France; Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, 14000 Caen, France
| | - I Pelissou-Guyotat
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Department of Neurosurgery, 59, Boulevard Pinel, 69667 Bron, France
| | - F Proust
- Department of Neurosurgery, Hautepierre Hospital Strasbourg, University Hospital, 67098 Strasbourg, France
| | - L Thines
- Neurosurgery Department, Besançon University Hospital, 3, Boulevard Alexandre Fleming, 25030 Besançon cedex, France
| | - T Gaberel
- CHU Caen, Department of Neurosurgery, Caen University Hospital, Avenue de la Côte de Nacre, 14033 Caen, France; Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, 14000 Caen, France
| | - E Magro
- Department of Neurosurgery, CHRU de la Cavale Blanche, Boulevard Tanguy-Prigent, 29609 Brest cedex, France; Université de Bretagne Occidentale, INSERM, UMR 1101, LaTIM, Laboratoire de Traitement de l'Information Médicale, 29200 Brest, France
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10
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Whitworth GL, Jaramillo-Fernandez J, Pariente JA, Garcia PD, Blanco A, Lopez C, Sotomayor-Torres CM. Simulations of micro-sphere/shell 2D silica photonic crystals for radiative cooling. Opt Express 2021; 29:16857-16866. [PMID: 34154238 DOI: 10.1364/oe.420989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/07/2021] [Indexed: 06/13/2023]
Abstract
Passive daytime radiative cooling has recently become an attractive approach to address the global energy demand associated with modern refrigeration technologies. One technique to increase the radiative cooling performance is to engineer the surface of a polar dielectric material to enhance its emittance at wavelengths in the atmospheric infrared transparency window (8-13 µm) by outcoupling surface-phonon polaritons (SPhPs) into free-space. Here we present a theoretical investigation of new surface morphologies based upon self-assembled silica photonic crystals (PCs) using an in-house built rigorous coupled-wave analysis (RCWA) code. Simulations predict that silica micro-sphere PCs can reach up to 73 K below ambient temperature, when solar absorption and conductive/convective losses can be neglected. Micro-shell structures are studied to explore the direct outcoupling of the SPhP, resulting in near-unity emittance between 8 and 10 µm. Additionally, the effect of material composition is explored by simulating soda-lime glass micro-shells, which, in turn, exhibit a temperature reduction of 61 K below ambient temperature. The RCWA code was compared to FTIR measurements of silica micro-spheres, self-assembled on microscope slides.
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Abstract
Introduction Handwriting disorder is considered to be one of the major public health problems among school-aged children worldwide. All the scales in the literature use handwriting tasks but it could be interesting to investigate a more accurate assessment of handwriting difficulties before the development and acquisition of handwriting as such. Objectives The objective of our study is to examine the validity of a prescriptural task consisting of copying a line of cycloid loops in the diagnosis of handwriting disorders. Methods
35 children with handwriting disabilities and 331 typically developing right-handed children in primary school, aged 6-11 years old, were included in the study. They performed a copy of a line of cycloid loops, in an ecological setting, with a paper sheet put on the table. The kinematic measures were recorded with a digital pen. A Receiver Operating Characteristic method (ROC curve) was used to determine whether the loops line copy may be a sensitive test to diagnose handwriting disorders. Results
Six kinematic variables recorded during the prescriptural task were found to be relevant markers of handwriting disorders with a sensibility between 0.743 and 0.880: strokes number, total and effective drawing time, in-air pauses times, loops number, number of peaks velocity. Conclusions The graphomotor task of copying a line of cycloid loops showed a good sensitivity to diagnose handwriting disorders and appeared to be a good predictor test, more particularly with the variables reflecting the strokes temporal organization.Drawing loops is a rapid graphomotor task, useful for exploring prerequisites of handwriting in screening for handwriting disorders.
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Alnsasra H, Asleh R, Kumar N, Toya T, Lopez C, Kremers W, Edwards B, Daly R, Kushwaha S. Incidence, Predictors and Outcomes of Stroke Following Cardiac Transplantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.662] [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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13
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Waisberg F, Lopez C, Burton J, Hirsch I, Enrico D, Mandó P, Martin C, Chacón M, Seetharamu N. MA04.04 Assessing the Methodological Quality of Quality-of-Life Analyses in First-Line Lung Cancer Trials: A Systematic Review. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.226] [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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14
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Stoyanova R, Lopez C, Breto A, Xu I, Kwon D, Franco G, Pra AD, Abramowitz M, Punnen S, Pollack A. The Effects of Androgen-Deprivation Therapy on MRI Delta Radiomics Features in a Prospective Radiotherapy Treatment Trial for Prostate Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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15
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Kennedy K, Cal R, Casey R, Lopez C, Adelfio A, Molloy B, Wall AM, Holton TA, Khaldi N. The anti-ageing effects of a natural peptide discovered by artificial intelligence. Int J Cosmet Sci 2020; 42:388-398. [PMID: 32453870 DOI: 10.1111/ics.12635] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 01/20/2020] [Revised: 04/08/2020] [Accepted: 05/20/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE As skin ages, impaired extracellular matrix (ECM) protein synthesis and increased action of degradative enzymes manifest as atrophy, wrinkling and laxity. There is mounting evidence for the functional role of exogenous peptides across many areas, including in offsetting the effects of cutaneous ageing. Here, using an artificial intelligence (AI) approach, we identified peptide RTE62G (pep_RTE62G), a naturally occurring, unmodified peptide with ECM stimulatory properties. The AI-predicted anti-ageing properties of pep_RTE62G were then validated through in vitro, ex vivo and proof of concept clinical testing. METHODS A deep learning approach was applied to unlock pep_RTE62G from a plant source, Pisum sativum (pea). Cell culture assays of human dermal fibroblasts (HDFs) and keratinocytes (HaCaTs) were subsequently used to evaluate the in vitro effect of pep_RTE62G. Distinct activities such as cell proliferation and ECM protein production properties were determined by ELISA assays. Cell migration was assessed using a wound healing assay, while ECM protein synthesis and gene expression were analysed, respectively, by immunofluorescence microscopy and PCR. Immunohistochemistry of human skin explants was employed to further investigate the induction of ECM proteins by pep_RTE62G ex vivo. Finally, the clinical effect of pep_RTE626 was evaluated in a proof of concept 28-day pilot study. RESULTS In vitro testing confirmed that pep_RTE62G is an effective multi-functional anti-ageing ingredient. In HaCaTs, pep_RTE62G treatment significantly increases both cellular proliferation and migration. Similarly, in HDFs, pep_RTE62G consistently induced the neosynthesis of ECM protein elastin and collagen, effects that are upheld in human skin explants. Lastly, in our proof of concept clinical study, application of pep_RTE626 over 28 days demonstrated anti-wrinkle and collagen stimulatory potential. CONCLUSION pep_RTE62G represents a natural, unmodified peptide with AI-predicted and experimentally validated anti-ageing properties. Our results affirm the utility of AI in the discovery of novel, functional topical ingredients.
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Affiliation(s)
- K Kennedy
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - R Cal
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - R Casey
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - C Lopez
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - A Adelfio
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - B Molloy
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - A M Wall
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - T A Holton
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - N Khaldi
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
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16
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Viudez A, Crespo G, Dorronsoro MG, Paredes BG, Custodio A, Hernando J, Sevilla I, Goñi S, Lopez C, Benavent M, Fonseca PJ, Alonso-Orduña V, Borja IG, Hernandez I, Muñoz ML, Carmona A, Sanz JP, Vicente BLS, Jesus-Acosta AD. P-245 GETNET-SILVELUL study: An original or modified immunohistochemical score (IPS or mIPS) in patients (pts) with pancreatic neuroendocrine tumors (PanNET) treated with everolimus or CAPTEM. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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17
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Chung V, Alistar A, George B, Kim K, Kindler H, Oh D, Allen S, Barak H, Ci B, Lau J, Retiere A, Shemesh C, Teichgräber V, Zhang X, Lopez C. SO-4 phase Ib/II, open-label, randomised evaluation of atezolizumab plus RO6874281 vs control in MORPHEUS–pancreatic ductal adenocarcinoma. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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18
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Asleh R, Briasoulis A, Smith B, Lopez C, Lerman A, Pereira N, Daly R, Kremers W, Clavell A, Stulak J, Kushwaha S. Effects of Aspirin on Progression of Cardiac Allograft Vasculopathy and Outcomes after Heart Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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19
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Mehta S, Botelho R, Fernandez F, Villagran C, Frauenfelder A, Matheus C, Vieira D, Torres MA, Ceschim M, Nola F, Pinto G, Mazzini J, Cecilio E, Acosta MI, Lopez C. P6422Physician vs machine: an innovative ST-elevation myocardial infarction pathway through artificial intelligence. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1016] [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
Background
The diagnosis of ST-Elevation Myocardial Infarction (STEMI) has traditionally relied on a cardiologist's interpretation of an Electrocardiogram (EKG). This cumbersome process is costly, inefficient and out of date. Artificial Intelligence (AI) -guided algorithms can provide point-of-care, accurate STEMI diagnosis that will facilitate STEMI management.
Purpose
To demonstrate the feasibility of an automated AI-guided EKG analysis for STEMI diagnosis.
Methods
An observational, retrospective, case-control study. Sample: 8,511 EKG cardiologist-annotated records, including 4,255 STEMI cases. Records excluded patient and medical information. The sample was derived from the private International Telemedical Systems (ITMS) database. LUMENGT-AI Algorithm was employed. Preprocessing: detection of QRS complexes by wavelet system, segmentation of each EKG into individual heartbeats (90,592 total beats) with fixed window of 0.4s to the left and 0.9s to the right of main QRS; Classification: A 1-D convolutional neural network was implemented, “STEMI” and “Not-STEMI” classes were considered for each heartbeat, individual probabilities were aggregated to generate the final label for each record. Training & Testing: 90% and 10% of the sample were used, respectively. Experiments: Intel PC i7 8750H processor at 2.21GHz, 16GB RAM, Windows 10 OS with NVidia GTX 1070 GPU, 8GB RAM.
Results
The model achieved an accuracy of 96.5%, with a sensitivity of 96.3%, and a specificity of 96.8%.
Conclusion(s)
1) AI-guided interpretation of the EKG can reliably diagnose STEMI; 2) AI algorithms can be incorporated into ambulance systems for pre-hospital diagnosis, single page activation, emergency department bypass, facilitating more efficient STEMI pathways.
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - R Botelho
- Lumen Foundation, Miami, United States of America
| | - F Fernandez
- Lumen Foundation, Miami, United States of America
| | - C Villagran
- Lumen Foundation, Miami, United States of America
| | | | - C Matheus
- Lumen Foundation, Miami, United States of America
| | - D Vieira
- Lumen Foundation, Miami, United States of America
| | - M A Torres
- Lumen Foundation, Miami, United States of America
| | - M Ceschim
- Lumen Foundation, Miami, United States of America
| | - F Nola
- Lumen Foundation, Miami, United States of America
| | - G Pinto
- Lumen Foundation, Miami, United States of America
| | - J Mazzini
- Lumen Foundation, Miami, United States of America
| | - E Cecilio
- Lumen Foundation, Miami, United States of America
| | - M I Acosta
- Lumen Foundation, Miami, United States of America
| | - C Lopez
- Lumen Foundation, Miami, United States of America
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20
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Mehta S, Fernandez F, Villagran C, Frauenfelder A, Matheus C, Ceschim M, Vieira D, Torres MA, Mazzini J, Quintero S, Safie R, Aboushi H, Munguia A, Cecilio E, Lopez C. P6421Can cardiologists rely on artificial intelligence to identify the culprit vessel in STEMI? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1015] [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: 11/12/2022] Open
Abstract
Abstract
Background
The importance of culprit lesion identification is critical for risk stratification of a patient with an ST-Elevation Myocardial Infarction (STEMI). The aforementioned provide patients with a more elaborated strategy of management and treatment either they are treated with PCI or less invasive techniques such as thrombolysis. We report a novel approach that employs AI-guided electrocardiogram (EKG) algorithms for rapid and accurate identification of the culprit STEMI vessel.
Purpose
To create an innovative, machine learning tool for a more effective risk stratification of STEMI patients.
Methods
An observational, retrospective, case-control study. Sample: 2,542 exclusively STEMI diagnosis EKG records that included post discharge feedback from healthcare centers, confirming diagnosis and culprit vessel (Left Main Coronary Artery [LMCA]; Left Anterior Descending [LAD]; Right Coronary Artery [RCA]; Left Circumflex Artery [LCX]; Saphenous Vein Graft [SVG]). Records excluded other patient and medical information. The sample was derived from the private International Telemedical Systems (ITMS) database. LUMENGT-AI Algorithm was employed. Preprocessing: detection of QRS complexes using a wavelet system, segmentation of each EKG into individual heartbeats (27,125 total beats) with fixed window of 0.4s to the left and 0.9s to the right of main QRS; Classification: A 1-D convolutional neural network was implemented; “LCMA”, “LAD”, “LCX”, “RCA”, “SVG”, and “No Information” classes were considered for each heartbeat; individual probabilities were aggregated to generate the final label for each record. Training & Testing: 90% and 10% of the sample was used, respectively. Experiments: Intel PC i7 8750H processor at 2.21GHz, 16GB RAM, Windows 10 OS with NVidia GTX 1070 GPU, 8GB RAM.
Results
Global Accuracy: 79.4%; LAD: Sensitivity 86.2%; Specificity 84.8%. RCA: Sensitivity 85.7%; Specificity 83.7%. LCX: Sensitivity 43.5%; Specificity 96.9%.
Conclusions
Coupling an AI-augmented algorithm and 12-lead EKG provides encouraging results for STEMI culprit vessel localization. Overall, risk stratification is possible for individual lesions located in the LAD and RCA. However, our approach yielded uncertain results in the LCX territory. We plan to continue to exploring variables for improvement of our results.
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - F Fernandez
- Lumen Foundation, Miami, United States of America
| | - C Villagran
- Lumen Foundation, Miami, United States of America
| | | | - C Matheus
- Lumen Foundation, Miami, United States of America
| | - M Ceschim
- Lumen Foundation, Miami, United States of America
| | - D Vieira
- Lumen Foundation, Miami, United States of America
| | - M A Torres
- Lumen Foundation, Miami, United States of America
| | - J Mazzini
- Lumen Foundation, Miami, United States of America
| | - S Quintero
- Lumen Foundation, Miami, United States of America
| | - R Safie
- Lumen Foundation, Miami, United States of America
| | - H Aboushi
- Lumen Foundation, Miami, United States of America
| | - A Munguia
- Lumen Foundation, Miami, United States of America
| | - E Cecilio
- Lumen Foundation, Miami, United States of America
| | - C Lopez
- Lumen Foundation, Miami, United States of America
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21
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Lopez C. The vestibular system and body schema. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Mehta S, Botelho R, Fernandez F, Feres F, Abizaid A, Cade J, Perin M, Prudente M, Cavalcanti R, Dusilek C, Nola F, Pisana L, Safie R, Aboushi H, Lopez C. P5241Balancing limited resources, infra-structure deficits & cultural differences in sustaining the growth of LATIN telemedicine program. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0214] [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: 11/12/2022] Open
Abstract
Abstract
Background
In resource-constrained nations, population-based AMI coverage is daunting. Telemedicine can transform with efficient, cost-effective and scalable programs. We present our data with screening >780,000 patients with innovative hub and spoke strategies.
Purpose
Scientifically pristine protocols, rigorous training, unflinching quality assurance, technology upgrades and education of broad stakeholders are essential attributes for creating population-based AMI programs.
Methods
Latin America Telemedicine Infarct Network (LATIN) required methodical groundwork during a 12-month pilot prior to its formal launch and sustenance for 5 years. It involved scrupulous site selection, technology, and telemedicine optimization and system-wide process metrics. Spokes are the LATIN nucleus and require constant (3-T) training: Triage, Telemedicine, and Transportation. Plus, a mandatory deconstruct of their role in LATIN, of urgent transfer and desist non-critical care. Telemedicine requires constant upgrading of platform, tele-equipment and cloud computing. Ambulance availability is a constant challenge as is the battle with payers. Data entry has required meticulous training and oversight. Strict QA processes have monitored critical metrics: Spokes (Door In Door Out, DIDO and Transport Times); Hubs (Door to Balloon Times, D2B); Telemedicine Platform (Time to Telemedicine Diagnosis, TTD).
Results
Linear growth is observed in the number of sites and telemedicine screenings with simultaneous and sustained improvements in D2B and TTD. 784,395 patients were screened at 350 LATIN centers (Brazil 143, Colombia 118, Mexico 82, Argentina 7). With expanded reach, 8,440 (1.08%) patients were diagnosed and 3,924 (46.5%) urgently reperfused, including 3,048 (77.7%) with PCI. Time to Telemedicine Diagnosis (TTD) was 3 min, tele-accuracy 98.9%, D2B 51 min and in-hospital morality 5.2%. Major reasons for non-treatment were insurance, lack of ICU beds and delayed presentation.
Conclusions
As other regions of the world develop large, population-based AMI management initiatives, LATIN can provide important lessons in the sustainability of these processes.
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - R Botelho
- Lumen Foundation, Miami, United States of America
| | - F Fernandez
- Lumen Foundation, Miami, United States of America
| | - F Feres
- Lumen Foundation, Miami, United States of America
| | - A Abizaid
- Lumen Foundation, Miami, United States of America
| | - J Cade
- Lumen Foundation, Miami, United States of America
| | - M Perin
- Lumen Foundation, Miami, United States of America
| | - M Prudente
- Lumen Foundation, Miami, United States of America
| | - R Cavalcanti
- Lumen Foundation, Miami, United States of America
| | - C Dusilek
- Lumen Foundation, Miami, United States of America
| | - F Nola
- Lumen Foundation, Miami, United States of America
| | - L Pisana
- Lumen Foundation, Miami, United States of America
| | - R Safie
- Lumen Foundation, Miami, United States of America
| | - H Aboushi
- Lumen Foundation, Miami, United States of America
| | - C Lopez
- Lumen Foundation, Miami, United States of America
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23
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Mehta S, Fernandez F, Villagran C, Frauenfelder A, Matheus C, Vieira D, Torres MA, Mazzini J, Pisana L, Quintero S, Cecilio E, Aboushi H, Acosta MI, Lopez C, Sunkaraneni S. P1466Can physicians trust a machine learning algorithm to diagnose ST elevation myocardial infarction? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0231] [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
For the past years, the medical field has been taking advantage of the endless possibilities that Artificial Intelligence (AI) provides. Using computer-aided devices that can perform and interpret electrocardiograms (EKG) accurately pushes current healthcare boundaries. We present the LUMENGT-AI, this model can handle large datasets, multiclass diagnoses, complex EKG morphology, and still detect ST Elevation MI (STEMI) accurately.
Purpose
To develop an innovative AI-based system for automated STEMI specific EKG analysis.
Methods
An observational, retrospective, case-control study. Sample: 8,511 EKG records, previously diagnosed as “normal”, “abnormal” (over 200 conditions) or “STEMI” (4,255 cases). Records excluded patient and medical information. The sample was derived from the private International Telemedical Systems (ITMS) database. LUMENGT-AI Algorithm was employed. Preprocessing: detection of QRS complexes by wavelet system, segmentation of each EKG into individual heartbeats (90,592 total beats) with fixed window of 0.4s to the left and 0.9s to the right of main QRS; Classification: A 1-D convolutional neural network was implemented, “STEMI” and “Not-STEMI” classes were considered for each heartbeat, individual probabilities were aggregated to generate the final label for each record. Training & Testing: 90% and 10% of the sample were used, respectively. Experiments: Intel PC i7 8750H processor at 2.21GHz, 16GB RAM, Windows 10 OS with NVidia GTX 1070 GPU, 8GB RAM.
Results
Ground Truth Score – Accuracy (94.1%), Sensitivity (87.8%), Specificity (98.1%) – see the comparison to published data in Table.
Conclusions
A statistical analysis allowed us to compare STEMI recognition efficiency between physicians and our model. The LUMENGT algorithm results secured its place as a reliable tool to diagnose STEMI faster and more accurately than physicians.
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - F Fernandez
- Lumen Foundation, Miami, United States of America
| | - C Villagran
- Lumen Foundation, Miami, United States of America
| | | | - C Matheus
- Lumen Foundation, Miami, United States of America
| | - D Vieira
- Lumen Foundation, Miami, United States of America
| | - M A Torres
- Lumen Foundation, Miami, United States of America
| | - J Mazzini
- Lumen Foundation, Miami, United States of America
| | - L Pisana
- Lumen Foundation, Miami, United States of America
| | - S Quintero
- Lumen Foundation, Miami, United States of America
| | - E Cecilio
- Lumen Foundation, Miami, United States of America
| | - H Aboushi
- Lumen Foundation, Miami, United States of America
| | - M I Acosta
- Lumen Foundation, Miami, United States of America
| | - C Lopez
- Lumen Foundation, Miami, United States of America
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Hernando Cubero J, Grande E, Castellano Gauna D, Ibrahim T, Fazio N, Lopez C, Teulé A, Valle J, Alonso V, Molina-Cerrillo J, Tafuto S, Custodio A, Trejo L, Casteras A, Manneh Kopp R, Miqueo C, Roca Herrera M, Garcia-Carbonero R, Salazar R, Capdevila J. Differences in multikinase inhibitors (MKI) toxicity profile according to gender. A pooled analysis of three phase II trials with lenvatinib, pazopanib and sorafenib in patients (pts) with advanced gastroenteropancreatic (GEP) neuroendocrine tumours (NETs). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz256.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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25
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Capdevila J, Castaño J, Mancuso F, Pedraza-Arevalo S, Matos I, Palmer H, Salva F, Landolfi S, Jimenez-Fonseca P, Garcia-Carbonero R, Lopez C, Ogbah Z, Nuciforo P, Casteras A, Acosta D, Diez M, Hernando J, Luque R, Vivancos A. RNA expression profiles and splicing alterations in grade 1/2 neuroendocrine neoplasms from small intestine origin (siNENs). Final results of the GETNE-NETSEQ study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz256.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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De Jesus-Acosta A, Crespo Herrero G, Gómez-Dorronsoro M, Alonso V, Riesco Martinez M, Custodio A, Lopez C, Benavent M, Carmona Bayonas A, Jimenez-Fonseca P, Llanos M, López De San Vicente B, Arrazubi Arrula V, Grandez R, González-Borja I, Goñi S, Arozarena I, Baretti M, Viudez A. SILVELUL project: Immunohistochemical panel analyses as potential predictive and prognostic factors in pancreatic neuroendocrine tumours (PanNET) treated with CAPTEM or everolimus. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz245.006] [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: 11/12/2022] Open
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Mehta S, Fernandez F, Villagran C, Ceschim M, Matheus C, Pinto G, Mazzini J, Pisana L, Quintero S, Nola F, Safie R, Aboushi H, Munguia A, Cecilio E, Lopez C. P6418The continued proficiency of artificial intelligence for interpreting EKG: single lead EKG for STEMI culprit lesion localization. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1012] [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
Traditionally, the 12-lead electrocardiogram (EKG) has been used for diagnosing ST-Elevation Myocardial Infarction (STEMI) and for identifying the culprit lesion. We have previously demonstrated the impact of combining a Single Lead approach with Artificial Intelligence (AI) to replace tasks previously dominated by the 12 lead EKG. This research explores the role of the single lead EKG in identifying a culprit lesion.
Purpose
To test the use of a single lead approach to accurately locate the culprit vessel.
Methods
An observational, retrospective, case-control study. Sample: 2,542 exclusively STEMI diagnosis EKG records that included post discharge feedback from healthcare centers, confirming diagnosis and culprit vessel (Left Main Coronary Artery [LMCA]; Left Anterior Descending [LAD]; Right Coronary Artery [RCA]; Left Circumflex Artery [LCX]; Saphenous Vein Graft [SVG]). Records excluded other patient and medical information. The sample was derived from the private International Telemedical Systems (ITMS) database. LUMENGT-AI Algorithm was employed. Preprocessing:detection of QRS complexes using a wavelet system, segmentation of each EKG into individual heartbeats (27,125 total beats) with fixed window of 0.4s to the left and 0.9s to the right of main QRS; Classification: A 1-D convolutional neural network was implemented; “LCMA”, “LAD”, “CX”, “RCA”, “SVG”, and “No Information” classes were considered for each heartbeat per lead; individual probabilities were aggregated to generate the final label for each record. Training & Testing: 90% and 10% of the sample was used, respectively. Experiments: Intel PC i7 8750H processor at 2.21GHz, 16GB RAM, Windows 10 OS with NVidia GTX 1070 GPU, 8GB RAM.
Results
Accuracy: 77.4% Lead III; Sensitivity: LMCA (Lead aVL 25%); LAD (Lead aVF 87.8%); RCA (Leads V1, V3 92.9%); LCX (Lead aVL 21.7%).
Conclusions
Our results yielded the dominance of a specific single lead to each culprit vessels, aVF for LAD and V1 and V3 for RCA. We continue testing with different algorithms to search for reliable results for the LMCA and LCX. Nonetheless, conjugating a Single Lead EKG with an AI-augmented algorithm enables faster and easier management for patients that present with STEMI affecting the LAD and RCA territories.
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - F Fernandez
- Lumen Foundation, Miami, United States of America
| | - C Villagran
- Lumen Foundation, Miami, United States of America
| | - M Ceschim
- Lumen Foundation, Miami, United States of America
| | - C Matheus
- Lumen Foundation, Miami, United States of America
| | - G Pinto
- Lumen Foundation, Miami, United States of America
| | - J Mazzini
- Lumen Foundation, Miami, United States of America
| | - L Pisana
- Lumen Foundation, Miami, United States of America
| | - S Quintero
- Lumen Foundation, Miami, United States of America
| | - F Nola
- Lumen Foundation, Miami, United States of America
| | - R Safie
- Lumen Foundation, Miami, United States of America
| | - H Aboushi
- Lumen Foundation, Miami, United States of America
| | - A Munguia
- Lumen Foundation, Miami, United States of America
| | - E Cecilio
- Lumen Foundation, Miami, United States of America
| | - C Lopez
- Lumen Foundation, Miami, United States of America
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Grande E, Lopez C, Alonso Gordoa T, Benavent M, Capdevila J, Teulé A, Custodio A, Sevilla I, Gajate P, Molina-Cerrillo J, Hernando Cubero J, Garcia-Carbonero R. SUNitinib with EVOfosfamide (TH-302) for G1/G2 metastatic pancreatic neuroendocrine tumours (pNETs) naïve for systemic treatment. The SUNEVO phase II trial of the Spanish task force group for neuroendocrine and endocrine tumours (GETNE). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz256.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Le-Rademacher J, Lopez C, Wolfe E, Jatoi A. Weight loss over time in non-small cell lung cancer: Results from a landmark analysis of 800+ prospectively-treated patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz265.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ordoñez C, Tiet Q, Scott S, Lopez C, Kixmiller J, Collins W. B-78 Social Skills Training for Verbal Aggression in Conserved Adults with Traumatic Brain Injury, Schizophrenia, and Schizoaffective Disorder. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
This pilot study examined the effectiveness of a social skills training (SST) program aimed to decrease verbal aggressive behavior and increase prosocial skills of conserved adults.
Method
Conserved adults (N = 10) with traumatic brain injury, schizophrenia, and schizoaffective disorder received SST for six weeks, an hour weekly, and they were assessed pre- and post-intervention. The Overt Aggression Scale-Modified for Neurorehabilitation-Extended was used to measure aggressive behaviors. Aggressive behavior to self, objects, and others was rated by facility staff that were not involved in the SST. Acquisition of social skills was rated by facility staff on the number of observed prosocial behavior (self-initiates greeting, responds to greeting, expresses gratitude). Only verbal aggression and prosocial scores were used given SST’s content. A paired samples t-test was conducted to evaluate the pre-post effectiveness and effect sizes.
Results
Aggression improved from M = 2.83 (SD = 3.39) to M = 1.00 (SD = 1.98), an improvement of 1.83, but was not statistically significant (t[8] = 2.28, p = .052; Cohen’s d = .76). 95% confidence interval ranged from -0.02 to 3.67. Prosocial behaviors improved from M = 8.67 (SD = 2.35) to M = 9.83 (SD = 2.41), an improvement of 1.17, but was not statistically significant (t[8] = -1.56, p = .158; Cohen’s d = .52). 95% confidence interval ranged from -2.90 to .56.
Conclusions
Effect sizes showed a decrease in aggression and social skills improvement of the participants. This SST is promising and should be examined with randomized controlled trial studies with larger sample sizes.
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Lopez C, Braga P. [Clinico-electroencephalographic variants in pharmacoresistant mesial temporal lobe epilepsy]. Rev Neurol 2019; 69:18-26. [PMID: 31236907 DOI: 10.33588/rn.6901.2018328] [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: 11/24/2022]
Abstract
INTRODUCTION Focal epilepsy secondary to mesial temporal sclerosis (MTS) is one of the main causes of refractory epilepsy. It is typically associated with frontotemporal discharges in the electroencephalogram (EEG), a characteristic image in the magnetic resonance scan and a probability of post-operative remission above 70%. AIMS To identify different patterns of ictal propagation in surface EEG recordings in patients with refractory epilepsy and MTS, and to analyse their relation with the post-operative outcome. PATIENTS AND METHODS We conducted a retrospective review of the medical records of patients with refractory epilepsy secondary to MTS evaluated in the Epilepsy Surgery Programme of the Hospital de Clinicas, Montevideo (n = 30). The propagation of ictal rhythms was analysed in time windows of three seconds, and propagation maps were produced for each seizure. RESULTS Six patterns were identified: ipsilateral temporal (type 1; 37%), bilateral frontotemporal with (type 2A; 22%) or without (type 2B; 17%) extension to suprasylvian regions, alternating temporal (type 3; 13%), unilateral suprasylvian (type 4; 7%) and bilateral at onset (type 5; 3%). The type 1 pattern was associated with classic clinical features and a favourable post-operative outcome. The clinical variants were associated with extratemporal EEG propagation. Patients with reflex seizures continued with post-operative seizures. Overall, no unambiguous relation was found between the ictal EEG pattern and the post-operative outcome. CONCLUSIONS The ictal EEG pattern does not allow for a surgical prognosis in patients with epilepsy secondary to MTS. The history of reflex seizures in these patients may be a red flag suggesting a less favourable surgical outcome.
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Affiliation(s)
- C Lopez
- Hospital de Clinicas, Montevideo, Uruguay
| | - P Braga
- Hospital de Clinicas, Montevideo, Uruguay
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Sinha M, Griffith M, Betts C, Choe G, Sivagnanam S, Cheung A, Tamaki W, Liu E, Sudduth-Klinger J, Vaccaro G, Lopez C, Fong L, Coussens L, Tempero M. Immune modulatory effects of ibrutinib in pancreatic ductal adenocarcinoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Affiliation(s)
- C. Lopez
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Washington State University; Pullman Washington USA
| | - M. Ciccarelli
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Washington State University; Pullman Washington USA
| | - J. R. Gold
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Washington State University; Pullman Washington USA
| | - A. Tibary
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Washington State University; Pullman Washington USA
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Rouby P, Marioni G, Lopez C. La confusion mentale en oncologie pédiatrique : réflexion à partir d’un cas. PSYCHO-ONCOLOGIE 2018. [DOI: 10.3166/pson-2018-0039] [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: 11/20/2022]
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Garcia-Carbonero R, Alonso V, Capdevila J, Sanchez Canovas M, Alonso T, Benavent M, Custodio A, Crespo Herrero G, Lopez C, Hernando J, Riesco Martinez M, Escudero P, Gallego Plazas J, Marazuela M, Diaz J, Llanos-Munoz M, La Casta A, Percovich J, Jimenez-Fonseca P, Carmona-Bayonas A. Development and internal validation of a predictive nomogram of progression-free survival in well-differentiated stage IV gastroenteropancreatic neuroendocrine tumours treated with somatostatin analogues: GETNE-TRASGU study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy293.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Capdevila J, Fazio N, Lopez C, Teule A, Valle J, Tafuto S, Custodio A, Reed N, Raderer M, Grande E, Garcia-Carbonero R, Jimenez Fonseca P, Alonso V, Antonuzzo L, Spallanzani A, Berruti A, Sevilla Garcia I, La Casta A, Hernando J, Ibrahim T. Efficacy of lenvatinib in patients with advanced pancreatic (panNETs) and gastrointestinal (giNETs) grade 1/2 (G1/G2) neuroendocrine tumors: Results of the international phase II TALENT trial (GETNE 1509). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy293] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Mata Velasco E, González-Flores E, Juez Martel I, Alonso V, Iranzo Gomez P, Martinez Lago N, Lopez C, Cabrera Romero J, Safont Aguilera M, Ruiz Casado A, Salgado Fernandez M, González Astorga B, Escudero P, Rivera Herrero F, Pericay Pijaume C, Vera R. In the pathway to response: Is aflibercept an optimal treatment for RASwt mCRC patients after progression to 1st line containing anti-EGFR? Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hernando Cubero J, Grande E, Jimenez Fonseca P, Villabona C, Trigo Perez J, Martinez Trufero J, Pajares Bernad I, Lopez C, Alonso T, Biarnes J, RamónY Cajal T, Duran M, Grau J, Arevalo Lobera S, Mesia Nin R, Llanos M, Dalmau Portulas E, Alvarez C, Zafon C, Capdevila J. Efficacy and safety of vandetanib for patients with advanced and progressive medullary thyroid cancer (MTC) as systemic treatment beyond first-line therapy. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy293.022] [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: 11/12/2022] Open
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Margari A, Cocozzella D, Bravo M, Lopez C, Garce S, Maurizi D, Gordovil M, Seijo S, Altamirano S. Epidemiology of HIV among argentinian Army personnel. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.3923] [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] Open
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Lopez C, Giuliano C, Gersztein A, Angulo A, Ruybal P. Chagas disease panniculitis in a patient with AIDS. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.4119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Piscicelli C, Barra J, Detante O, Krainik A, Lopez C, Pérennou D. Polymodal areas in the right brain support the human sense of upright. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gavazzi G, Meyrignac L, Drevet S, Mitha N, Zerhouni N, Lopez C, Fourny M, François P. Apports de la procalcitonine et de la CRP dans les bactériémies du sujet âgé : étude monocentrique sur 776 hémocultures. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.191] [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: 10/14/2022]
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Ramon y Cajal T, Lasa A, Llort G, Lopez C, Yagüe C, Cornet M, Gisbert A, Fisas D, Calvo N, Vethencourt A, Barba A, Quero S, Martinez E, Hernan I, Ruiz A, Arcusa A, Saigi E, Barnadas A, Surralles J. Multi-gene panels: new clinical experience in hereditary breast and ovarian cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx383.012] [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: 11/12/2022] Open
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Hernandez I, Estrella A, Salazar J, Duarte Y, Torres E, Lopez C, Teran E. SUN-P130: Cardiovascular Risk and ATPIII Goals Achievement in Ecuadorian Population. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30497-1] [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]
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Abstract
IntroductionAlthough more than 85% of children with DCD are affected by handwriting disorders, their characteristics and underlying mechanisms remain poorly known.ObjectivesWe aim to better identify the nature of handwriting disorders in subtyping DCD children.MethodsSchool children aged between 5 to 15 years and exhibited a DCD (according to DSM-5) are eligible for inclusion. They were classified in three subtypes of DCD: ideomotor (IM), visual-spatial and/or constructional (VSC), and mixed (MX). They were assessed with a standardized handwriting evaluation including quality and speed and a clinical observation of motor gestual developmental and temporal-spatial organization of handwriting highlighting six qualitative criteria: irregular handwriting (criterion 1), immaturity of handwriting gesture (criterion 2), excessive pressure of the pen on the paper (criterion 3), neuro-vegetative responses (criterion 4), trembling (criterion 5), slow handwriting velocity (criterion 6). Two groups are established: children with poor handwriting (PH) and children with dysgraphia (DysG).ResultsWhile 89% of children have handwriting disorders, only 20% exhibit dysgraphia. IM DCD is characterized by an immaturity of handwriting gesture and is associated with PH. Dysgraphia appears only in VSC and MX DCD which are characterized by the association of criteria 1, 2, 3, and 4. This association appears to more than 80% in DysG. Slow handwriting velocity is constant between PH and DysG.ConclusionImmaturity of handwriting gesture is a possible underlying mechanism of poor handwriting. Dysgraphia is associated with specific impairments in spatial organization of letters and in motor control of handwriting gesture.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Lopez C, Bertram-Farough A, Heywood D, Dawson L, Dillon M, Chochinov HM, Plourde P. Knowing about you: eliciting dimensions of personhood within tuberculosis care. Int J Tuberc Lung Dis 2017; 21:149-153. [PMID: 28234077 DOI: 10.5588/ijtld.16.0630] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knowing someone with tuberculosis (TB) as a person, rather than defining them by their illness, is part of recognising their dignity and unique individuality, and a requirement for effective care. OBJECTIVE An adaptation of the Patient Dignity Question (PDQ) was formalised for persons receiving treatment for active TB or latent tuberculous infection (LTBI), and its impact was evaluated for both the person and health care providers (HCPs). DESIGN Individuals with active TB or LTBI receiving treatment in Winnipeg, MB, Canada, were asked the PDQ as part of routine care. Patients and HCPs were subsequently invited to evaluate the application of the PDQ. RESULTS Of the 58 participants who responded to the PDQ, 97% felt both that it was important to ask about them as an individual, and that the PDQ should be asked of all patients, while 55% thought it made a difference to their care. Thirty-eight per cent of HCPs said they learned something new about their patient, and 31% said it influenced their sense of connectedness with and sense of empathy for patients, as well as their personal satisfaction in providing care. CONCLUSION Formalising a dignity question as part of person-centred care provides a mechanism to create a respectful environment that is caring of the most marginalised who carry the burden of TB.
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Affiliation(s)
- C Lopez
- Integrated Tuberculosis Services, Winnipeg Regional Health Authority, Winnipeg, Department of Medical Microbiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - A Bertram-Farough
- Integrated Tuberculosis Services, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - D Heywood
- Public Health Programme, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - L Dawson
- Klinic Community Health Centre, Winnipeg, Manitoba, Canada
| | - M Dillon
- Klinic Community Health Centre, Winnipeg, Manitoba, Canada
| | - H M Chochinov
- CancerCare Manitoba, Winnipeg, Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg
| | - P Plourde
- Integrated Tuberculosis Services, and Public Health Programme, Winnipeg Regional Health Authority; Department of Medical Microbiology, and Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Kiazyk S, Larcombe L, Lopez C, Matyas S, Mesa C, Orr P, Juno J, Waruk J, Sharma M, Ball TB. IFN-γ promoter polymorphisms do not affect QuantiFERON ® TB Gold In-Tube test results in a Canadian population. Int J Tuberc Lung Dis 2016; 20:1647-1652. [DOI: 10.5588/ijtld.16.0223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Márquez-Rodas I, Lobo M, Flores-Sanchez C, Sanz M, Luque S, Lizarraga S, González-Asanza C, Pajares JA, Peligros MI, Bueno O, Mata C, Lopez C, López-Tarruella S, Jerez Y, Muñoz-Martin A, Blanco M, Die-Trill M, Justel JP, Solera J, Martin M. Five Years of Multidisciplinary Care in Hereditary Cancer: Our Experience in a Spanish University Hospital. Oncology 2016; 92:68-74. [PMID: 27855387 DOI: 10.1159/000452280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 10/06/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyse the evolution of a multidisciplinary heredofamilial cancer unit (HFCU) in a university hospital. METHODS This was a retrospective analysis of the activity of our HFCU in its first 5 years of existence. RESULTS Between July 2010 and July 2015, 1,518 patients from 1,318 families attended our HFCU. Genetic testing was offered to 862 patients. Of those, 833 (96.6%) accepted testing, with available results for 636 (76.4%). Pathogenic mutations in BRCA1 and BRCA2 were found in 175 patients. Lynch syndrome and adenomatous polyposis were the most frequent syndromes diagnosed (151/175, 86.3%) among 17 different syndromes studied. Of the 404 patients without a previous genetic diagnosis in the family, 62 (15.3%) were found to have mutations in disease-causing genes. Prophylactic surgery and follow-up (33.7%) or follow-up only (66.3%) was proposed for mutation carriers according to international guidelines and patients' preferences. CONCLUSION We have a high mutation detection rate, genetic test acceptance, and compliance with risk reduction strategies. However, there is room for improvement, especially in genetic testing timing, considering that an increase in the indications for genetic testing is expected.
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Affiliation(s)
- I Márquez-Rodas
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Muffatti F, Tamburrino D, Partelli S, Lopez C, Albers M, Milanetto A, Pasquali C, Manzoni M, Toumpanakis C, Fusai G, Bartsch D, Falconi M. Long-term comparison of conservative management versus surgery for nonfunctioning pancreatic neuroendocrine tumors less than 2 cm affecting patients with men1 syndrome. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Capdevila J, Teulé A, Barriuso J, Castellano D, Lopez C, Manzano J, Alonso V, Garcia-Carbonero R, Dotor E, Matos I, Custodio A, Casanovas O, Salazar R. Phase II study of everolimus (EVL) and octreotide (OCT) LAR in patients with non-functioning gastrointestinal neuroendocrine tumours (GI-NETs): EVERLAR study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw369.29] [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: 11/14/2022] Open
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