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Warren M, Barrett A, Bhalla N, Brada M, Chuter R, Cobben D, Eccles CL, Hart C, Ibrahim E, McClelland J, Rea M, Turtle L, Fenwick JD. Sorting lung tumor volumes from 4D-MRI data using an automatic tumor-based signal reduces stitching artifacts. J Appl Clin Med Phys 2024; 25:e14262. [PMID: 38234116 PMCID: PMC11005973 DOI: 10.1002/acm2.14262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/30/2023] [Accepted: 12/18/2023] [Indexed: 01/19/2024] Open
Abstract
PURPOSE To investigate whether a novel signal derived from tumor motion allows more precise sorting of 4D-magnetic resonance (4D-MR) image data than do signals based on normal anatomy, reducing levels of stitching artifacts within sorted lung tumor volumes. METHODS (4D-MRI) scans were collected for 10 lung cancer patients using a 2D T2-weighted single-shot turbo spin echo sequence, obtaining 25 repeat frames per image slice. For each slice, a tumor-motion signal was generated using the first principal component of movement in the tumor neighborhood (TumorPC1). Signals were also generated from displacements of the diaphragm (DIA) and upper and lower chest wall (UCW/LCW) and from slice body area changes (BA). Pearson r coefficients of correlations between observed tumor movement and respiratory signals were determined. TumorPC1, DIA, and UCW signals were used to compile image stacks showing each patient's tumor volume in a respiratory phase. Unsorted image stacks were also built for comparison. For each image stack, the presence of stitching artifacts was assessed by measuring the roughness of the compiled tumor surface according to a roughness metric (Rg). Statistical differences in weighted means of Rg between any two signals were determined using an exact permutation test. RESULTS The TumorPC1 signal was most strongly correlated with superior-inferior tumor motion, and had significantly higher Pearson r values (median 0.86) than those determined for correlations of UCW, LCW, and BA with superior-inferior tumor motion (p < 0.05). Weighted means of ratios of Rg values in TumorPC1 image stacks to those in unsorted, UCW, and DIA stacks were 0.67, 0.69, and 0.71, all significantly favoring TumorPC1 (p = 0.02-0.05). For other pairs of signals, weighted mean ratios did not differ significantly from one. CONCLUSION Tumor volumes were smoother in 3D image stacks compiled using the first principal component of tumor motion than in stacks compiled with signals based on normal anatomy.
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Affiliation(s)
- Mark Warren
- School of Health Sciences, Institute of Population HealthUniversity of LiverpoolLiverpoolUK
| | | | - Neeraj Bhalla
- The Clatterbridge Cancer Centre NHS Foundation TrustLiverpoolUK
| | - Michael Brada
- Molecular & Clinical Cancer Medicine, Institute of Institute of Systems, Molecular and Integrative BiologyUniversity of LiverpoolLiverpoolUK
| | - Robert Chuter
- Christie Medical Physics and EngineeringThe Christie NHS Foundation TrustManchesterUK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - David Cobben
- The Clatterbridge Cancer Centre NHS Foundation TrustLiverpoolUK
- Department of Health Data Science, Institute of Population HealthUniversity of LiverpoolLiverpoolUK
| | - Cynthia L. Eccles
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- RadiotherapyThe Christie NHS Foundation TrustManchesterUK
| | - Clare Hart
- The Clatterbridge Cancer Centre NHS Foundation TrustLiverpoolUK
| | - Ehab Ibrahim
- The Clatterbridge Cancer Centre NHS Foundation TrustLiverpoolUK
| | - Jamie McClelland
- Department of Medical Physics and BioengineeringUniversity College LondonLondonUK
| | - Marc Rea
- The Clatterbridge Cancer Centre NHS Foundation TrustLiverpoolUK
| | - Louise Turtle
- The Clatterbridge Cancer Centre NHS Foundation TrustLiverpoolUK
| | - John D. Fenwick
- Department of Medical Physics and BioengineeringUniversity College LondonLondonUK
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Pearson J, Khan A, Bhogal T, Wong H, Law A, Mills S, Santamaria N, Bishop J, Cliff J, Errington D, Hall A, Hart C, Malik Z, Sripadam R, Innes H, Flint H, Langton G, Ahmed E, Jackson R, Palmieri C. A comparison of the efficacy of trastuzumab deruxtecan in advanced HER2-positive breast cancer: active brain metastasis versus progressive extracranial disease alone. ESMO Open 2023; 8:102033. [PMID: 37866031 PMCID: PMC10774880 DOI: 10.1016/j.esmoop.2023.102033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/29/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Trastuzumab deruxtecan (T-DXd) has demonstrated efficacy in patients with brain metastasis (BM), a group historically with poor outcomes. The prevalence of BMs in patients commencing T-DXd is currently unknown. No direct comparisons have been made of the activity of T-DXd in patients with active BM versus those with extracranial progression alone. This real-world study explored the prevalence of BMs in patients commencing T-DXd, the efficacy of T-DXd in active BM versus extracranial progression alone and the safety of T-DXd. PATIENTS AND METHODS Patients with human epidermal growth factor receptor 2-positive advanced breast cancer treated with T-DXd between June 2021 and February 2023 at our specialist cancer hospital were identified and notes reviewed. Clinicopathological information, prior treatment, the presence or absence of central nervous system (CNS) disease, outcomes and treatment-emergent adverse events (TEAEs) were recorded. RESULTS Twenty-nine female patients, with a median age of 52 years (interquartile range 44-62 years), were identified; the prevalence of BM was 41%. Median number of lines of prior therapy was 2 (range 2-6). At a median follow-up of 13.8 months, median progression-free survival (PFS) for the overall population was 13.9 months [95% confidence interval (CI) 12.4 months-not estimable (NE)], 16.1 months (95% CI 15.1 months-NE) for active BMs and 12.4 months (95% CI 8.3 months-NE) for progressive extracranial disease alone. The 12-month overall survival (OS) rate was 74% (95% CI 59% to 95%) in the overall population, and 83% (95% CI 58% to 100%) and 66% (95% CI 45% to 96%) for active BMs and extracranial disease only, respectively. Most common TEAEs were fatigue, alopecia, and constipation. In nine patients (31%, including two deaths), pneumonitis occurred. CONCLUSION In this real-world population, we demonstrate T-DXd to be effective in patients with active BMs and those with progressive extracranial disease alone. PFS and OS were numerically longer in those with active BMs. These data demonstrate that patients with active BM treated with T-DXd have at least comparable outcomes to those with extracranial disease alone. The high rate of pneumonitis warrants further consideration.
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Affiliation(s)
- J Pearson
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool; Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool
| | - A Khan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - T Bhogal
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool; Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool
| | - H Wong
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - A Law
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - S Mills
- The Walton NHS Foundation Trust, Liverpool, UK
| | - N Santamaria
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - J Bishop
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - J Cliff
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - D Errington
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - A Hall
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - C Hart
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - Z Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - R Sripadam
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - H Innes
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - H Flint
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - G Langton
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - E Ahmed
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - R Jackson
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool
| | - C Palmieri
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool; Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool.
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Stevens S, Moloney S, Blackmore A, Hart C, Rixham P, Bangiri A, Pooler A, Doolan P. IPEM topical report: guidance for the clinical implementation of online treatment monitoring solutions for IMRT/VMAT. Phys Med Biol 2023; 68:18TR02. [PMID: 37531959 DOI: 10.1088/1361-6560/acecd0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/02/2023] [Indexed: 08/04/2023]
Abstract
This report provides guidance for the implementation of online treatment monitoring (OTM) solutions in radiotherapy (RT), with a focus on modulated treatments. Support is provided covering the implementation process, from identification of an OTM solution to local implementation strategy. Guidance has been developed by a RT special interest group (RTSIG) working party (WP) on behalf of the Institute of Physics and Engineering in Medicine (IPEM). Recommendations within the report are derived from the experience of the WP members (in consultation with manufacturers, vendors and user groups), existing guidance or legislation and a UK survey conducted in 2020 (Stevenset al2021). OTM is an inclusive term representing any system capable of providing a direct or inferred measurement of the delivered dose to a RT patient. Information on each type of OTM is provided but, commensurate with UK demand, guidance is largely influenced byin vivodosimetry methods utilising the electronic portal imager device (EPID). Sections are included on the choice of OTM solutions, acceptance and commissioning methods with recommendations on routine quality control, analytical methods and tolerance setting, clinical introduction and staffing/resource requirements. The guidance aims to give a practical solution to sensitivity and specificity testing. Functionality is provided for the user to introduce known errors into treatment plans for local testing. Receiver operating characteristic analysis is discussed as a tool to performance assess OTM systems. OTM solutions can help verify the correct delivery of radiotherapy treatment. Furthermore, modern systems are increasingly capable of providing clinical decision-making information which can impact the course of a patient's treatment. However, technical limitations persist. It is not within the scope of this guidance to critique each available solution, but the user is encouraged to carefully consider workflow and engage with manufacturers in resolving compatibility issues.
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Affiliation(s)
| | - Stephen Moloney
- University Hospitals Dorset NHS Foundation Trust, Poole, United Kingdom
| | | | - Clare Hart
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Philip Rixham
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Anna Bangiri
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Alistair Pooler
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, United Kingdom
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Wolf CM, Zenker M, Boleti O, Norrish G, Russell M, Meisner JK, Peng DM, Prendiville T, Kleinmahon J, Kantor P, Gottlieb SD, Human D, Ewert P, Krueger M, Reber D, Donner B, Hart C, Komazec IO, Rupp S, Hahn A, Hanser A, Draaisma JM, Ten CF, Mussa A, Ferrero GB, Vaujois L, Raboisson MJ, Marquis C, Théoret Y, Bogarapu S, Dancea A, Moller HM, Kemna M, Kaski JP, Gelb BD, Andelfinger G. MAPK and mTOR Inhibition Improves Childhood RASopathy-Associated Hypertrophic Cardiomyopathy. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Affiliation(s)
- C. M. Wolf
- German Heart Center Munich, Technical University Munich, Munich, Deutschland
| | - M. Zenker
- Institute of Human Genetics and University Children's Hospital, Magdeburg, Deutschland
| | - O. Boleti
- Centre for Inherited Cardiovascular Diseases, Institute of Cardiovascular Science, London, United Kingdom
| | - G. Norrish
- Centre for Inherited Cardiovascular Diseases, Institute of Cardiovascular Science, London, United Kingdom
| | - M. Russell
- University of Michigan, Michigan, United States
| | | | - D. M. Peng
- University of Michigan, Michigan, United States
| | | | - J. Kleinmahon
- Ochsner Hospital for Children, New Orleans, United States
| | - P. Kantor
- Children's Hospital Los Angeles, Los Angeles, United States
| | - S. D. Gottlieb
- Johns Hopkins School of Medicine, Baltimore, United States
| | - D. Human
- British Columbia's Children's Hospital, Vancouver, Canada
| | - P. Ewert
- German Heart Center Munich, Technical University Munich, Munich, Deutschland
| | - M. Krueger
- Municipal Hospital Munich Schwabing, Munich, Deutschland
| | - D. Reber
- Municipal Hospital Munich Schwabing, Munich, Deutschland
| | - B. Donner
- University Children's Hospital of Basel, Basel, Switzerland
| | - C. Hart
- University of Bonn, Bonn, Deutschland
| | | | - S. Rupp
- University of Giessen and Marburg, Giessen, Deutschland
| | - A. Hahn
- University of Giessen, Giessen, Deutschland
| | - A. Hanser
- University Hospital Tübingen, Eberhard-Karls University Tübingen, Tübingen, Deutschland
| | - J. M. Draaisma
- Radboud University Medical Center, Nijmegen, Netherlands
| | - C. F.E. Ten
- Radboud University Medical Center, Nijmegen, Netherlands
| | - A. Mussa
- University of Torino, Torino, Italy
| | | | | | | | - C. Marquis
- Université de Montréal, Montreal, Canada
| | - Y. Théoret
- Université de Montréal, Montreal, Canada
| | - S. Bogarapu
- University of Illinois College of Medicine, Peoria, United States
| | - A. Dancea
- McGill University Health Center, Montreal, Canada
| | | | - M. Kemna
- Seattle Children´s Hospital, Seattle, United States
| | - J. P. Kaski
- Centre for Inherited Cardiovascular Diseases, Institute of Cardiovascular Science, London, United Kingdom
| | - B. D. Gelb
- Icahn School of Medicine at Mount Sinai, New York, United States
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Gumus M, Sukalinskaya A, Andric Z, Cheshuk V, Ciuleanu TE, Sezgin Goksu S, Cil T, Cicin I, Bulat I, Ostapenko Y, Penkov K, Hart C, Lai M, Chaao B, Jimenez J, Sepahi A, Shi G, Trott S, Hooper E. 181P SELECT: A phase II randomized trial evaluating 2 doses of vopratelimab (V) + pimivalimab (P) vs P in TISvopra selected patients (pts). Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Andelfinger G, Zenker M, Norrish G, Russell M, Meisner J, Peng D, Prendiville T, Kleinmahon J, Kantor P, Sen DG, Human D, Ewert P, Krueger M, Reber D, Donner B, Hart C, Odri-Komazec I, Rupp S, Hahn A, Hanser A, Hofbeck M, Draaisma J, Udink ten Cate F, Mussa A, Ferrero G, Vaujois L, Raboisson M, Delrue M, Marquis C, Théorêt Y, Kaski J, Gelb B, Wolf C. MAPK AND AKT/MTOR INHIBITION IMPROVES CHILDHOOD RASOPATHY-ASSOCIATED CARDIOMYOPATHY. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kravchenko D, Isaak A, Mesropyan N, Endler C, Bischoff L, Vollbrecht T, Pieper C, Sedaghat A, Kütting D, Hart C, Feißt A, Attenberger U, Luetkens J. Kardio MRT bei Verdacht auf akute Myokarditis nach mRNA COVID-19 Impfung. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - A Isaak
- Uniklinik Bonn, Klinik für diagnostische und interventionelle Radiologie, Bonn
| | - N Mesropyan
- Uniklinik Bonn, Klinik für diagnostische und interventionelle Radiologie, Bonn
| | - C Endler
- Uniklinik Bonn, Klinik für diagnostische und interventionelle Radiologie, Bonn
| | - L Bischoff
- Uniklinik Bonn, Klinik für diagnostische und interventionelle Radiologie, Bonn
| | - T Vollbrecht
- Uniklinik Bonn, Klinik für diagnostische und interventionelle Radiologie, Bonn
| | - C Pieper
- Uniklinik Bonn, Klinik für diagnostische und interventionelle Radiologie, Bonn
| | - A Sedaghat
- Uniklinik Bonn, Klinik für innere Medizin II – Kardiologie, Bonn
| | - D Kütting
- Uniklinik Bonn, Klinik für diagnostische und interventionelle Radiologie, Bonn
| | - C Hart
- Uniklinik Bonn, Kinderkardiologie, Bonn
| | - A Feißt
- Uniklinik Bonn, Klinik für diagnostische und interventionelle Radiologie, Bonn
| | - U Attenberger
- Uniklinik Bonn, Klinik für diagnostische und interventionelle Radiologie, Bonn
| | - J Luetkens
- Uniklinik Bonn, Klinik für diagnostische und interventionelle Radiologie, Bonn
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Vollbrecht T, Hart C, Herberg U, Katemann C, Zhang S, Isaak A, Mesropyan N, Kravchenko D, Bischoff ML, Pieper CC, Kütting D, Faridi B, Attenberger U, Geipel A, Luetkens AJ. Doppler-Ultraschall (DUS)-getriggerte fetale Herz-MRT zur Diagnose komplexer Herzfehler bei 3 Tesla: Klinische Etablierung und diagnostische Wertigkeit. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- T Vollbrecht
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - C Hart
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - U Herberg
- Uniklinikum Bonn, Abteilung für Kinderkardiologie, Bonn
| | | | - S Zhang
- Philips GmbH Market DACH, Hamburg
| | - A Isaak
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - N Mesropyan
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - D Kravchenko
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - M L Bischoff
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - C C Pieper
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - D Kütting
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - B Faridi
- Uniklinikum Bonn, Abteilung für Geburtshilfe und Pränatalmedizin, Bonn
| | - U Attenberger
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - A Geipel
- Uniklinikum Bonn, Abteilung für Geburtshilfe und Pränatalmedizin, Bonn
| | - A J Luetkens
- Uniklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
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Isaak A, Mesropyan N, Hart C, Kravchenko D, Endler C, Bischoff L, Zhang S, Katemann C, Weber O, Kuetting D, Attenberger U, Dabir D, Luetkens J. Kontrastmittelfreie REACT MRA unter freier Atmung zur Beurteilung der thorakalen Gefäße bei Kleinkindern mit angeborenen Herzfehlern. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A Isaak
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - N Mesropyan
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - C Hart
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Zentrum für Kinderheilkunde/Abteilung für Kinderkardiologie, Bonn
| | - D Kravchenko
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - C Endler
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - L Bischoff
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - S Zhang
- Philips GmbH Market DACH, Hamburg
| | | | - O Weber
- Philips GmbH Market DACH, Hamburg
| | - D Kuetting
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - U Attenberger
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - D Dabir
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
| | - J Luetkens
- Universitätsklinikum Bonn, Klinik für Diagnostische und Interventionelle Radiologie, Bonn
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Hart C, Shadbolt L, Kaklamanos M. 999 ACUTE FRAILTY ASSESSMENT UNIT: A 6-MONTH QUALITATIVE STUDY OF READMISSIONS WITHIN 28 DAYS OF DISCHARGE & COLLECTIVE CASE ANALYSIS. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.047] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Readmissions can have a negative impact on the care of frail individuals in regards to increased length of stay, healthcare-related harm, reduced quality of life and mortality. Review of frailty readmissions should lead to improvements of frailty care and clinical effectiveness.
Method
We conducted a retrospective, qualitative analysis of readmissions of frail individuals discharged from our Acute Frailty Unit (AFU) over a six-month period. This is a collective case study in which we used instrumental cases to highlight specific learning points. We used the Electronic Patient Records database to measure the total number of readmissions related to AFU discharges. The Framework methodology was then utilised to further analyse and cluster cases. Common themes linked to readmissions and the time-to-readmission were studied, leading to structured (SMART) quality improvement interventions.
Results
Four hundred and thirty individuals were discharged from AFU. Eighty-nine (21%) were readmitted within 28 days of index hospital admission. Fifty-eight percent (50/89) of individuals were readmitted to hospital (any ward) with a different presenting complaint compared to index admission. Twenty-two (25%) cases were readmitted with the same initial complaint, while nine (10%) experienced problems due to ineffective discharge planning. In eight (7%) cases, readmission was linked to healthcare-associated complications. Forty (45%,40/89) individuals stayed at home for <7 days after their index discharge, whilst the remaining forty-nine (55%) returned to hospital after 7–28 days. Only eight (9%) readmissions were from care home settings. A bundle of SMART interventions has been developed, including post-discharge support with acute frailty clinics, enhanced frailty dietetic support and improved communication with community partners.
Conclusion
(s) This collective case study shares important learnings related to the readmission patterns of acute frailty units. Individual case studies are essential in understanding the ways that patient-centred care should be tailored to become more effective.
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Affiliation(s)
- C Hart
- Frailty Team, East Kent Hospitals University Foundation Trust, Queen Elizabeth the Queen Mother Hospital , Margate, Kent
| | - L Shadbolt
- Frailty Team, East Kent Hospitals University Foundation Trust, Queen Elizabeth the Queen Mother Hospital , Margate, Kent
| | - M Kaklamanos
- Frailty Team, East Kent Hospitals University Foundation Trust, Queen Elizabeth the Queen Mother Hospital , Margate, Kent
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Nagarkar M, Keely SP, Jahne M, Wheaton E, Hart C, Smith B, Garland J, Varughese EA, Braam A, Wiechman B, Morris B, Brinkman NE. SARS-CoV-2 monitoring at three sewersheds of different scales and complexity demonstrates distinctive relationships between wastewater measurements and COVID-19 case data. Sci Total Environ 2022; 816:151534. [PMID: 34780821 PMCID: PMC8590472 DOI: 10.1016/j.scitotenv.2021.151534] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 05/18/2023]
Abstract
Wastewater monitoring of SARS-CoV-2 presents a means of tracking COVID-19 community infection dynamics on a broader geographic scale. However, accounting for environmental and sample-processing losses may be necessary for wastewater measurements to readily inform our understanding of infection prevalence. Here, we present measurements of the SARS-CoV-2 N1 and N2 gene targets from weekly wastewater samples at three sites in Hamilton County, Ohio, during an increase and subsequent decline of COVID-19 infections. The concentration of N1 or N2 RNA in wastewater, measured over the course of six months, ranged from below the detection limit to over 104 gene copies/l, and correlated with case data at two wastewater treatment plants, but not at a sub-sewershed-level sampling site. We also evaluated the utility of a broader range of variables than has been reported consistently in previous work, in improving correlations of SARS-CoV-2 concentrations with case data. These include a spiked matrix recovery control (OC43), flow-normalization, and assessment of fecal loading using endogenous fecal markers (HF183, PMMoV, crAssphage). We found that adjusting for recovery, flow, and fecal indicators increased these correlations for samples from a larger sewershed (serving ~488,000 people) with greater industrial and stormwater inputs, but raw N1/N2 concentrations corresponded better with case data at a smaller, residential-oriented sewershed. Our results indicate that the optimal adjustment factors for correlating wastewater and clinical case data moving forward may not be generalizable to all sewersheds.
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Affiliation(s)
- M Nagarkar
- Office of Research and Development, United States Environmental Protection Agency, 26 W Martin Luther King Dr, Cincinnati, OH, USA.
| | - S P Keely
- Office of Research and Development, United States Environmental Protection Agency, 26 W Martin Luther King Dr, Cincinnati, OH, USA.
| | - M Jahne
- Office of Research and Development, United States Environmental Protection Agency, 26 W Martin Luther King Dr, Cincinnati, OH, USA.
| | - E Wheaton
- Office of Research and Development, United States Environmental Protection Agency, 26 W Martin Luther King Dr, Cincinnati, OH, USA.
| | - C Hart
- Office of Research and Development, United States Environmental Protection Agency, 26 W Martin Luther King Dr, Cincinnati, OH, USA.
| | - B Smith
- Office of Research and Development, United States Environmental Protection Agency, 26 W Martin Luther King Dr, Cincinnati, OH, USA.
| | - J Garland
- Office of Research and Development, United States Environmental Protection Agency, 26 W Martin Luther King Dr, Cincinnati, OH, USA.
| | - E A Varughese
- Office of Research and Development, United States Environmental Protection Agency, 26 W Martin Luther King Dr, Cincinnati, OH, USA.
| | - A Braam
- APTIM Corp., 4171 Essen Lane, Baton Rouge, LA 70809.
| | - B Wiechman
- APTIM Corp., 4171 Essen Lane, Baton Rouge, LA 70809.
| | - B Morris
- Pegasus Technical Services Inc., 26 W Martin Luther King Dr, Cincinnati, OH, USA.
| | - N E Brinkman
- Office of Research and Development, United States Environmental Protection Agency, 26 W Martin Luther King Dr, Cincinnati, OH, USA.
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12
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Piddock K, Nautiyal H, Ahmed M, Barron M, Bhalla N, Cook T, Cubbin S, Davis G, Dobson R, Escriu C, Ghoz H, Hart C, Johnston M, McManus C, Montasem A, Sohl H, Rose S, Tippett V, Wong H, Cobben D. Frailty, comorbidity and cardiovascular risk assessment in older patients with lung cancer. Lung Cancer 2022. [DOI: 10.1016/s0169-5002(22)00134-9] [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: 10/19/2022]
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13
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Wolf CM, Zenker M, Norrish G, Russell M, Meisner JK, Peng DM, Prendiville T, Kleinmahon J, Kantor PF, Sen DG, Human DG, Ewert P, Krueger M, Reber D, Donner BC, Hart C, Odri-Komazec I, Rupp S, Hahn A, Hanser A, Hofbeck M, Draaisma JM, Cate FUT, Mussa A, Ferrero GB, Marquis C, Théoret Y, Kaski JP, Gelb BD, Andelfinger G. AKT/mTOR and MAPK Inhibition Improves Childhood RASopathic Cardiomyopathy. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - M. Zenker
- Institute of Human Genetics and Applied Genomics, Magdeburg, Deutschland
| | | | - M. Russell
- University of Michigan, Michigan, United States
| | | | - D. M. Peng
- University of Michigan, Michigan, United States
| | | | - J. Kleinmahon
- Ochsner Hospital for Children, New Orleans, United States
| | - P. F. Kantor
- Children's Hospital Los Angeles, Los Angeles, United States
| | | | - D. G. Human
- British Columbia's Children's Hospital, Vancouver, Canada
| | - P. Ewert
- Lazarettstr. 36, München, Deutschland
| | - M. Krueger
- Department of Neonatology, Municipal Hospital Munich Schwabing, Munich, Deutschland
| | - D. Reber
- Department of Neonatology, Municipal Hospital Munich Schwabing, Munich, Deutschland
| | - B. C. Donner
- Pediatric Cardiology, University Children's Hospital of Basel (UKBB), University of Basel, Basel, Switzerland
| | - C. Hart
- Paediatric Heart Center, Children's Hospital, University of Bonn, Bonn, Deutschland
| | | | - S. Rupp
- Launsbacher Straße 29a, Gießen, Deutschland
| | - A. Hahn
- Kinderklinik Gießen, Gießen, Deutschland
| | - A. Hanser
- Hoppe-Seyler-Str. 1, Tübingen, Deutschland
| | - M. Hofbeck
- Hoppe-Seyler-Str. 1, Tübingen, Deutschland
| | - J. M. Draaisma
- Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - F.E.A. Udink Ten Cate
- Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - A. Mussa
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - G. B. Ferrero
- Department of Clinical and Biological Sciences, School of Medicine, University of Torino, Torino, Italy
| | - C. Marquis
- Department of Pediatrics, CHU Sainte Justine, Université de Montréal, Montreal, Canada
| | - Y. Théoret
- Department of Pediatrics, CHU Sainte Justine, Université de Montréal, Montreal, Canada
| | - J. P. Kaski
- FRCP, Centre for Inherited Cardiovascular Diseases, Institute of Cardiovascular Science, London, United Kingdom
| | - B. D. Gelb
- Icahn School of Medicine at Mount Sinai, New York, United States
| | - G. Andelfinger
- Cardiovascular Genetics, CHU Sainte Justine, Université de Montreal, Montreal, Canada
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14
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W Stevens S, Moloney S, Bangiri A, Blackmore A, Hart C, Holmes-Smith W, Pooler A, Rixham P, Doolan P. IPEM topical report: results of a 2020 UK survey on the use of online treatment monitoring solutions for IMRT/VMAT. Phys Med Biol 2021; 66. [PMID: 34666321 DOI: 10.1088/1361-6560/ac311a] [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: 07/06/2021] [Accepted: 10/19/2021] [Indexed: 11/11/2022]
Abstract
Numerous commercial technologies for online treatment monitoring (OTM) in radiotherapy (RT) are currently available including electronic portal imaging device (EPID)in vivodosimetry (IVD), transmission detectors and log files analysis. Despite this, in the UK there exists limited guidance on how to implement and commission a system for clinical use or information about the resources required to set up and maintain a service. A Radiotherapy Special Interest Group working party, established by Institute of Physics and Engineering in Medicine was formed with a view to reassess the current practice for OTM in the UK and an aim to develop consensus guidelines for the implementation of a system. A survey distributed to Heads of Medical Physics at 71 UK RT departments investigated: availability of OTM in the UK; estimates of workload; clinical implementation; methods of analysis; quality assurance; and opinions on future directions. The survey achieved a 76% response rate and demonstrated that OTM is widely supported in the UK, with 87% of respondents indicating all patients should undergo OTM. EPID IVD (EIVD) was the most popular form of OTM. An active EIVD service was reported by 37% of respondents, with 84% believing it was the optimal solution. This demonstrates a steady increase in adoption since 2012. Other forms of OTM were in use but they had only been adopted by a minority of centres. Financial barriers and the increase of staff workload continue to hinder wider implementation in other centres. Device automation and integration is a key factor for successful future adoption and requires support between treatment machine and OTM manufacturers. The survey has provided an updated analysis on the use of OTM methods across the UK. Future guidance is recommended on commissioning, adoption of local tolerances and root-cause analysis strategies to assist departments intending to implement OTM.
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Affiliation(s)
| | - Stephen Moloney
- University Hospitals Dorset NHS Foundation Trust, Poole, United Kingdom
| | - Anna Bangiri
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | | | - Clare Hart
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - William Holmes-Smith
- Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Alistair Pooler
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Philip Rixham
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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15
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Angamuthu N, Gilliland J, Chowdhury S, D'Souza R, Hart C, Knowles J. 293 A Reflection of Experience Gained in Emergency General Surgery During The COVID-19 Pandemic at A London University Hospital. Br J Surg 2021. [PMCID: PMC8524542 DOI: 10.1093/bjs/znab259.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background During COVID-19, acute surgical services witnessed an overhaul of practice due to constraints on staff and resource (beds, imaging, and theater) availability. Fear of COVID-19, among general population potentially added to delay in patients seeking medical assistance. This study describes experiences of acute general surgery at a COVID-19 designated tertiary institution wherein elective surgical work was put on hold and emergency on-call rota was modified during the pandemic. Method A retrospective analysis (March-April 2019 vs 2020) of the surgical work from a prospectively maintained surgical database during COVID-19 was performed. Results Emergency surgical admissions during March 2020 vs 2019 was 106 vs 207. Comparing the workload March-April 2020 vs 2019, emergency referrals were 266 vs 341, operations performed 71 vs 92. 31.5% (84/266) of patients were tested for COVID and 30% (25/84) were positive. Emergency surgery was performed in 71 patients (including appendectomies (28), hernia repair(3), laparotomy(3), Hartman’s procedure(3), hemicolectomy(7) and anterior resection with covering ileostomy(2)). In this group, a male preponderance was noted (M:F 1.84:1), the average age was 43.2 years (6-91), length of stay 4.8 days (<23 hours-34 days). In the operative group, the 30-day mortality was 4.23% (3/71) and the morbidity was 31%. Conclusions With local changes, stopping elective services, modifying on-call rota, a surgical department can continue to be functional and offer emergency surgical service for a sustained period during a pandemic. During the COVID pandemic, the average number of referrals, admissions and surgeries were lower when compared to the non-covid period.
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Affiliation(s)
| | | | | | - R D'Souza
- Royal Free Hospital, London, United Kingdom
| | - C Hart
- Royal Free Hospital, London, United Kingdom
| | - J Knowles
- Royal Free Hospital, London, United Kingdom
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16
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Hart C, Freeman H, Jones I, Turer R. 259 Improving Emergency Medicine Order Effectiveness: A Comprehensive Revision of the "Quick List” Order Model. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Lehane M, Connolly S, Crowley M, Hart C, O"flynn AM. Kidney function decline in heart failure patients: an audit of out-patient heart failure services. Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.015] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
A bidirectional relationship exists between the kidney and the heart; the lower the eGFR the more challenging it is to manage the heart failure (HF) patient. Worsening renal function is common in HF patients and associated with a two-fold increase in mortality and a lower likelihood of being prescribed efficacious HF therapy. The role of cardio-renal interactions in HF is essential to identify risk and subsequent treatment strategies.
Purpose
The purpose of this audit is to provide insights into the assessment of renal function in a real world heart failure population by identifying the degree of renal dysfunction and changes in renal function over a five year time frame.
Methods
A retrospective audit included patients with HFrEF attending a heart failure service. These patients were classified using KIDGO criteria CKD 1-5. A current eGFR sample was compared with a sample taken five years earlier, identified using the electronic laboratory record. Ethical approval was granted from the Research Ethics Committee.
Resultss
100 patients with HFrEF attending a heart failure service fulfilled the selection criteria of which sixty three patients with an eGFR >60ml/min/1.73 m2 were audited. Of this group 43 were CKD class 2 and 20 were CKD class 1. Thirty seven patients had an eGFR <60ml/min/1.73 m2 of which 9 were class 3b, 9 were CKD class 4 and 1 was CKD Class 5.
Of the 100 patients enrolled, 6 were excluded from the analysis of kidney function decline as an eGFR from five years earlier was unavailable. Within a five year time span, 44 patients did not change their CKD class, 31 patients declined by one class, 9 patients declined by two classes, 3 patients declined by three classes and 7 patients improved their kidney function.
GFR < 60mL/min/1.73m2,
n = 37
GFR > 60mL/min/1.73m2, n = 63
Age – mean (range)
77.8 (49-94)
66.5 (45-89)
Gender – female (%)
12 (32%)
16 (25%)
Average renal function measurements (mean, range)
6.4
6.7
Total albumin
creatinine ratio measurements
8
6
Actively attending renal service
6
0
Conclusion
Nurses should be aware of the increasing risk conferred by the dual diagnosis of heart failure and chronic kidney disease. Patients with heart failure who have decreasing eGFR levels (especially less than 30 mL/min), should have collaborative management with nephrology services to optimise outcomes. Recognition of CKD in our institution and referral to nephrology services was suboptimal and further work is necessary to optimise the management of these patients.
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Affiliation(s)
- M Lehane
- Mallow General Hospital, Heart Failure Unit, Cork, Ireland
| | - S Connolly
- Mallow General Hospital, Heart Failure Unit, Cork, Ireland
| | - M Crowley
- Mallow General Hospital, Heart Failure Unit, Cork, Ireland
| | - C Hart
- Mallow General Hospital, Heart Failure Unit, Cork, Ireland
| | - AM O"flynn
- Mallow General Hospital, Heart Failure Unit, Cork, Ireland
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18
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Brown M, Hart C, Sachdeva A, Oliveira P, Frankhauser C, Wedge D, Clarke N. Localised activation of the EMT switch by peri–neural invading epithelial cells in prostate cancer. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00810-1] [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: 10/20/2022]
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19
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Sueblinvong V, Chang S, Park C, Benza R, Archer D, Sutliff R, Hart C, Kang B. Circular RNA Expression in the Lungs of Sickle Cell Disease Mice. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.03765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Sarah Chang
- MedicineEmory UniversityAtlantaGA
- Emory UniversityAtlantaGA
| | - Changwon Park
- Cellular and Molecular PhysiologyLouisiana State University Health Science CenterShreveportLA
| | | | | | | | | | - Bum‐Yong Kang
- MedicineEmory UniversityAtlantaGA
- Emory UniversityAtlantaGA
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20
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Wong PM, Barker DH, Raynor HA, Hart C, Carskadon MA. 0257 Preliminary Findings: Attentional Bias for Food Cues Unrelated to Time Awake or Circadian Phase During Forced Desynchrony in Adolescents. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.255] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Sleep quantity and quality influence attentional bias, and attentional bias for food cues has been associated with body weight. Whether the endogenous circadian cycle and/or time from awakening to bedtime contribute to attentional bias for food and differences in weight remain unclear. Using a 28-h forced desynchrony (FD) design, we hypothesized that adolescents with overweight (OW) and obesity (O) would have more attentional bias for food cues later in the wake episode and at a later circadian phase compared to adolescents with a healthy weight (HW).
Methods
50 (28 male) adolescents (12-15yr) completed 7 FD cycles. Participants completed an attentional bias task that included three food word categories (savory, sweet, fruits/vegetables) and one non-food word category (school supplies). The task was completed at 6 fixed times each cycle: Task 1 was 1.3h after scheduled awaking, Task 2 was 2h after Task 1, and Tasks 3–6 followed at 3-h intervals. Weight categorization used body mass index (BMI) percentiles (CDC): HW (>5th and <85th; n=24), OW (85th and <95th; n=13), or O (≥95th; n=14). Endogenous circadian period was determined using salivary melatonin onsets (Mean: HW=23.88h; OW=24.01h; O=23.86h). Effect of circadian phase and time since scheduled awakening was assessed by mixed effects modeling using 6 circadian and 6 time-awake bins.
Results
We found no significant differences between weight groups in attentional bias for any of the food categories (p’s >.05). We also saw no significant time awake effects or circadian influence on attentional bias, nor did time awake or circadian phase moderate the associations between weight category and attentional bias (p’s >.05).
Conclusion
Weight groups did not impact food-related attentional bias across the wake episode or circadian phase. Future directions will explore whether attentional bias for food types predicts food choice and food consumption in this study.
Support
DK101046
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Affiliation(s)
- P M Wong
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - D H Barker
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI
| | - H A Raynor
- Department of Nutrition, University of Tennessee, Knoxville, TN
| | - C Hart
- Department of Public Health, Temple University, Philadelphia, PA
| | - M A Carskadon
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI
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Carskadon M, Barker D, Hart C, Raynor H, Mason I, Scheer F. Caloric intake in normal weight, overweight, and obese adolescents: circadian and homeostatic influences measured from 28-hour forced desynchrony (FD). Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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Gnatiuc L, Herrington WG, Halsey J, Tuomilehto J, Fang X, Kim HC, De Bacquer D, Dobson AJ, Criqui MH, Jacobs DR, Leon DA, Peters SAE, Ueshima H, Sherliker P, Peto R, Collins R, Huxley RR, Emberson JR, Woodward M, Lewington S, Aoki N, Arima H, Arnesen E, Aromaa A, Assmann G, Bachman DL, Baigent C, Bartholomew H, Benetos A, Bengtsson C, Bennett D, Björkelund C, Blackburn H, Bonaa K, Boyle E, Broadhurst R, Carstensen J, Chambless L, Chen Z, Chew SK, Clarke R, Cox C, Curb JD, D'Agostino R, Date C, Davey Smith G, De Backer G, Dhaliwal SS, Duan XF, Ducimetiere P, Duffy S, Eliassen H, Elwood P, Empana J, Garcia-Palmieri MH, Gazes P, Giles GG, Gillis C, Goldbourt U, Gu DF, Guasch-Ferre M, Guize L, Haheim L, Hart C, Hashimoto S, Hashimoto T, Heng D, Hjermann I, Ho SC, Hobbs M, Hole D, Holme I, Horibe H, Hozawa A, Hu F, Hughes K, Iida M, Imai K, Imai Y, Iso H, Jackson R, Jamrozik K, Jee SH, Jensen G, Jiang CQ, Johansen NB, Jorgensen T, Jousilahti P, Kagaya M, Keil J, Keller J, Kim IS, Kita Y, Kitamura A, Kiyohara Y, Knekt P, Knuiman M, Kornitzer M, Kromhout D, Kronmal R, Lam TH, Law M, Lee J, Leren P, Levy D, Li YH, Lissner L, Luepker R, Luszcz M, MacMahon S, Maegawa H, Marmot M, Matsutani Y, Meade T, Morris J, Morris R, Murayama T, Naito Y, Nakachi K, Nakamura M, Nakayama T, Neaton J, Nietert PJ, Nishimoto Y, Norton R, Nozaki A, Ohkubo T, Okayama A, Pan WH, Puska P, Qizilbash N, Reunanen A, Rimm E, Rodgers A, Saitoh S, Sakata K, Sato S, Schnohr P, Schulte H, Selmer R, Sharp D, Shifu X, Shimamoto K, Shipley M, Silbershatz H, Sorlie P, Sritara P, Suh I, Sutherland SE, Sweetnam P, Tamakoshi A, Tanaka H, Thomsen T, Tominaga S, Tomita M, Törnberg S, Tunstall-Pedoe H, Tverdal A, Ueshima H, Vartiainen E, Wald N, Wannamethee SG, Welborn TA, Whincup P, Whitlock G, Willett W, Woo J, Wu ZL, Yao SX, Yarnell J, Yokoyama T, Yoshiike N, Zhang XH. Sex-specific relevance of diabetes to occlusive vascular and other mortality: a collaborative meta-analysis of individual data from 980 793 adults from 68 prospective studies. Lancet Diabetes Endocrinol 2018; 6:538-546. [PMID: 29752194 PMCID: PMC6008496 DOI: 10.1016/s2213-8587(18)30079-2] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/20/2018] [Accepted: 02/26/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Several studies have shown that diabetes confers a higher relative risk of vascular mortality among women than among men, but whether this increased relative risk in women exists across age groups and within defined levels of other risk factors is uncertain. We aimed to determine whether differences in established risk factors, such as blood pressure, BMI, smoking, and cholesterol, explain the higher relative risks of vascular mortality among women than among men. METHODS In our meta-analysis, we obtained individual participant-level data from studies included in the Prospective Studies Collaboration and the Asia Pacific Cohort Studies Collaboration that had obtained baseline information on age, sex, diabetes, total cholesterol, blood pressure, tobacco use, height, and weight. Data on causes of death were obtained from medical death certificates. We used Cox regression models to assess the relevance of diabetes (any type) to occlusive vascular mortality (ischaemic heart disease, ischaemic stroke, or other atherosclerotic deaths) by age, sex, and other major vascular risk factors, and to assess whether the associations of blood pressure, total cholesterol, and body-mass index (BMI) to occlusive vascular mortality are modified by diabetes. RESULTS Individual participant-level data were analysed from 980 793 adults. During 9·8 million person-years of follow-up, among participants aged between 35 and 89 years, 19 686 (25·6%) of 76 965 deaths were attributed to occlusive vascular disease. After controlling for major vascular risk factors, diabetes roughly doubled occlusive vascular mortality risk among men (death rate ratio [RR] 2·10, 95% CI 1·97-2·24) and tripled risk among women (3·00, 2·71-3·33; χ2 test for heterogeneity p<0·0001). For both sexes combined, the occlusive vascular death RRs were higher in younger individuals (aged 35-59 years: 2·60, 2·30-2·94) than in older individuals (aged 70-89 years: 2·01, 1·85-2·19; p=0·0001 for trend across age groups), and, across age groups, the death RRs were higher among women than among men. Therefore, women aged 35-59 years had the highest death RR across all age and sex groups (5·55, 4·15-7·44). However, since underlying confounder-adjusted occlusive vascular mortality rates at any age were higher in men than in women, the adjusted absolute excess occlusive vascular mortality associated with diabetes was similar for men and women. At ages 35-59 years, the excess absolute risk was 0·05% (95% CI 0·03-0·07) per year in women compared with 0·08% (0·05-0·10) per year in men; the corresponding excess at ages 70-89 years was 1·08% (0·84-1·32) per year in women and 0·91% (0·77-1·05) per year in men. Total cholesterol, blood pressure, and BMI each showed continuous log-linear associations with occlusive vascular mortality that were similar among individuals with and without diabetes across both sexes. INTERPRETATION Independent of other major vascular risk factors, diabetes substantially increased vascular risk in both men and women. Lifestyle changes to reduce smoking and obesity and use of cost-effective drugs that target major vascular risks (eg, statins and antihypertensive drugs) are important in both men and women with diabetes, but might not reduce the relative excess risk of occlusive vascular disease in women with diabetes, which remains unexplained. FUNDING UK Medical Research Council, British Heart Foundation, Cancer Research UK, European Union BIOMED programme, and National Institute on Aging (US National Institutes of Health).
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Domenyuk V, Liu X, Magee D, Gatalica Z, Stark A, Kennedy P, Rosenow M, Barker A, Berry D, Poste G, Halbert D, Hart C, Famulok M, Mayer G, Korn M, Miglarese M, Spetzler D. Poly-Ligand Profiling differentiates pancreatic cancer patients according to treatment benefit from gemcitabine+placebo versus gemcitabine+evofosfamide and identifies candidate targets. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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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24
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Bradley T, Hart C, Hora B, Pollara J, Browne E, Anthony Moody M, Ferrari G, Margolis D, Haynes B. High-throughput single-cell transcriptome analysis of immune cells from HIV-1 infected individuals before and after therapy. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30548-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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25
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Rickers C, Andrade A, Jerosch-Herold M, Wegner P, Voges I, Pham M, Hart C, Gabbert D, Kristo I, Kramer H. Determinants of Left Ventricular Dysfunction and Remodeling in Patients with Corrected Tetralogy of Fallot (ToF). Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C. Rickers
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - A. Andrade
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - P. Wegner
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - I. Voges
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - M. Pham
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - C. Hart
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - D. Gabbert
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - I. Kristo
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - H. Kramer
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
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26
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Hart C, Cock IE. An examination of the antimicrobial and anticancer properties of Garcinia cambogia fruit pericarp extracts. ACTA ACUST UNITED AC 2016. [DOI: 10.5530/bems.2016.2.10] [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: 11/23/2022]
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Di Donato S, Mislang A, Vignoli A, Mori E, Vitale S, Biagioni C, Hart C, Becheri D, Del Monte F, Luchinat C, Di Leo A, Mottino G, Tenori L, Biganzoli L. Serum metabolomic as biomarkers to differentiate early from metastatic disease in elderly colorectal cancer (crc) patients. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw335.20] [Citation(s) in RCA: 2] [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: 11/13/2022] Open
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Eyre R, Spence K, Alferez D, Santiago-Gomez A, Hart C, Simoes B, Brown M, Gurney A, Farnie G, Clarke R. The bone metastatic niche promotes breast cancer stem cell activity via IL-1β-Wnt signalling. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61224-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bromby A, Hart C, Brown M, Clarke N. Prognostic potential of EphA2 expression in prostate cancer patients. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61654-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hart C, Müller M, Scheewe J, Kramer H. Sinusknotendysfunktion im Langzeitverlauf beim Hypoplastischen Linksherzsyndrom (HLHS). Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571860] [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: 10/22/2022]
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Salehi R, Attmann T, Scheewe J, Al Bulushi A, Gabbert D, Wegner P, Pardun E, Voges I, Hart C, Kristo I, Kramer H, Rickers C. The Effect of the Simultaneous Left Pulmonary Artery (LPA) Patch Enlargement during the Modified Norwood Procedure on the Lung Perfusion: First MRI Results of HLHS Patients. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571862] [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: 10/22/2022]
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Gabbert D, Hart C, Wegner P, Jerosch-Herold M, Salehi R, Voges I, Kristo I, Al Bulushi A, Kramer HH, Rickers C. Atmung oder Herzschlag: Was sind die Blutflussbeiträge im Fontan-Tunnel? Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571864] [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: 10/22/2022]
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Puri K, Kocoshis S, Risma K, Perez L, Hart C, Chin C, Ryan TD, Jefferies JL, Schumacher KR, Castleberry C. Basiliximab treatment for autoimmune bowel disease in a pediatric heart transplant patient. Pediatr Transplant 2015; 19:E165-9. [PMID: 26374667 PMCID: PMC8215525 DOI: 10.1111/petr.12584] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2015] [Indexed: 01/09/2023]
Abstract
Autoimmune-mediated bowel disease has been reported after pediatric heart transplantation. Recognition and treatment of these patients has been difficult. We describe a patient who responded to steroids and basiliximab therapy after an inflammatory process secondary to abnormal T-cell activation. Our patient is a 28-month-old female who received a heart transplant at five wk of age. At 24 months post-transplant, she developed fever and bloody stools. Initial investigations were significant for an elevated ESR (>120) and CRP (15.2). Symptoms persisted despite bowel rest and mycophenolate discontinuation. Endoscopic evaluation revealed discontinuous ulcerative disease involving esophagus, terminal ileum, right and left colon, necessitating extensive bowel resection. She had additional airway inflammation leading to a TEF at the site of esophageal ulceration, requiring tracheostomy. Immune evaluation revealed autoimmune dysregulation that responded to parenteral methylprednisolone. Chronic basiliximab therapy allowed for successful weaning of steroids with sustained remission. She has been transitioned to sirolimus and tacrolimus maintenance immunosuppression with plans to discontinue basiliximab once off steroids. In conclusion, bowel disease in the setting of pediatric heart transplantation can be severe and refractory to traditional treatment methods. Tailoring immune therapy to activated T cells can result in remission. Basiliximab therapy was used in our patient to maintain steroid-induced remission, but long-term complications of this disease process are unknown.
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Affiliation(s)
- K. Puri
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - S. Kocoshis
- Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - K. Risma
- Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - L. Perez
- Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - C. Hart
- Otolaryngology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - C. Chin
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - T. D. Ryan
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - J. L. Jefferies
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - K. R. Schumacher
- Pediatric Cardiology, CS Mott Children’s Hospital, Ann Arbor, MI, USA
| | - C. Castleberry
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Hart C, Vogelhuber M, Hafner C, Landthaler M, Berneburg M, Haferkamp S, Herr W, Reichle A. Biomodulatory metronomic therapy in stage IV melanoma is well-tolerated and may induce prolonged progression-free survival, a phase I trial. J Eur Acad Dermatol Venereol 2015; 30:e119-e121. [PMID: 26417987 PMCID: PMC5108438 DOI: 10.1111/jdv.13391] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- C Hart
- Department of Internal Medicine III, Haematology & Oncology, University Hospital of Regensburg, Regensburg, Germany
| | - M Vogelhuber
- Department of Internal Medicine III, Haematology & Oncology, University Hospital of Regensburg, Regensburg, Germany
| | - C Hafner
- Department of Dermatology, University Hospital of Regensburg, Regensburg, Germany
| | - M Landthaler
- Department of Dermatology, University Hospital of Regensburg, Regensburg, Germany
| | - M Berneburg
- Department of Dermatology, University Hospital of Regensburg, Regensburg, Germany
| | - S Haferkamp
- Department of Dermatology, University Hospital of Regensburg, Regensburg, Germany
| | - W Herr
- Department of Internal Medicine III, Haematology & Oncology, University Hospital of Regensburg, Regensburg, Germany
| | - A Reichle
- Department of Internal Medicine III, Haematology & Oncology, University Hospital of Regensburg, Regensburg, Germany.
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Hart C. Erkrankungen von Herz und Gefäßen im Kindesalter. Radiologe 2015; 55:561-9. [DOI: 10.1007/s00117-014-2772-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kristo I, Wegner P, Voges I, Jerosch-Herold M, Pham M, Gabbert D, Hart C, Kramer H, Rickers C. Diffuse Myocardial Fibrosis and Left Ventricular Diastolic Dysfunction is present in Children and Young Adults with Repaired Aortic Coarctation. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1556041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hart C, Müller M, Scheewe J, Kramer H. Sinusknotendysfunktion (SND) im Langzeitverlauf beim Hypoplastischen Linksherzsyndrom (HLHS). Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1555978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Khalifeh H, Johnson S, Howard LM, Borschmann R, Osborn D, Dean K, Hart C, Hogg J, Moran P. Violent and non-violent crime against adults with severe mental illness. Br J Psychiatry 2015; 206:275-82. [PMID: 25698767 DOI: 10.1192/bjp.bp.114.147843] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 09/25/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Little is known about the relative extent of crime against people with severe mental illness (SMI). AIMS To assess the prevalence and impact of crime among people with SMI compared with the general population. METHOD A total of 361 psychiatric patients were interviewed using the national crime survey questionnaire, and findings compared with those from 3138 general population controls participating in the contemporaneous national crime survey. RESULTS Past-year crime was experienced by 40% of patients v. 14% of controls (adjusted odds ratio (OR) = 2.8, 95% CI 2.0-3.8); and violent assaults by 19% of patients v. 3% of controls (adjusted OR = 5.3, 95% CI 3.1-8.8). Women with SMI had four-, ten- and four-fold increases in the odds of experiencing domestic, community and sexual violence, respectively. Victims with SMI were more likely to report psychosocial morbidity following violence than victims from the general population. CONCLUSIONS People with SMI are at greatly increased risk of crime and associated morbidity. Violence prevention policies should be particularly focused on people with SMI.
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Affiliation(s)
- H Khalifeh
- H. Khalifeh, MSc, MRCPsych, S. Johnson, MD, MRCPsych, Division of Psychiatry, University College London, London; L. M. Howard, PhD, MRCPsych, R. Borschmann, DClinPsy, David Goldberg Centre, Institute of Psychiatry, London; D. Osborn, PhD, MRCPsych, Division of Psychiatry, University College London, London; K. Dean, PhD, MRCPsych, Institute of Psychiatry, London, and School of Psychiatry, University of New South Wales and Justice Health & Forensic Mental Health Network; C. Hart, MSc, J. Hogg, MSc, P. Moran, PhD, MRCPsych, David Goldberg Centre, Institute of Psychiatry, London, UK
| | - S Johnson
- H. Khalifeh, MSc, MRCPsych, S. Johnson, MD, MRCPsych, Division of Psychiatry, University College London, London; L. M. Howard, PhD, MRCPsych, R. Borschmann, DClinPsy, David Goldberg Centre, Institute of Psychiatry, London; D. Osborn, PhD, MRCPsych, Division of Psychiatry, University College London, London; K. Dean, PhD, MRCPsych, Institute of Psychiatry, London, and School of Psychiatry, University of New South Wales and Justice Health & Forensic Mental Health Network; C. Hart, MSc, J. Hogg, MSc, P. Moran, PhD, MRCPsych, David Goldberg Centre, Institute of Psychiatry, London, UK
| | - L M Howard
- H. Khalifeh, MSc, MRCPsych, S. Johnson, MD, MRCPsych, Division of Psychiatry, University College London, London; L. M. Howard, PhD, MRCPsych, R. Borschmann, DClinPsy, David Goldberg Centre, Institute of Psychiatry, London; D. Osborn, PhD, MRCPsych, Division of Psychiatry, University College London, London; K. Dean, PhD, MRCPsych, Institute of Psychiatry, London, and School of Psychiatry, University of New South Wales and Justice Health & Forensic Mental Health Network; C. Hart, MSc, J. Hogg, MSc, P. Moran, PhD, MRCPsych, David Goldberg Centre, Institute of Psychiatry, London, UK
| | - R Borschmann
- H. Khalifeh, MSc, MRCPsych, S. Johnson, MD, MRCPsych, Division of Psychiatry, University College London, London; L. M. Howard, PhD, MRCPsych, R. Borschmann, DClinPsy, David Goldberg Centre, Institute of Psychiatry, London; D. Osborn, PhD, MRCPsych, Division of Psychiatry, University College London, London; K. Dean, PhD, MRCPsych, Institute of Psychiatry, London, and School of Psychiatry, University of New South Wales and Justice Health & Forensic Mental Health Network; C. Hart, MSc, J. Hogg, MSc, P. Moran, PhD, MRCPsych, David Goldberg Centre, Institute of Psychiatry, London, UK
| | - D Osborn
- H. Khalifeh, MSc, MRCPsych, S. Johnson, MD, MRCPsych, Division of Psychiatry, University College London, London; L. M. Howard, PhD, MRCPsych, R. Borschmann, DClinPsy, David Goldberg Centre, Institute of Psychiatry, London; D. Osborn, PhD, MRCPsych, Division of Psychiatry, University College London, London; K. Dean, PhD, MRCPsych, Institute of Psychiatry, London, and School of Psychiatry, University of New South Wales and Justice Health & Forensic Mental Health Network; C. Hart, MSc, J. Hogg, MSc, P. Moran, PhD, MRCPsych, David Goldberg Centre, Institute of Psychiatry, London, UK
| | - K Dean
- H. Khalifeh, MSc, MRCPsych, S. Johnson, MD, MRCPsych, Division of Psychiatry, University College London, London; L. M. Howard, PhD, MRCPsych, R. Borschmann, DClinPsy, David Goldberg Centre, Institute of Psychiatry, London; D. Osborn, PhD, MRCPsych, Division of Psychiatry, University College London, London; K. Dean, PhD, MRCPsych, Institute of Psychiatry, London, and School of Psychiatry, University of New South Wales and Justice Health & Forensic Mental Health Network; C. Hart, MSc, J. Hogg, MSc, P. Moran, PhD, MRCPsych, David Goldberg Centre, Institute of Psychiatry, London, UK
| | - C Hart
- H. Khalifeh, MSc, MRCPsych, S. Johnson, MD, MRCPsych, Division of Psychiatry, University College London, London; L. M. Howard, PhD, MRCPsych, R. Borschmann, DClinPsy, David Goldberg Centre, Institute of Psychiatry, London; D. Osborn, PhD, MRCPsych, Division of Psychiatry, University College London, London; K. Dean, PhD, MRCPsych, Institute of Psychiatry, London, and School of Psychiatry, University of New South Wales and Justice Health & Forensic Mental Health Network; C. Hart, MSc, J. Hogg, MSc, P. Moran, PhD, MRCPsych, David Goldberg Centre, Institute of Psychiatry, London, UK
| | - J Hogg
- H. Khalifeh, MSc, MRCPsych, S. Johnson, MD, MRCPsych, Division of Psychiatry, University College London, London; L. M. Howard, PhD, MRCPsych, R. Borschmann, DClinPsy, David Goldberg Centre, Institute of Psychiatry, London; D. Osborn, PhD, MRCPsych, Division of Psychiatry, University College London, London; K. Dean, PhD, MRCPsych, Institute of Psychiatry, London, and School of Psychiatry, University of New South Wales and Justice Health & Forensic Mental Health Network; C. Hart, MSc, J. Hogg, MSc, P. Moran, PhD, MRCPsych, David Goldberg Centre, Institute of Psychiatry, London, UK
| | - P Moran
- H. Khalifeh, MSc, MRCPsych, S. Johnson, MD, MRCPsych, Division of Psychiatry, University College London, London; L. M. Howard, PhD, MRCPsych, R. Borschmann, DClinPsy, David Goldberg Centre, Institute of Psychiatry, London; D. Osborn, PhD, MRCPsych, Division of Psychiatry, University College London, London; K. Dean, PhD, MRCPsych, Institute of Psychiatry, London, and School of Psychiatry, University of New South Wales and Justice Health & Forensic Mental Health Network; C. Hart, MSc, J. Hogg, MSc, P. Moran, PhD, MRCPsych, David Goldberg Centre, Institute of Psychiatry, London, UK
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Kang B, Yeligar S, Bijli K, Adesina S, Kleinhenz J, Murphy T, Sutliff R, Hart C. Loss of PPARγ Promotes Mitochondrial Dysfunction through Downregulation of PGC1α. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.1031.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Bum‐Yong Kang
- Department of MedicineAtlanta Veterans Affairs and Emory University Medical CentersDecaturGAUnited States
| | - Samantha Yeligar
- Department of MedicineAtlanta Veterans Affairs and Emory University Medical CentersDecaturGAUnited States
| | - Kaiser Bijli
- Department of MedicineAtlanta Veterans Affairs and Emory University Medical CentersDecaturGAUnited States
| | - Sherry Adesina
- Department of MedicineAtlanta Veterans Affairs and Emory University Medical CentersDecaturGAUnited States
| | - Jennifer Kleinhenz
- Department of MedicineAtlanta Veterans Affairs and Emory University Medical CentersDecaturGAUnited States
| | - Tamara Murphy
- Department of MedicineAtlanta Veterans Affairs and Emory University Medical CentersDecaturGAUnited States
| | - Roy Sutliff
- Department of MedicineAtlanta Veterans Affairs and Emory University Medical CentersDecaturGAUnited States
| | - C Hart
- Department of MedicineAtlanta Veterans Affairs and Emory University Medical CentersDecaturGAUnited States
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Abstract
INTRODUCTION The laparoscopic approach to repairing ventral and incisional hernias has gained increasing popularity worldwide. We reviewed the experience of laparoscopic ventral hernia repair at a district general hospital in the UK with particular reference to patients with massive defects (diameter ≥15cm) and the morbidly obese. METHODS A total of 144 patients underwent laparoscopic ventral (incisional or umbilical/paraumbilical) hernia repair between April 2007 and September 2012. RESULTS The prevalence of conversion to open surgery was 2.8%. The prevalence of postoperative complications was 3.5%. Median postoperative follow-up was 30.2 months. A total of 5.6% cases suffered late complications and 2.8% developed recurrence. Thirty-four patients underwent repair of defects ≥10cm in diameter with a prevalence of recurrence of 5.6%. Sixteen patients underwent repair of 'massive' incisional hernia (diameter ≥15cm) with a prevalence of recurrence of 12.5%. Sixteen patients with a body mass index (BMI) ≥40kg/m(2) (range, 40-61kg/m(2)) underwent laparoscopic repair with a prevalence of recurrence of 6.3% (p>0.05 vs BMI <40kg/m(2)). CONCLUSIONS Laparoscopic ventral hernia repair can be carried out safely with a low prevalence of recurrence. It may have advantages in morbidly obese patients in whom open repair would represent a significant undertaking. Laparoscopic ventral hernia repair may be used in cases of large and massive hernias, in which the risk of recurrence increases but is comparable with open repair and associated with low morbidity.
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Affiliation(s)
- C D Mann
- Northampton General Hospital, UK
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Khalifeh H, Moran P, Borschmann R, Dean K, Hart C, Hogg J, Osborn D, Johnson S, Howard LM. Domestic and sexual violence against patients with severe mental illness. Psychol Med 2015; 45:875-886. [PMID: 25180908 PMCID: PMC4413870 DOI: 10.1017/s0033291714001962] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 07/08/2014] [Accepted: 07/18/2014] [Indexed: 11/05/2022]
Abstract
BACKGROUND Domestic and sexual violence are significant public health problems but little is known about the extent to which men and women with severe mental illness (SMI) are at risk compared with the general population. We aimed to compare the prevalence and impact of violence against SMI patients and the general population. METHOD Three hundred and three randomly recruited psychiatric patients, in contact with community services for ⩾ 1 year, were interviewed using the British Crime Survey domestic/sexual violence questionnaire. Prevalence and correlates of violence in this sample were compared with those from 22 606 general population controls participating in the contemporaneous 2011/12 national crime survey. RESULTS Past-year domestic violence was reported by 27% v. 9% of SMI and control women, respectively [odds ratio (OR) adjusted for socio-demographics, aOR 2.7, 95% confidence interval (CI) 1.7-4.0], and by 13% v. 5% of SMI and control men, respectively (aOR 1.6, 95% CI 1.0-2.8). Past-year sexual violence was reported by 10% v. 2.0% of SMI and control women respectively (aOR 2.9, 95% CI 1.4-5.8). Family (non-partner) violence comprised a greater proportion of overall domestic violence among SMI than control victims (63% v. 35%, p < 0.01). Adulthood serious sexual assault led to attempted suicide more often among SMI than control female victims (53% v. 3.4%, p < 0.001). CONCLUSIONS Compared to the general population, patients with SMI are at substantially increased risk of domestic and sexual violence, with a relative excess of family violence and adverse health impact following victimization. Psychiatric services, and public health and criminal justice policies, need to address domestic and sexual violence in this at-risk group.
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Affiliation(s)
- H. Khalifeh
- Division of Psychiatry, Faculty of Brain
Sciences, UCL (University College London),
UK
| | - P. Moran
- Health Service and Population Research Department,
Institute of Psychiatry, King's College London,
UK
| | - R. Borschmann
- Health Service and Population Research Department,
Institute of Psychiatry, King's College London,
UK
| | - K. Dean
- School of Psychiatry, UNSW
and Justice Health and Forensic Mental Health Network,
NSW, Australia
| | - C. Hart
- Health Service and Population Research Department,
Institute of Psychiatry, King's College London,
UK
| | - J. Hogg
- Health Service and Population Research Department,
Institute of Psychiatry, King's College London,
UK
| | - D. Osborn
- Division of Psychiatry, Faculty of Brain
Sciences, UCL (University College London),
UK
| | - S. Johnson
- Division of Psychiatry, Faculty of Brain
Sciences, UCL (University College London),
UK
| | - L. M. Howard
- Health Service and Population Research Department,
Institute of Psychiatry, King's College London,
UK
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Hart C, Spannagl M. [Coagulation disorders in the intensive care station]. Internist (Berl) 2014; 55:521-8. [PMID: 24715275 DOI: 10.1007/s00108-013-3422-5] [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: 11/29/2022]
Abstract
Coagulation disorders are frequently encountered in the intensive care unit (ICU) and are challenging due to a variety of potential etiologies. Critically ill patients with coagulation abnormalities may present with an increased risk of bleeding, show coagulation activation resulting in thromboembolism, or have no specific symptoms. Hemostatic abnormalities observed in ICU patients range from isolated thrombocytopenia or prolonged global clotting tests to complex and life-threatening coagulation defects. Successful management of coagulation disorders requires prompt and accurate identification of the underlying cause. This review describes the most frequently occurring diagnoses found in intensive care patients with thrombocytopenia and coagulation test abnormalities and summarizes appropriate diagnostic interventions and current approaches to differential diagnosis.
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Affiliation(s)
- C Hart
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Regensburg, Franz-Josef-Strauss Allee 11, Regensburg, 93053, Deutschland,
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Khalifeh H, Moran P, Borschmann R, Dean K, Hart C, Hogg J, Osborn D, Johnson S, Howard L. Domestic and sexual violence against people with severe mental illness: comparisons with the 2011/2012 National Crime survey for England and Wales. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku162.048] [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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Hart C, Gruer L. Comparing the impact of personal and parental risk factors, and parental lifespan on all-cause mortality and cardiovascular disease: findings from the 1996 Midspan Family Study in Scotland. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku166.033] [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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Wegner P, Pham HM, Jerosch-Herold M, Voges I, Christo I, Andrade A, Hart C, Rickers C, Kramer HH. Abnormalities of myocardial blood flow, viability and diffuse fibrosis in patients after Arterial Switch and Ross Operation assessed with magnetic resonance imaging. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1394004] [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: 10/24/2022]
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Lim JS, Tan ES, John CM, Poh S, Yeo SJ, Ang JSM, Adakalaisamy P, Rozalli RA, Hart C, Tan ETH, Ranieri E, Rajadurai VS, Cleary MA, Goh DLM. Inborn Error of Metabolism (IEM) screening in Singapore by electrospray ionization-tandem mass spectrometry (ESI/MS/MS): An 8 year journey from pilot to current program. Mol Genet Metab 2014; 113:53-61. [PMID: 25102806 DOI: 10.1016/j.ymgme.2014.07.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 07/15/2014] [Accepted: 07/15/2014] [Indexed: 12/14/2022]
Abstract
IEM screening by ESI/MS/MS was introduced in Singapore in 2006. There were two phases; a pilot study followed by implementation of the current program. The pilot study was over a 4 year period. During the pilot study, a total of 61,313 newborns were screened, and 20 cases of IEM were diagnosed (detection rate of 1:3065; positive predictive value (PPV) of 11%). Regular self-review, participation in external quality assessment and the Region 4 Genetic collaborative programs (http://www.region4genetics.org/) had led to the robust development of our current NBS MS/MS program. Overall, from July 2006 to April 2014, we screened a total of 177,267 newborns. The mean age at the time of sampling was 47.9h. Transportation of samples to the testing laboratory averaged 0.92 day. Upon receipt of sample, the NBS result was available within 1.64 days and within 3.8 days if a second tier test was required. Using absolute cut-off values in place of the initial 99th percentile reference range for the analyte markers and the introduction of two 2nd tier tests (MMA and Succinylacetone) had significantly reduced the high recall rate from an initial 1.5% during the period 2006-07 to 0.12% in 2013. The NBS MS/MS program was supported by a centralized confirmatory/diagnostic testing laboratory and a rapid response team of metabolic specialists. The detection rate was 1: 3165 (1:2727 if maternal conditions were also included). There were 23 newborns affected with organic acidemias (incidence: 1:6565), 23 with fatty acid oxidation disorders (incidence: 1:6565), and 10 with amino acidopathies (incidence 1:17,726). The performance metrics for the screening test were acceptable (sensitivity: 95.59%, specificity: 99.85%, PPV: 20%, FPR: 0.15). Participation in the NBS MS/MS program by hospitals was voluntary, and in 2013, the uptake rate was 71% of the annual births. We hope that newborn screening by MS/MS will become a standard of care for all babies in Singapore.
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Affiliation(s)
- J S Lim
- Biochemical Genetics and National Expanded Newborn Screening, Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road 229899, Singapore
| | - E S Tan
- Genetics Services, Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road 229899, Singapore
| | - C M John
- Biochemical Genetics and National Expanded Newborn Screening, Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road 229899, Singapore
| | - S Poh
- Biochemical Genetics and National Expanded Newborn Screening, Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road 229899, Singapore
| | - S J Yeo
- Biochemical Genetics and National Expanded Newborn Screening, Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road 229899, Singapore
| | - J S M Ang
- Biochemical Genetics and National Expanded Newborn Screening, Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road 229899, Singapore
| | - P Adakalaisamy
- Biochemical Genetics and National Expanded Newborn Screening, Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road 229899, Singapore
| | - R A Rozalli
- Biochemical Genetics and National Expanded Newborn Screening, Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road 229899, Singapore
| | - C Hart
- Biochemical Genetics and National Expanded Newborn Screening, Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road 229899, Singapore
| | - E T H Tan
- Biochemical Genetics and National Expanded Newborn Screening, Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road 229899, Singapore
| | - E Ranieri
- South Australian Neonatal Screening Centre Directorate of Genetic and Molecular Pathology Women's and Children's Hospital Campus, Adelaide SA Pathology, 72 King William Road, North Adelaide, South Australia 5006, Australia
| | - V S Rajadurai
- Department of Neonatology, KK Women's and Children's Hospital, 100 Bukit Timah Road 229899, Singapore
| | - M A Cleary
- Genetics Services, Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road 229899, Singapore
| | - D L M Goh
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore 119228; Department of Paediatrics, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore 119228
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47
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Sutliff R, Kleinhenz J, Murphy T, Pokutta‐Paskaleva A, Gleason R, Lyle A, Taylor W, Yang Q, Hart C. Smooth muscle‐targeted overexpression of peroxisome proliferator‐activated receptor gamma disrupts vascular wall structure and function (866.4). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.866.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Roy Sutliff
- Emory University/Atlanta VA Medical CenterATLANTAGAUnited States
| | | | - Tamara Murphy
- Emory University/Atlanta VA Medical CenterATLANTAGAUnited States
| | | | | | | | - W. Taylor
- Emory UniversityAtlantaGAUnited States
| | - Qinglin Yang
- University of Alabama Birmingham BiminghamALUnited States
| | - C. Hart
- Emory University/Atlanta VA Medical CenterATLANTAGAUnited States
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48
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Sutliff R, Kleinhenz J, Ma J, Hart C. Endothelium‐targeted deletion of Nox4 attenuates hypoxia‐induced increases in right ventricular pressure (1089.19). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.1089.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Roy Sutliff
- Pulmonary and Critical Care Medicine Emory University/Atlanta VA Medical CenterDecaturGAUnited States
| | - Jennifer Kleinhenz
- Medicine Emory University/Atlanta VA Medical CenterDecaturGAUnited States
| | - Jing Ma
- Pulmonary and Critical Care Medicine Emory University/Atlanta VA Medical CenterDecaturGAUnited States
| | - C. Hart
- Pulmonary and Critical Care Medicine Emory University/Atlanta VA Medical CenterDecaturGAUnited States
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49
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Adesina S, Hart C, Sutliff R. The role of mitochondrial reactive oxygen species in hypoxia‐induced pulmonary hypertension (1089.16). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.1089.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sherry Adesina
- Division of Pulmonary and Critical Care Medicine ATLANTA VA/Emory University/ Medical Centers Emory UniversityDecaturGAUnited States
| | - C. Hart
- Division of Pulmonary and Critical Care Medicine ATLANTA VA/Emory University/ Medical Centers Emory UniversityDecaturGAUnited States
| | - Roy Sutliff
- Division of Pulmonary and Critical Care Medicine ATLANTA VA/Emory University/ Medical Centers Emory UniversityDecaturGAUnited States
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50
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Bijli K, Kang B, Adesina S, Murphy T, Kleinhenz J, Hart C. Proline‐rich tyrosine kinase regulates NF‐κB and PPARγ to promote hypoxia‐induced proliferative phenotype of human pulmonary artery smooth muscle cells (1175.1). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.1175.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kaiser Bijli
- Department of Medicine Emory University & ATLANTA Veterans Affairs Medical CentersDecaturGAUnited States
| | - Bum‐Yong Kang
- Department of Medicine Emory University & ATLANTA Veterans Affairs Medical CentersDecaturGAUnited States
| | - Sherry Adesina
- Department of Medicine Emory University & ATLANTA Veterans Affairs Medical CentersDecaturGAUnited States
| | - Tamara Murphy
- Department of Medicine Emory University & ATLANTA Veterans Affairs Medical CentersDecaturGAUnited States
| | - Jennifer Kleinhenz
- Department of Medicine Emory University & ATLANTA Veterans Affairs Medical CentersDecaturGAUnited States
| | - C Hart
- Department of Medicine Emory University & ATLANTA Veterans Affairs Medical CentersDecaturGAUnited States
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