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Cronshaw R, Maclean E, Newby D, Williams M, Nicol E. What’s The Score? Evaluation Of The Prognostic Ability Of Semi-quantitative Coronary Ct Angiography Scores In The SCOT-HEART Trial. J Cardiovasc Comput Tomogr 2023. [DOI: 10.1016/j.jcct.2023.01.005] [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: 02/27/2023]
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2
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Nazir M, Murphy T, Poku N, Wheen P, Nowbar A, Andres M, Ramalingham S, Rosen S, Nicol E, Lyon A. Clinical Utility And Prognostic Value Of Coronary Computed Tomography Angiography In Cancer Patients. J Cardiovasc Comput Tomogr 2023. [DOI: 10.1016/j.jcct.2023.01.015] [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: 02/26/2023]
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3
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McPhail S, Steed D, Holdsworth D, Nicol E, Bennett A, Phillips S. Development, design and experience of the UK Military's return to diving pathway following SARS-CoV-2 infection. BMJ Mil Health 2022:e002327. [PMID: 36581498 DOI: 10.1136/military-2022-002327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/31/2022]
Abstract
After the emergence of the SARS-CoV-2 virus in early 2020, it quickly became clear that symptomatic or asymptomatic infection had the potential to negatively impact on an individual's fitness to dive through effects on the respiratory, cardiovascular or neurological systems. The significance of these effects in the military diving environment was initially unclear due to an absence of data concerning incidence, chronology or severity. In order to safely return divers to the water and maintain operational capability, the UK Military developed a pathway for SARS-CoV-2 positive divers that stratified risk of sequelae and extent of required clinical investigation, while minimising reliance on viral testing and hospital-based investigations. We present this process, provide rationale and support for its design and detail the number of SARS-CoV-2 positive divers who have been returned to full diving fitness following infection of varying degrees of severity.
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Affiliation(s)
- Stuart McPhail
- Underwater Medicine Division, Institute of Naval Medicine, Alverstoke, UK
- Department of Anaesthesia, University Hospitals Plymouth NHS Trust, Plymouth, Devon, UK
| | - D Steed
- Underwater Medicine Division, Institute of Naval Medicine, Alverstoke, UK
| | - D Holdsworth
- Academic Department of Military Medicine, Royal Centre for Defence Medicine (Research and Clinical Innovation), Birmingham, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - E Nicol
- Royal Brompton Hospital, London, UK
- King's College London School of Biomedical Engineering and Imaging Sciences, London, UK
| | - A Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Headley Court, Epsom, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - S Phillips
- Underwater Medicine Division, Institute of Naval Medicine, Alverstoke, UK
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4
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Adam T, Sammito S, Nicol E, Guettler NJ. Return to flying duties of German military pilots after recovery from COVID-19. BMJ Mil Health 2022:e002122. [PMID: 35868711 DOI: 10.1136/military-2022-002122] [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: 03/17/2022] [Accepted: 07/03/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Pilots are working in a unique and exacting environment with hypobaric hypoxia and acceleration forces. In military flying, missions are often challenging with possible combat scenarios and in remote areas with impaired infrastructure. METHODS We analysed all German military pilots and pilot candidates with confirmed SARS-CoV-2 infection, who have all been evaluated prior to their return to flying duties between April 2020 and January 2022 by the German Air Force Centre of Aerospace Medicine. Symptoms, comorbidities, scope of investigations, examination results, vaccination status and aeromedical disposition are described. RESULTS 90 pilots (82 active pilots and 8 pilot candidates) with a median age of 35 years (IQR 15 years) were included. 78 pilots (87%) reported symptoms, with median duration of 6 days. Symptoms included influenza-like symptoms (70.0%), headache (45.6%), impaired physical fitness (37.8%), anosmia/ageusia (36.7%), fever (27.8%), exertional dyspnoea (8.9%), memory and concentration disorders (4.4%), diarrhoea (3.3%) and dyspnoea at rest (2.2%). Only one pilot (1.1%) was hospitalised, two (2.2%) required outpatient treatment. All pilots were allowed to return to unrestricted flying duties after the assessment, with eight (8.9%) reporting ongoing mild symptoms. CONCLUSION Due to their demanding working environment, pilots, and other high-hazard employees, should undergo medical evaluation prior to return to their duties to exclude ongoing symptoms and the development of post-acute COVID-19 or post-COVID-19 syndrome. The scope of examinations may depend on the severity of the disease, comorbidities, the vaccination status, the predominant SARS-CoV-2 variant and the type of aircraft flown.
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Affiliation(s)
- Tim Adam
- Internal Medicine, Air Force Centre of Aerospace Medicine, Fuerstenfeldbruck, Germany
| | - S Sammito
- Experimental Aerospace Medicine Research, Air Force Centre of Aerospace Medicine, Cologne, Germany
- Occupational Medicine, Otto von Guericke University Medical Faculty, Magdeburg, Germany
| | - E Nicol
- Clinical Aviation Medicine Service, RAF, Birmingham, UK
- Cardiology, Royal Brompton Hospital, London, UK
| | - N J Guettler
- Internal Medicine, Air Force Centre of Aerospace Medicine, Fuerstenfeldbruck, Germany
- Cardiology, Justus Liebig University, University Hospital Giessen, Medical Clinic, Giessen, Germany
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Hur D, Nagpal P, Weir-McCall J, Madan N, Ferencik M, Maroules C, Nicol E, Villines T. 510 Cardiovascular Computed Tomography Education In Current-day Trainees: Results From Scct’S 2021 International Cct Training Survey. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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6
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Nicol E, Adani N, Lin B, Tor E. The temporal analysis of elite breaststroke swimming during competition. Sports Biomech 2021:1-13. [PMID: 34547991 DOI: 10.1080/14763141.2021.1975810] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 08/29/2021] [Indexed: 10/20/2022]
Abstract
Breaststroke is the only competitive stroke characterised by propulsive discontinuity. It is consequently paramount that swimmers optimally coordinate limb movements in order to maintain the highest average velocity possible. The present study aimed to investigate the temporal patterns of elite breaststroke swimmers. 50 m long-course competition footage of (1) 20 male 100 m races, (2) 24 female 100 m races, (3) 15 male 200 m races, and (4) 27 female 200 m races from 2018 to 2020 were digitised and analysed. Six points within each stroke cycle were identified and used to calculate 15 temporal parameters. Analyses revealed multiple temporal pattern differences between groups based on sex and race distance. It is recommended that coaches individualise swimmers' breaststroke temporal patterns based on individual needs, strengths, and morphological characteristics.
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Affiliation(s)
- E Nicol
- Queensland Academy of Sport, Brisbane, Australia
- Griffith Sports Science, Griffith University, Gold Coast, Australia
| | - N Adani
- Victorian Institute of Sport, Melbourne, Australia
| | - B Lin
- Victorian Institute of Sport, Melbourne, Australia
| | - E Tor
- Victorian Institute of Sport, Melbourne, Australia
- Institute for Health and Sport, Victoria University, Melbourne, Australia
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7
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Lota A, Nicol E. Evaluation Of Cardiac CT Activity During The Covid-19 Pandemic At The Royal Brompton And Harefield Hospitals (London, UK). J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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Tzolos E, Williams M, McElhinney P, Lin A, Grodecki K, Guadalupe F, Cadet S, Kwiecinski J, Doris M, Adamson P, Moss A, Alam S, Hunter A, Shah A, Mills N, Pawade T, Wang C, Weir-McCall J, Roditi G, van Beek E, Shaw L, Nicol E, Berman D, Slomka P, Dweck M, Newby D, Dey D. Pericoronary Adipose Tissue Attenuation, Low Attenuation Plaque Burden And 5-year Risk Of Myocardial Infarction. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Williams M, Kwiecinski J, Doris M, McElhinney P, Cadet S, Adamson P, Moss A, Alam S, Hunter A, Shah A, Mills N, Pawade T, Wang C, Weir-McCall J, Roditi G, van Beek E, Shaw L, Nicol E, Berman D, Slomka P, Newby D, Dweck M, Dey D. Sex-specific CT Coronary Plaque Characterization And Risk Of Myocardial Infarction. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Camm CJF, Crawford W, Olivarius-Mcallister J, Prachee I, Schaefer A, Raouf Z, Bello A, Ginks M, Nicol E. Does industry funding differ between men and women in electrophysiology and devices research? Europace 2021. [DOI: 10.1093/europace/euab116.526] [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
Funding Acknowledgements
Type of funding sources: None.
Background
A significant gender bias has been identified in cardiology. Industry funding may be important developing electrophysiology (EP) and devices research. Such funding leads to potential conflicts of interest (COI) which must be disclosed on research presentations. There is limited evidence whether the gender bias in cardiology extends to industry funding of research.
Purpose
To assess whether COI disclosures in EP and devices presentations at the ESC Annual Congress differ between men and women.
Methods
Recorded presentations from the Arrhythmia & Devices section of ESC Annual Congresses 2016-2020 were assessed. Presentations were excluded if the original presentation contained no slides, it was a panel discussion, it was a non-scientific presentation, or part of the presentation was missing. Presentations with multiple speakers were also excluded. Chi-squared and Mann-Whitney U tests were used to assess differences between groups for dichotomous and continuous data respectively.
Results
Of 1,153 presentations assessed, 999 were suitable for inclusion. Women made up 22% (n = 221) of presenters. There was no difference in whether COI declaration slides were missing between women (5.9%, n = 13) and men (7.6%, n = 56), p = 0.38. In those with COI disclosure slides (n = 927), women declared significantly lower median number of COIs (0, IQR 0-3) compared with men (2, IQR 0-8), p < 0.0001. In contrast, women spent a greater time-per-word on their COI disclosure slides (250ms, IQR 125-375ms) compared with men (200ms, IQR 118-333ms), p < 0.0001.
Conclusions
Women made up a minority of presenters in EP/devices talks at the ESC annual congress. Women were less likely to have COIs which may suggest that they are less likely to receive industry funding. Despite this, women spent a greater amount of time-per-word on their COI slides. The lower number of declared COIs in women highlights another potential area of gender bias in cardiology that needs further investigation so that it can be addressed.
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Affiliation(s)
- CJF Camm
- University of Oxford, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - W Crawford
- University of Oxford, Oxford, United Kingdom of Great Britain & Northern Ireland
| | | | - I Prachee
- University of Oxford, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - A Schaefer
- University of Oxford, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - Z Raouf
- University of Oxford, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - A Bello
- University of Oxford, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - M Ginks
- Oxford University Hospitals NHS Foundation Trust, Cardiology Department, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - E Nicol
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
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11
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O'Sullivan O, Barker-Davies R, Chamley R, Sellon E, Jenkins D, Burley R, Holden L, Nicol AM, Phillip R, Bennett AN, Nicol E, Holdsworth DA. Defence Medical Rehabilitation Centre (DMRC) COVID-19 Recovery Service. BMJ Mil Health 2021; 169:271-276. [PMID: 33547188 DOI: 10.1136/bmjmilitary-2020-001681] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 11/04/2022]
Abstract
Coronavirus disease 2019 (COVID-19) causes significant mortality and morbidity, with an unknown impact in the medium to long term. Evidence from previous coronavirus epidemics indicates that there is likely to be a substantial burden of disease, potentially even in those with a mild acute illness. The clinical and occupational effects of COVID-19 are likely to impact on the operational effectiveness of the Armed Forces. Collaboration between Defence Primary Healthcare, Defence Secondary Healthcare, Defence Rehabilitation and Defence Occupational Medicine resulted in the Defence Medical Rehabilitation Centre COVID-19 Recovery Service (DCRS). This integrated clinical and occupational pathway uses cardiopulmonary assessment as a cornerstone to identify, diagnose and manage post-COVID-19 pathology.
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Affiliation(s)
- Oliver O'Sullivan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, Nottinghamshire, UK.,Headquarters Army Medical Services (HQ AMS), Camberley, Surrey, UK
| | - R Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, Nottinghamshire, UK.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - R Chamley
- Academic Department of Military Medicine, Birmingham, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - E Sellon
- Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK.,Royal Centre for Defence Medicine, Birmingham, UK
| | - D Jenkins
- Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK.,Royal Centre for Defence Medicine, Birmingham, UK
| | - R Burley
- Headquarters Defence Primary Healthcare, Lichfield, Staffordshire, UK
| | - L Holden
- Royal Centre for Defence Medicine, Birmingham, UK
| | - A M Nicol
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, Nottinghamshire, UK
| | - R Phillip
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, Nottinghamshire, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, Nottinghamshire, UK.,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - E Nicol
- Royal Centre for Defence Medicine, Birmingham, UK.,Royal Brompton Hospital, London, UK
| | - D A Holdsworth
- Academic Department of Military Medicine, Birmingham, UK .,Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
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12
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Mahon C, Davis A, Gambaro A, Musella F, Costam A, Nicol E, Duncan A, Mirsadraee S. Feasibility Of Quantifying Individual Aortic Leaflet Calcification And It’S Association With Paravalvular Regurgitation And Conduction Abnormalities In Transcatheter Aortic Valve Implantation. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Weir-McCall J, Roditi G, Williams M, Rudd J, Newby D, Nicol E. Impact Of Training And Hardware Availability On Uptake Of Coronary Computed Tomography In Response To Guidelines. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Williams M, Weir-McCall J, Moss A, Schmitt M, Stirrup J, Holloway B, Gopalan D, Deshpande A, Morgan Hughes G, Agrawal B, Nicol E, Roditi G, Shambrook J, Bull R. Radiologist Opinions Regarding Reporting Incidental Coronary And Cardiac Calcification On Thoracic CT. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Madan N, Gannon M, Gupta S, Weir-McCall J, Kumar A, Nagpal P, Fentanes E, Lee J, Choi A, Nicol E. Contemporary Description Of Cardiovascular Computed Tomography Training And Clinical Utilization: A Survey By SCCT-FiRST Committee. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Yucel-Finn A, Nicol E, Leipsic JA, Weir-McCall JR. CT in planning transcatheter aortic valve implantation procedures and risk assessment. Clin Radiol 2019; 76:73.e1-73.e19. [PMID: 31883615 DOI: 10.1016/j.crad.2019.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/13/2019] [Indexed: 12/31/2022]
Abstract
For surgical aortic valve replacement, the Society of Thoracic Surgeons score (STSS) is the reference standard for the prediction of operative risk. In transcatheter aortic valve implantation (TAVI) though, where the procedure itself is minimally invasive, the traditional risk assessment is supplemented by CTA. Through a consistent approach to the acquisition of high-quality images and the standardised reporting of annular measurements and adverse root and vascular features, patients at risk of complications can be identified. In turn, this may allow for a personalised procedural approach and treatment strategies devised to potentially reduce or mitigate this risk. This article provides a systematic and standardised approach to pre-procedural work-up with computed tomography angiography (CTA) and explores the current state of evidence and future areas of development in this rapidly developing field.
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Affiliation(s)
| | - E Nicol
- Royal Brompton Hospital, London, UK
| | - J A Leipsic
- St Paul's Hospital, Vancouver, British Columbia, Canada
| | - J R Weir-McCall
- Royal Papworth Hospital, Cambridge, UK; University of Cambridge School of Clinical Medicine, Cambridge, UK.
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17
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Nicol E, Semple T, Baleswaran S, Wong TOM. P3384Left atrial appendage pseudo-thrombus as an independent risk factor for ischaemic stroke in patients with non-valvular atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Left atrial appendage (LAA) pseudo-thrombus is a well recognised phenomenon in patients with atrial fibrillation (AF) undergoing cardiovascular CT (CCT). The clinical significance of LAA pseudothrombus on CCT, in those with non-valvular AF (NVAF) is unknown.
Objectives
To determine the association of LAA pseudo-thrombus in those with NVAF and ischaemic stroke.
Methods
216 consecutive patients with NVAF, referred for CCT (with both standard and 60-second delayed acquisitions) were assessed for the LAA pseudo-thrombus, LA and LAA dimensions and morphology, cardiovascular risk factors, treatment, and ischaemic stroke risk
Results
Mean age (±SD) was 65.0±10.6 years (range 32–89) and 70.8% were male. LAA pseudo-thrombus was present in 59/216 (27%) patients. Ischaemic stroke is more frequent with increasing age (OR 1.10 (95% confidence intervals (CI) 1.06, 1.16), p<0.0001), vascular disease (3.21 (1.18, 8.75) p=0.023), pseudo-thrombus on CCT (4.18 (1.97, 8.88) p<0.0001), cauliflour LAA morphology (4.93 (1.06, 22.09) p=0.042), and increased LAA ostial area: LAA tortuosity (4.64 (1.57, 13.71) p=0.006).
Age (1.09 (1.03, 1.15) p<0.0001), vascular disease (4.07 (1.19, 13.98) p=0.026), cauliflour LAA morphology (15.01 (2,93, 76.81) p=0.001) and pseudothrombus on CCT (3.62 (1.38, 9.50), p=0.009) were independently associated with ischaemic stroke. Pseudothrombus remained an independent risk factor even after CHA2DS2-VASc was included (3.21 (1.22, 8.41), p=0.018).
Conclusion
Pseudothrombus on CCT is a common finding in patients with NVAF and has a strong positive association with ischaemic stroke. Inclusion of pseudothrombus on CCT in risk assessment is additive to CHA2DS2-VASc in prediction of ischaemic stroke risk in patients with NVAF.
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Affiliation(s)
- E Nicol
- Royal Brompton Hospital, London, United Kingdom
| | - T Semple
- Royal Brompton Hospital, London, United Kingdom
| | | | - T O M Wong
- Royal Brompton Hospital, London, United Kingdom
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18
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Constantine AH, Segura T, Nicol E, Kempny AH, Rafiq I, Barradas Pires A, Barracano R, Gatzoulis MA, Rubens M, Semple T, Dimopoulos K. P3654Location of the coronary origins in transposition patients following anatomical repair: Implications for invasive coronary angiography and intervention. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Surgical repair of transposition of the great arteries (TGA) is most commonly via the arterial switch operation (ASO). This involves translocation of the aorta and pulmonary trunk, typically with anastomosis of the branch pulmonary arteries anteriorly (LeCompte manoeuvre) and re-implantation of the coronary arteries onto the posterior neo-aorta. As such, the position of the coronary ostia may differ from their expected locations.
Purpose
To use ECG-gated CT angiography to describe the anatomic position of coronary ostia in post-switch TGA patients guiding potential catheter interventions in this population.
Methods
All post ASO patients who underwent CT imaging between 2008–2018 were identified. Patients with complex anatomy such as double outlet right ventricle were excluded. The positions of the coronary ostia were measured in degrees from vertical on a double-oblique reconstruction in the aortic valve plane. Ostium positions were compared to those of patients with no congenital heart disease via Watson's two-sample test of homogeneity for circular data. Angular dispersion was compared between groups via the Wallraff test. P<0.05 indicated statistical significance.
Results
Of 206 adult patients with TGA and ASO followed in our adult congenital heart disease centre, 38 (18.4%) had CT imaging available for analysis during the study period (mean age 24±6.8, 75% male).
The control group consisted of 15 patients investigated for chest pain (mean age 54±15.1, 73% male). In the control group, the right and left coronary ostia arose at a mean angle of −19 and +125 degrees from vertical (figure 1a). This was significantly different to the mean ASO coronary ostia clustered at mean angles of −70 and +29 degrees from vertical (Watson p<0.001) (figure 1b, with stenosis at the left coronary anastomosis).
There was no significant difference in spread of left ostia (Rho 0.9 vs 0.99, p=0.12), but right ostia were significantly more variable in ASO patients than controls (0.71 vs 0.96, p=0.003).
Figure 1
Conclusions
Coronary ostial positions in the neo-aorta of post-ASO patients differ significantly from those of normal controls, with considerable variability, especially in right coronary position. CT can demonstrate coronary ostia in 3D space and derive appropriate tube angles to guide catheterisation in post-operative congenital cardiac patients, optimise catheter selection, reduce catheterisation tome, radiation and contrast dose.
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Affiliation(s)
- A H Constantine
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - T Segura
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - E Nicol
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - A H Kempny
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - I Rafiq
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - A Barradas Pires
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - R Barracano
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - M A Gatzoulis
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - M Rubens
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - T Semple
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - K Dimopoulos
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
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MacLean E, Sehmi J, Kanaganayagam GS, Ngee T, Nicol E. P2243CTCA alone demonstrates superior diagnostic accuracy, prognostic utility and is less expensive than CTCA combined with subsequent multi-modality functional imaging in patients with ischaemic symptoms. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The evaluation of suspected ischaemic symptoms incorporates multi-modality anatomical and functional imaging tests. The 2016 update to the UK's NICE guidelines recommends CT coronary angiogram (CTCA) first line in patients without known coronary artery disease. Additive multi-modality functional imaging may provide synergistic diagnostic and prognostic information.
Purpose
To investigate the diagnostic accuracy, prognostic utility and cost of CTCA combined with subsequent multi-modality functional testing versus (vs) CTCA alone.
Methods
772 consecutive patients were referred to a single UK tertiary centre with symptoms suggestive of ischaemia. 657 individuals (“CTCA group”) underwent CTCA alone, and 115 individuals (“Combined group”) underwent CTCA and then either perfusion cardiac MRI (n=25), stress echocardiogram (n=16), or myocardial perfusion scintigraphy (n=74). Patients underwent invasive angiography (n=79) +/− revascularisation at the discretion of the referring clinician. All readers and operators were aware of previous imaging findings. Revascularised patients (n=52) were excluded from long term follow-up. The remaining patients were followed-up for a mean of 38.1±17.4 months and the incidence of major adverse cardiovascular events (MACE) recorded. Costs were derived from the NICE guidelines.
Results
Baseline characteristics were similar between groups. The Combined group underwent significantly more invasive angiograms than the CTCA group (29.6% vs 6.8%, p=0.0001) with no significant difference in the rate of revascularisation (73% vs 67%, p=0.72). Mean time from CTCA to angiogram was significantly longer in the Combined group (81.2 vs 38.1 days, p=0.0001). Both sensitivity and specificity were lower in the Combined group than in the CTCA group (sensitivity: 70% vs 93%, specificity: 75% vs 100%). The rate of long term MACE was significantly higher in the Combined group (8.7% vs 2.6%, p=0.0026). Multivariate analysis of CTCA and functional imaging findings found that CTCA-derived four vessel aggregate stenosis score (0–12) was the strongest predictor of MACE for the whole cohort (OR 4.4, p<0.0001), and also for those with negative functional tests (OR 3.9, p<0.0001). Per patient, a combined strategy was more expensive than CTCA alone (£1551 vs £368, p=0.0001).
CTCA and functional data vs outcomes
Conclusions
Combining multi-modality functional testing with CTCA increased costs but did not improve diagnostic accuracy or long term outcomes. Further reductions in both MACE and unnecessary invasive angiography are desirable; CT-derived functional data such as FFRCT may be implicated.
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Affiliation(s)
- E MacLean
- St Bartholomews and Queen Mary University, London, United Kingdom
| | - J Sehmi
- Royal Brompton Hospital, Cardiovascular Imaging, London, United Kingdom
| | - G S Kanaganayagam
- Royal Brompton Hospital, Cardiovascular Imaging, London, United Kingdom
| | - T Ngee
- Royal Brompton Hospital, Cardiovascular Imaging, London, United Kingdom
| | - E Nicol
- Royal Brompton Hospital, Cardiovascular Imaging, London, United Kingdom
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Affiliation(s)
- T Syburra
- Heart Centre, Luzern Kantonsspital, Luzern, Switzerland.,Swiss Air Force, Aeromedical Centre, Dübendorf, Switzerland
| | - R von Wattenwyl
- Heart Centre, Luzern Kantonsspital, Luzern, Switzerland.,Swiss Air Force, Aeromedical Centre, Dübendorf, Switzerland
| | - D Bron
- Swiss Air Force, Aeromedical Centre, Dübendorf, Switzerland
| | - E Nicol
- Royal Air Force, Clinical Aviation Medical Service, Henlow, UK
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Harries IB, Williams M, Weir-Mccall J, Vedwan K, Shambrook J, Roditi G, Nicol E, Moss A. 189CT TAVR assessment in the United Kingdom: insights from a national BSCI/BSCCT survey. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez144] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- I B Harries
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - M Williams
- University of Edinburgh, Edinburgh Imaging Facility, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - J Weir-Mccall
- University of Cambridge, School of Clinical Medicine, Biomedical Research Centre, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - K Vedwan
- University of Southampton, Department of Cardiothoracic Radiology, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - J Shambrook
- University of Southampton, Department of Cardiothoracic Radiology, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - G Roditi
- University of Glasgow, Institute of Clinical Sciences, Glasgow, United Kingdom of Great Britain & Northern Ireland
| | - E Nicol
- Royal Brompton Hospital, Departments of Cardiology and Radiology, London, United Kingdom of Great Britain & Northern Ireland
| | - A Moss
- University of Edinburgh, Edinburgh Imaging Facility, Edinburgh, United Kingdom of Great Britain & Northern Ireland
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Tayal U, King L, Schofield R, Castellano I, Stirrup J, Pontana F, Earls J, Nicol E. Image reconstruction in cardiovascular CT: Part 2 - Iterative reconstruction; potential and pitfalls. J Cardiovasc Comput Tomogr 2019; 13:3-10. [PMID: 31014928 DOI: 10.1016/j.jcct.2019.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/04/2019] [Accepted: 04/15/2019] [Indexed: 12/22/2022]
Abstract
The use of IR in CT previously has been prohibitively complicated and time consuming, however improvements in computer processing power now make it possible on almost all CT scanners. Due to its potential to allow scanning at lower doses, IR has received a lot of attention in the medical literature and has become a successful commercial product. Its use in cardiovascular CT has been driven in part due to concerns about radiation dose and image quality. This manuscript discusses the various vendor permutations of iterative reconstruction (IR) in detail and critically appraises the current clinical research available on the various IR techniques used in cardiovascular CT.
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Affiliation(s)
- U Tayal
- Department of Cardiovascular CT, Royal Brompton Hospital, London, UK.
| | - L King
- Joint Department of Physics, The Royal Marsden, London, UK.
| | - R Schofield
- Department of Cardiovascular CT, Royal Brompton Hospital, London, UK.
| | - I Castellano
- Joint Department of Physics, The Royal Marsden, London, UK.
| | - J Stirrup
- Department of Cardiology, Royal Berkshire Hospital, Reading, UK.
| | - F Pontana
- Department of Cardiovascular Imaging, Lille University Hospital, France.
| | - J Earls
- George Washington University Hospital, Washington DC, USA.
| | - E Nicol
- Department of Cardiovascular CT, Royal Brompton Hospital, London, UK.
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Evans J, Silberbauer J, Glover B, Kontogeorgis A, McLellan A, Panikker S, Sieniewicz B, Martin C, Burg M, Providencia R, Behar J, Burke M, Withers K, White J, Lencioni M, Carolan-Rees G, Wood K, Patrick H, Griffith M, Gomes J, Kirubakaran S, O'Nunain S, Bencat M, McCready J, Michael K, Hashemi J, Gupta D, Akl S, Redfearn D, Lim E, Panikker S, Butcher C, Khan H, Mantziari L, Jarman J, Hussain W, Jones D, Clague J, Ernst S, Markides V, Wong T, Ezzat V, Schilling R, Lowe M, Whitaker J, Virmani R, Kutys R, Jarman J, Fastl T, Haldar S, Butcher C, Khan H, Mantziari L, O'Neill M, Corado C, Nicol E, Foran J, Markides V, Niederer S, Wong T, Behar J, Sohal M, Jais P, Derval N, Spragg D, Van Gelder B, Bracke F, Steendijk P, Rinaldi C, Chooneea B, Gajendragadkar P, Ahsan S, Begley D, Dhinoja M, Earley M, Ezzat V, Finlay M, Grace A, Heck P, Hunter R, Lambiase P, Lowe M, Rowland E, Schilling R, Segal O, Sporton S, Virdee M, Chow A, Apap Bologna R, Camilleri W, Sammut M, Aquilina O, Barra S, Papageorgiou N, Falconer D, Duehmke R, Rehal O, Ahsan S, Ezzat V, Dhinoja M, Ioannou A, Segal O, Sporton S, Rowland E, Lowe M, Lambiase P, Agarwal S, Chow A, Toth D, Mountney P, Reiml S, Panayioutu M, Brost A, Fahn B, Sohal M, Patel N, Claridge S, Jackson T, Adhya S, Sieniwicz B, O'Neill M, Razavi R, Rhode K, Rinaldi C, Tjong F, Brouwer T, Koop B, Soltis B, Shuros A, Knops R. ORAL ABSTRACTS (2)EP & Ablation19CARDIAC ABLATION PATIENT REPORTED OUTCOMES MEASURES (PROMS): ANALYSIS OF POST-ABLATION AND 1 YEAR FOLLOW-UP DATA20INTENTIONAL CORONARY VEIN EXIT AND CARBON DIOXIDE INSUFFLATION TO ALLOW SAFE SUBXIPHOID EPICARDIAL ACCESS FOR VENTRICULAR MAPPING AND ABLATION - FIRST EXPERIENCE21PACED FRACTIONATION DETECTION AS A TOOL FOR MAPPING SCARS IN VT22DOES USE OF CONTACT-FORCE SENSING CATHETERS IMPROVE THE OUTCOME OF ABLATION OF VENTRICULAR TACHYCARDIA?23RETROGRADE AORTIC ACCESS OF THE PULMONARY VENOUS ATRIUM PROVIDES EQUIVALENT OUTCOMES TO RIGHT ATRIAL OR TRANSEPTAL ACCESS OF THE LEFT ATRIUM IN PATIENTS WITH CONGENITAL HEART DISEASE24COMPUTATIONAL THREE-DIMENSION LEFT ATRIAL APPENDAGE WALL THICKNESS MAPS AND HISTOLOGICAL ANALYSIS TO GUIDE LEFT ATRIAL APPENDAGE ELECTRICAL ISOLATIONPacing & Devices25IDENTIFYING THE OPTIMAL LOCATION FOR LV ENDOCARIDAL PACING:RESULTS FROM A MULTICENTRE INTERNATIONAL REGISTRY OF LV ENDOCARDIAL PACING26UK MULTI-CENTRE REGISTRY OF TRANSVENOUS LEAD EXTRACTION: CLINICAL OUTCOME USING TRACTION, CUTTING SHEATHS AND LASER TECHNIQUES27SKIN FISTULA FORMATION - A NEW EXPERIENCE WITH THE NEW TYRX ABSORBABLE ANTIMICROVIAL ENVELOPE28BIFOCAL RIGHT VENTRICULAR PACING IN PATIENTS WITH FAILED CORONARY-SINUS LEAD IMPLANTS: LONG-TERM RESULTS FROM MULTICENTRE REGISTRY29REAL TIME X-MRI GUIDED LEFT VENTRICULAR LEAD IMPLANTATION FOR TARGETED DELIVERY OF CARDIAC RESYNCHRONIZATION THERAPY30ACUTE AND CHRONIC PERFORMANCE OF COMMUNICATING LEADLESS ANTI-TACHYCARDIA PACEMAKER AND SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR. Europace 2016. [DOI: 10.1093/europace/euw271] [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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Ewington I, Nicol E, Adam M, Cox AT, Green AD. Transferring patients with Ebola by land and air: the British military experience. J ROY ARMY MED CORPS 2016; 162:217-21. [PMID: 27177575 DOI: 10.1136/jramc-2016-000623] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 03/30/2016] [Indexed: 11/03/2022]
Abstract
The Ebola epidemic of 2014/2015 led to a multinational response to control the disease outbreak. Assurance for British aid workers included provision of a robust treatment pathway including repatriation back to the UK. This pathway involved the use of both land and air assets to ensure that patients were transferred quickly, and safely, to a high-level isolation unit in the UK. Following a road move in Sierra Leone, an air transportable isolator (ATI) was used to transport patients for the flight and onward transfer to the Royal Free Hospital. There are several unique factors related to managing a patient with Ebola virus disease during prolonged evacuation, including the provision of care inside an ATI. These points are considered here along with an outline of the evacuation pathway.
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Affiliation(s)
- Ian Ewington
- Royal Centre for Defence Medicine, Birmingham, UK Department of Anaesthesia and Intensive Care Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - E Nicol
- Centre of Aviation Medicine, RAF Henlow, Bedfordshire, UK
| | - M Adam
- Royal Centre for Defence Medicine, Birmingham, UK Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
| | - A T Cox
- Royal Centre for Defence Medicine, Birmingham, UK St George's University of London, Cranmer Terrace, London, UK
| | - A D Green
- Royal Centre for Defence Medicine, Birmingham, UK
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Klymenko A, Colombani O, Nicol E, Chassenieux C, Nicolai T. Effect of Self-Assembly on Phase Separation of Di- and Triblock Copolymers Mixed with Homopolymers in Aqueous Solution. Macromolecules 2016. [DOI: 10.1021/acs.macromol.6b00583] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A. Klymenko
- LUNAM Université,
Université du Maine, IMMM − UMR CNRS 6283, Université du Maine, av. O. Messiaen, 72085 Le Mans, cedex 9, France
| | - O. Colombani
- LUNAM Université,
Université du Maine, IMMM − UMR CNRS 6283, Université du Maine, av. O. Messiaen, 72085 Le Mans, cedex 9, France
| | - E. Nicol
- LUNAM Université,
Université du Maine, IMMM − UMR CNRS 6283, Université du Maine, av. O. Messiaen, 72085 Le Mans, cedex 9, France
| | - C. Chassenieux
- LUNAM Université,
Université du Maine, IMMM − UMR CNRS 6283, Université du Maine, av. O. Messiaen, 72085 Le Mans, cedex 9, France
| | - T. Nicolai
- LUNAM Université,
Université du Maine, IMMM − UMR CNRS 6283, Université du Maine, av. O. Messiaen, 72085 Le Mans, cedex 9, France
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Klymenko A, Nicol E, Nicolai T, Colombani O. Effect of Self-Assembly on Probe Diffusion in Solutions and Networks of pH-Sensitive Triblock Copolymers. Macromolecules 2015. [DOI: 10.1021/acs.macromol.5b01324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A. Klymenko
- LUNAM Université,
Université du Maine, IMMM−UMR CNRS 6283, Université du Maine, av. O. Messiaen, 72085 Le Mans, cedex 9, France
| | - E. Nicol
- LUNAM Université,
Université du Maine, IMMM−UMR CNRS 6283, Université du Maine, av. O. Messiaen, 72085 Le Mans, cedex 9, France
| | - T. Nicolai
- LUNAM Université,
Université du Maine, IMMM−UMR CNRS 6283, Université du Maine, av. O. Messiaen, 72085 Le Mans, cedex 9, France
| | - O. Colombani
- LUNAM Université,
Université du Maine, IMMM−UMR CNRS 6283, Université du Maine, av. O. Messiaen, 72085 Le Mans, cedex 9, France
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Evans B, Cox A, Nicol E, Patil Mead M, Behr E. Drug-associated arrhythmia in the military patient. J ROY ARMY MED CORPS 2015; 161:253-8. [DOI: 10.1136/jramc-2015-000492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2015] [Indexed: 02/02/2023]
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Evans T, Holdsworth DA, Jackson S, Nicol E. Managing palpitations in the military patient. J ROY ARMY MED CORPS 2015; 161:192-9. [PMID: 26243805 DOI: 10.1136/jramc-2015-000507] [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: 06/28/2015] [Accepted: 06/29/2015] [Indexed: 11/04/2022]
Abstract
'Palpitations' include a broad range of symptoms relating to the perception of abnormal activity of the heart. They may reflect an underlying arrhythmia or a hyperawareness of normal cardiac activity caused by stress or anxiety. The challenge to a clinician assessing patients with palpitations is to assess the likely cause of symptoms, to stratify the individual patient risk and to choose the correct management strategy delivered with appropriate urgency. The young military population, subject to increased exposure to environmental stress, is at an increased risk of palpitations. Due to the distracting nature of this symptom and the frequently sudden and unheralded onset, a common consequence is medical downgrading. This article will provide a guide to assessing the heterogeneous group presenting with palpitations and how to both establish the cause and identify the correct treatment for each patient in a timely manner.
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Affiliation(s)
- Thomas Evans
- Medical Centre, British Army, Forres, Morayshire, UK Royal Centre for Defence Medicine, Defence Medical Services, Lichfield, UK
| | - D A Holdsworth
- Department of Physiology Anatomy and Genetics, Oxford University, Oxford, UK
| | | | - E Nicol
- Department of Cardiovascular CT, Royal Brompton Hospital, London, UK Royal Centre for Defence Medicine, Defence Medical Services, Lichfield, UK
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King M, Nicol E, Magee L. 94: Prospective audit of smoking cessation and lung cancer nurse specialist intervention within the Papworth Thoracic Oncology Service. Lung Cancer 2015. [DOI: 10.1016/s0169-5002(15)50092-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Klymenko A, Nicolai T, Benyahia L, Chassenieux C, Colombani O, Nicol E. Multiresponsive Hydrogels Formed by Interpenetrated Self-Assembled Polymer Networks. Macromolecules 2014. [DOI: 10.1021/ma501990r] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- A. Klymenko
- LUNAM Université,
Université du Maine, IMMM – UMR CNRS 6283, Université du Maine, 72085 Le Mans cedex 9, France
| | - T. Nicolai
- LUNAM Université,
Université du Maine, IMMM – UMR CNRS 6283, Université du Maine, 72085 Le Mans cedex 9, France
| | - L. Benyahia
- LUNAM Université,
Université du Maine, IMMM – UMR CNRS 6283, Université du Maine, 72085 Le Mans cedex 9, France
| | - C. Chassenieux
- LUNAM Université,
Université du Maine, IMMM – UMR CNRS 6283, Université du Maine, 72085 Le Mans cedex 9, France
| | - O. Colombani
- LUNAM Université,
Université du Maine, IMMM – UMR CNRS 6283, Université du Maine, 72085 Le Mans cedex 9, France
| | - E. Nicol
- LUNAM Université,
Université du Maine, IMMM – UMR CNRS 6283, Université du Maine, 72085 Le Mans cedex 9, France
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Vieira M, Lazoura O, Nicol E, Rubens M, Padley S. MRI in patients with cardiovascular implantable electronic devices. Clin Radiol 2013; 68:928-34. [DOI: 10.1016/j.crad.2013.04.003] [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] [Received: 09/15/2012] [Revised: 02/20/2013] [Accepted: 04/10/2013] [Indexed: 10/26/2022]
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Pavitt CW, Lindsay AC, Zielke S, Ray R, Harron K, Padley S, Rubens M, Nicol E. A novel method of coronary artery calcium quantification on CT coronary angiography. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p2928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Snow T, Zielke SW, Brinkert M, Lindsay AC, Davies SW, Di Mario C, Rubens M, Padley S, Moat NE, Nicol E. Non rate-controlled CT coronary angiography for the exclusion of obstructive coronary artery disease in the assessment of patients referred for transcatheter aortic valve implantation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pavitt CW, Zielke S, Ray R, Lindsay AC, Padley S, Rubens M, Nicol E. Deriving Coronary Artery Calcium Scores (CACS) from CT-Coronary Angiography (CTCA): a potential change to UK NICE guidelines. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p2937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
We present a series of patients with profound metabolic acidosis admitted to the Role 3 Medical Treatment Facility, Camp Bastion, Afghanistan, in 2012. A police service breath alcohol analyser, calculation of the osmolar gap and urine microscopy assisted in diagnosing methanol poisoning. The challenge of diagnosing and managing toxic alcohol poisoning in this resource-limited setting is discussed. We believe this is the first description of using a breath alcohol analyser to assist a diagnosis of methanol poisoning.
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Affiliation(s)
- Ed Barnard
- Emergency Department, Derriford Hospital, Plymouth, Devon, UK
| | - S Baladurai
- Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - T Badh
- Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK
| | - E Nicol
- Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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Patterson C, Ahmed N, Nicol E, Bryan L, Bell D. 139 Clinical outcomes of patients excluded from cardiac investigation in the NICE guidelines for chest pain of recent onset. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.139] [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: 11/03/2022]
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Patterson C, Nicol E, Bryan L, Woodcock T, Collinson J, Padley S, Bell D. RE: Letter to the Editor regarding 'The effect of applying NICE guidelines for the investigation of stable chest pain on out-patient cardiac services in the UK'. QJM 2012; 105:211-2. [PMID: 22179103 DOI: 10.1093/qjmed/hcr264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Patterson C, Nicol E, Bryan L, Woodcock T, Collinson J, Padley S, Bell D. The effect of applying NICE guidelines for the investigation of stable chest pain on out-patient cardiac services in the UK. QJM 2011; 104:581-8. [PMID: 21317133 DOI: 10.1093/qjmed/hcr011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The National Institute for Health and Clinical Excellence (NICE) recently released guidelines for the investigation of chest pain of recent onset. There is no published data regarding their impact on out-patient cardiac services. AIM This study was undertaken to assess the likelihood of coronary artery disease (CAD) in Rapid Access Chest Pain Clinic (RACPC) patients and the resultant investigation burden if NICE guidance was applied. METHODS Five hundred and ninety-five consecutive patients attending two RACPCs over 6 months preceding release of the NICE guidelines [51% male; median age 55 (range 22-94) years] were risk stratified using NICE criteria and the resultant investigations evaluated. RESULTS One hundred and six (18%) patients had a likelihood of CAD <10%, 123 (21%) between 10% and 29%, 175 (29%) between 30% and 60%, 141 (24%) between 61% and 90% and 50 (8%) >90%. NICE would have recommended 443 (74%) patients for no cardiac investigation, 10 (2%) for cardiac computed tomography (CCT), 69 (12%) for functional cardiac testing and 73 (12%) for invasive angiography. Relative to existing practice, there would have been a trend towards reduced functional cardiac testing (-24%, P = 0.06), no significant change in CCT (43%, P = 0.436) and a significant increase in invasive angiography (508%, P < 0.001). The cost of investigations recommended by NICE would have been £15,881 greater than existing practice. CONCLUSION This study suggests patients attending RACPC will have a greater likelihood of CAD than predicted by NICE. Differences between recommended investigations and existing practice will guide investment in cardiac services. Individual hospitals should assess their RACPC cohorts prior to implementing the NICE guidelines.
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Affiliation(s)
- C Patterson
- Department of Medicine and Therapeutics, Imperial College, London, UK.
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Patterson C, Bryan L, Nicol E, Duncan M, Bell D, Padley S. The consequences of applying NICE chest pain guidelines to an acute medical population: a role for cardiac computed tomography. QJM 2010; 103:959-63. [PMID: 20736181 DOI: 10.1093/qjmed/hcq146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cardiac computed tomography (CCT) is a well-validated investigation for the non-invasive assessment of coronary artery disease (CAD). The National Institute for Clinical Excellence (NICE) have recently released guidelines incorporating CCT into the diagnostic algorithm for chest pain of recent onset. AIM To assess the frequency of eligibility for CCT in medical admissions with suspected cardiac chest pain using criteria defined by NICE. DESIGN A retrospective, observational study, set in a teaching hospital acute medical unit. METHODS A total of 198 consecutive patients admitted over a 4-month period with suspected cardiac chest pain (57% male; mean age 63.5 years) were assessed for eligibility for CCT based on NICE guideline criteria. RESULTS Of the 198 patients admitted, 65 (33%) patients were excluded by a raised troponin I or ischaemic ECG changes; 100 (51%) patients were excluded by pain categorized as non-anginal and 171 (86%) patients were excluded by a modified Diamond Forrester score outside the range 10-29%. Applying NICE criteria to this population ultimately resulted in 2 (1%) patients recommended for CCT, 12 (6%) for functional cardiac testing and 17 (9%) for invasive angiography. CONCLUSION Applying current NICE guidelines for chest pain of recent onset to medical admissions results in a lesser uptake of CCT than functional testing and invasive angiography. If the NICE guidelines are revised to include patients with an intermediate pre-test probability of CAD, CCT may have a greater role.
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Affiliation(s)
- C Patterson
- Department of Medicine and Therapeutics, Chelsea and Westminster Hospital, London SW10 9NH, UK.
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Abstract
The joint forces and moments are commonly used in gait analysis. They can be computed by four different 3D inverse dynamic methods proposed in the literature, either based on vectors and Euler angles, wrenches and quaternions, homogeneous matrices, or generalized coordinates and forces. In order to analyze the influence of the inverse dynamic method, the joint forces and moments were computed during gait on nine healthy subjects. A ratio was computed between the relative dispersions (due to the method) and the absolute amplitudes of the gait curves. The influence of the inverse dynamic method was negligible at the ankle (2%) but major at the knee and the hip joints (40%). This influence seems to be due to the dynamic computation rather than the kinematic computation. Compared to the influence of the joint center location, the body segment inertial parameter estimation, and more, the influence of the inverse dynamic method is at least of equivalent importance. This point should be confirmed with other subjects, possibly pathologic, and other movements.
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Affiliation(s)
- R Dumas
- Univerité de Lyon, Laboratoire de Biomécanique et Mécanique des Chocs, UMR_T 9406-Universite Lyon 1 /INRETS, Bât. Oméga, Bd du 11 Novembre 1918, Villeurbanne, F-69622, France.
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Abstract
This article summarises the presentations at the Sports Medicine and Rehabilitation Study Day held by the Haywood Club at The Medical Society of London on 21 September 2006. The event was attended by over 100 serving and retired DMS personnel and included talks on a diverse range of subjects from the newly established speciality of Sports and Exercise medicine, the role of physiotherapy, exercise therapy and podiatry, core stability, tendon disorders, anterior knee pain, and the management of chronic pain.
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Lamb L, Nicol E. New and Emerging Concepts in Travel Medicine. J ROY ARMY MED CORPS 2007; 153:40-3. [PMID: 17575876 DOI: 10.1136/jramc-153-01-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The following article summarises the proceedings of the Travel Medicine Study Day run by the Haywood Club Tri-Service Medical Society at the Medical Society of London on 23 November 2006. The event was attended by over 50 serving and retired DMS personnel, including nurses, MSO's and medical officers and included talks on the historical contribution of the military medical services to the evolution of tropical medicine, the changing face of worldwide illness and insights into the behaviour of travellers that may increase their risk of illness.
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Affiliation(s)
- L Lamb
- Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH
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Ansari SA, Lassig JP, Nicol E, Thompson BG, Gemmete JJ, Gandhi D. Transarterial embolization of a cervical dural arteriovenous fistula. Presenting with subarachnoid hemorrhage. Interv Neuroradiol 2006; 12:313-8. [PMID: 20569588 DOI: 10.1177/159101990601200404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Accepted: 11/15/2006] [Indexed: 11/17/2022] Open
Abstract
SUMMARY We describe a case of a 75-year-old man who presented with acute onset of headache and subarachnoid hemorrhage and initial cerebral angiography was deemed "negative". In retrospect, a faint contrast collection was present adjacent to the right vertebral artery at the C1 level suspicious for a small dural arteriovenous fistula (dAVF). Follow-up angiography with selective microcatheter injections of the right vertebral artery and C1 radicular artery confirmed a complex dAVF with characteristically specific venous drainage patterns associated with a subarachnoid hemorrhage presentation. Subsequently, the cervical dAVF was treated with superselective glue embolization resulting in complete occlusion. Cervical dAVFs are extremely rare vascular causes of subarachnoid hemorrhage. Both diagnostic angiography and endovascular treatment of these lesions can be challenging, especially in an emergent setting, requiring selective evaluation of bilateral vertebral arteries and careful attention to their cervical segments. Although only a single prior case of a cervical dAVF presenting with subarachnoid hemorrhage has been successfully treated with embolization, modern selective transarterial techniques may allow easier detection and treatment of subtle pathologic arteriovenous connections.
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Affiliation(s)
- S A Ansari
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, U.S.A. -
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Price S, Nicol E, Gibson DG, Evans TW. Echocardiography in the critically ill: current and potential roles. Intensive Care Med 2005; 32:48-59. [PMID: 16292626 DOI: 10.1007/s00134-005-2834-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Accepted: 09/22/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The use of echocardiography in the critically ill presents specific challenges. However, information of direct relevance to clinical management can be obtained relating to abnormalities of structure and function and can be used to estimate pulmonary arterial and venous pressures. DISCUSSION Investigation of the consequences of myocardial ischaemia, valvular dysfunction and pericardial disease can be facilitated, and changes characteristic of specific conditions (e.g. sepsis, pulmonary thromboembolism) detected. Echocardiography can also be used to monitor the effects of therapeutic interventions. CONCLUSIONS The applications of echocardiography in the critical care setting (excluding standard peri-operative echocardiography for cardiac surgery) are reviewed, with particular emphasis on the assessment of cardiac physiology.
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Affiliation(s)
- S Price
- Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
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Dumas R, Nicol E, Chèze L. Comparison of four 3D inverse dynamic methods for gait analysis. Comput Methods Biomech Biomed Engin 2005. [DOI: 10.1080/10255840512331388407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gestoso P, Nicol E, Doxastakis M, Theodorou DN. Atomistic Monte Carlo Simulation of Polybutadiene Isomers: cis-1,4-Polybutadiene and 1,2-Polybutadiene. Macromolecules 2003. [DOI: 10.1021/ma034033l] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- P. Gestoso
- Institute of Chemical Engineering and Temperature Chemical Processes, P.O. Box 1414, 26500 Patras, Greece, and School of Chemical Engineering, Department of Materials Science and Engineering, National Technical University of Athens, 9 Heroon Polytechniou Street, Zografou Campus, 15780 Athens, Greece
| | - E. Nicol
- Institute of Chemical Engineering and Temperature Chemical Processes, P.O. Box 1414, 26500 Patras, Greece, and School of Chemical Engineering, Department of Materials Science and Engineering, National Technical University of Athens, 9 Heroon Polytechniou Street, Zografou Campus, 15780 Athens, Greece
| | - M. Doxastakis
- Institute of Chemical Engineering and Temperature Chemical Processes, P.O. Box 1414, 26500 Patras, Greece, and School of Chemical Engineering, Department of Materials Science and Engineering, National Technical University of Athens, 9 Heroon Polytechniou Street, Zografou Campus, 15780 Athens, Greece
| | - D. N. Theodorou
- Institute of Chemical Engineering and Temperature Chemical Processes, P.O. Box 1414, 26500 Patras, Greece, and School of Chemical Engineering, Department of Materials Science and Engineering, National Technical University of Athens, 9 Heroon Polytechniou Street, Zografou Campus, 15780 Athens, Greece
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Shandas R, Weinberg C, Ivy DD, Nicol E, DeGroff CG, Hertzberg J, Valdes-Cruz L. Development of a noninvasive ultrasound color M-mode means of estimating pulmonary vascular resistance in pediatric pulmonary hypertension: mathematical analysis, in vitro validation, and preliminary clinical studies. Circulation 2001; 104:908-13. [PMID: 11514378 DOI: 10.1161/hc3301.094926] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Accurate determination of pulmonary vascular resistance (PVR) is an important component in the evaluation and treatment of pediatric patients with pulmonary hypertension. We developed a novel technique, based on the concept of flow propagation, to estimate PVR noninvasively. The hypothesis is that changes in PVR cause changes in the velocity propagation (Vel(prop)) within the main pulmonary artery and that Vel(prop) can be quantified using color M-mode imaging. METHODS AND RESULTS We tested the hypothesis using mathematical modeling, in vitro experiments, and preliminary clinical studies. The mathematical model showed that pressure and velocity tracings are closely correlated in time and that 6 to 18 ms time resolution was needed to resolve propagation times within typical main pulmonary artery lengths (2 to 5 cm). The in vitro experiments demonstrated that it was feasible to use color M-mode to measure Vel(prop) and that Vel(prop) correlated well with downstream resistance [y=(-1.01x)+22.77; R=0.96]. The method was then evaluated on patients undergoing acute pulmonary reactivity testing (n=22 measurements). Good correlation between Vel(prop) and PVR was found [y=(-1.71x)+26.0; R=0.90; SEE=2.41]. CONCLUSION This newly developed method promises to be useful in the noninvasive evaluation of adults and children with pulmonary hypertension.
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Affiliation(s)
- R Shandas
- Children's Hospital/University of Colorado Health Sciences Center, Denver, CO 80219, USA.
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Nicol E, Bonnans-Plaisance C, Levesque G. A New Initiator System for the Living Thiiranes Ring-Opening Polymerization: A Way toward Star-Shaped Polythiiranes. Macromolecules 1999. [DOI: 10.1021/ma9900434] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E. Nicol
- Laboratoire de Chimie et Physique des Matériaux Polymères, CNRS (UMR 6515), Université du Maine, F-72085 Le Mans Cedex 9, France, and Laboratoire Polymères et Procédés, Université de Bretagne-Sud, F-56325 Lorient, France
| | - C. Bonnans-Plaisance
- Laboratoire de Chimie et Physique des Matériaux Polymères, CNRS (UMR 6515), Université du Maine, F-72085 Le Mans Cedex 9, France, and Laboratoire Polymères et Procédés, Université de Bretagne-Sud, F-56325 Lorient, France
| | - G. Levesque
- Laboratoire de Chimie et Physique des Matériaux Polymères, CNRS (UMR 6515), Université du Maine, F-72085 Le Mans Cedex 9, France, and Laboratoire Polymères et Procédés, Université de Bretagne-Sud, F-56325 Lorient, France
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