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Souza R, Winder A, Stanley EAM, Vigneshwaran V, Camacho M, Camicioli R, Monchi O, Wilms M, Forkert ND. Identifying Biases in a Multicenter MRI Database for Parkinson's Disease Classification: Is the Disease Classifier a Secret Site Classifier? IEEE J Biomed Health Inform 2024; 28:2047-2054. [PMID: 38198251 DOI: 10.1109/jbhi.2024.3352513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Sharing multicenter imaging datasets can be advantageous to increase data diversity and size but may lead to spurious correlations between site-related biological and non-biological image features and target labels, which machine learning (ML) models may exploit as shortcuts. To date, studies analyzing how and if deep learning models may use such effects as a shortcut are scarce. Thus, the aim of this work was to investigate if site-related effects are encoded in the feature space of an established deep learning model designed for Parkinson's disease (PD) classification based on T1-weighted MRI datasets. Therefore, all layers of the PD classifier were frozen, except for the last layer of the network, which was replaced by a linear layer that was exclusively re-trained to predict three potential bias types (biological sex, scanner type, and originating site). Our findings based on a large database consisting of 1880 MRI scans collected across 41 centers show that the feature space of the established PD model (74% accuracy) can be used to classify sex (75% accuracy), scanner type (79% accuracy), and site location (71% accuracy) with high accuracies despite this information never being explicitly provided to the PD model during original training. Overall, the results of this study suggest that trained image-based classifiers may use unwanted shortcuts that are not meaningful for the actual clinical task at hand. This finding may explain why many image-based deep learning models do not perform well when applied to data from centers not contributing to the training set.
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Camacho M, Wilms M, Almgren H, Amador K, Camicioli R, Ismail Z, Monchi O, Forkert ND. Exploiting macro- and micro-structural brain changes for improved Parkinson's disease classification from MRI data. NPJ Parkinsons Dis 2024; 10:43. [PMID: 38409244 PMCID: PMC10897162 DOI: 10.1038/s41531-024-00647-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/22/2024] [Indexed: 02/28/2024] Open
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disease. Accurate PD diagnosis is crucial for effective treatment and prognosis but can be challenging, especially at early disease stages. This study aimed to develop and evaluate an explainable deep learning model for PD classification from multimodal neuroimaging data. The model was trained using one of the largest collections of T1-weighted and diffusion-tensor magnetic resonance imaging (MRI) datasets. A total of 1264 datasets from eight different studies were collected, including 611 PD patients and 653 healthy controls (HC). These datasets were pre-processed and non-linearly registered to the MNI PD25 atlas. Six imaging maps describing the macro- and micro-structural integrity of brain tissues complemented with age and sex parameters were used to train a convolutional neural network (CNN) to classify PD/HC subjects. Explainability of the model's decision-making was achieved using SmoothGrad saliency maps, highlighting important brain regions. The CNN was trained using a 75%/10%/15% train/validation/test split stratified by diagnosis, sex, age, and study, achieving a ROC-AUC of 0.89, accuracy of 80.8%, specificity of 82.4%, and sensitivity of 79.1% on the test set. Saliency maps revealed that diffusion tensor imaging data, especially fractional anisotropy, was more important for the classification than T1-weighted data, highlighting subcortical regions such as the brainstem, thalamus, amygdala, hippocampus, and cortical areas. The proposed model, trained on a large multimodal MRI database, can classify PD patients and HC subjects with high accuracy and clinically reasonable explanations, suggesting that micro-structural brain changes play an essential role in the disease course.
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Affiliation(s)
- Milton Camacho
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada.
- Department of Radiology, University of Calgary, Calgary, AB, Canada.
| | - Matthias Wilms
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics and Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Hannes Almgren
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Kimberly Amador
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Richard Camicioli
- Neuroscience and Mental Health Institute and Department of Medicine (Neurology), University of Alberta, Edmonton, AB, Canada
| | - Zahinoor Ismail
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Oury Monchi
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Radio-oncology and Nuclear Medicine, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | - Nils D Forkert
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics and Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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Souza R, Stanley EAM, Camacho M, Camicioli R, Monchi O, Ismail Z, Wilms M, Forkert ND. A multi-center distributed learning approach for Parkinson's disease classification using the traveling model paradigm. Front Artif Intell 2024; 7:1301997. [PMID: 38384277 PMCID: PMC10879577 DOI: 10.3389/frai.2024.1301997] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/23/2024] [Indexed: 02/23/2024] Open
Abstract
Distributed learning is a promising alternative to central learning for machine learning (ML) model training, overcoming data-sharing problems in healthcare. Previous studies exploring federated learning (FL) or the traveling model (TM) setup for medical image-based disease classification often relied on large databases with a limited number of centers or simulated artificial centers, raising doubts about real-world applicability. This study develops and evaluates a convolution neural network (CNN) for Parkinson's disease classification using data acquired by 83 diverse real centers around the world, mostly contributing small training samples. Our approach specifically makes use of the TM setup, which has proven effective in scenarios with limited data availability but has never been used for image-based disease classification. Our findings reveal that TM is effective for training CNN models, even in complex real-world scenarios with variable data distributions. After sufficient training cycles, the TM-trained CNN matches or slightly surpasses the performance of the centrally trained counterpart (AUROC of 83% vs. 80%). Our study highlights, for the first time, the effectiveness of TM in 3D medical image classification, especially in scenarios with limited training samples and heterogeneous distributed data. These insights are relevant for situations where ML models are supposed to be trained using data from small or remote medical centers, and rare diseases with sparse cases. The simplicity of this approach enables a broad application to many deep learning tasks, enhancing its clinical utility across various contexts and medical facilities.
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Affiliation(s)
- Raissa Souza
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Emma A. M. Stanley
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Milton Camacho
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Richard Camicioli
- Department of Medicine (Neurology), Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Oury Monchi
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Radio-oncology and Nuclear Medicine, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Matthias Wilms
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Nils D. Forkert
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Souza R, Wilms M, Camacho M, Pike GB, Camicioli R, Monchi O, Forkert ND. Image-encoded biological and non-biological variables may be used as shortcuts in deep learning models trained on multisite neuroimaging data. J Am Med Inform Assoc 2023; 30:1925-1933. [PMID: 37669158 PMCID: PMC10654841 DOI: 10.1093/jamia/ocad171] [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: 04/11/2023] [Revised: 08/07/2023] [Accepted: 08/15/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVE This work investigates if deep learning (DL) models can classify originating site locations directly from magnetic resonance imaging (MRI) scans with and without correction for intensity differences. MATERIAL AND METHODS A large database of 1880 T1-weighted MRI scans collected across 41 sites originally for Parkinson's disease (PD) classification was used to classify sites in this study. Forty-six percent of the datasets are from PD patients, while 54% are from healthy participants. After preprocessing the T1-weighted scans, 2 additional data types were generated: intensity-harmonized T1-weighted scans and log-Jacobian deformation maps resulting from nonlinear atlas registration. Corresponding DL models were trained to classify sites for each data type. Additionally, logistic regression models were used to investigate the contribution of biological (age, sex, disease status) and non-biological (scanner type) variables to the models' decision. RESULTS A comparison of the 3 different types of data revealed that DL models trained using T1-weighted and intensity-harmonized T1-weighted scans can classify sites with an accuracy of 85%, while the model using log-Jacobian deformation maps achieved a site classification accuracy of 54%. Disease status and scanner type were found to be significant confounders. DISCUSSION Our results demonstrate that MRI scans encode relevant site-specific information that models could use as shortcuts that cannot be removed using simple intensity harmonization methods. CONCLUSION The ability of DL models to exploit site-specific biases as shortcuts raises concerns about their reliability, generalization, and deployability in clinical settings.
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Affiliation(s)
- Raissa Souza
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Matthias Wilms
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Milton Camacho
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - G Bruce Pike
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Richard Camicioli
- Department of Medicine (Neurology), Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Oury Monchi
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montréal, QC H3C 3J7, Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC H3W 1W4, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Nils D Forkert
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
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Holbrook J, Patel B, Camacho M, Kahanawita L, Greenland J, Williams-Gray CH. Natural killer cells have an activated profile in early Parkinson's disease. J Neuroimmunol 2023; 382:578154. [PMID: 37549558 DOI: 10.1016/j.jneuroim.2023.578154] [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: 04/19/2023] [Revised: 07/04/2023] [Accepted: 07/23/2023] [Indexed: 08/09/2023]
Abstract
Immune dysregulation is heavily implicated in Parkinson's disease (PD) but the role of Natural Killer (NK) cells has not been well characterised. Accumulating evidence indicates the immune response peaks early in the disease, hence this study focused on characterising NK cells in recently diagnosed PD. PBMCs were obtained from PD cases (< 2 years duration) and age-matched controls and immunophenotyped using flow cytometry. We found an increased proportion and number of NK cells (CD3-CD56+), mature cytotoxic NK cells (CD3-CD16 + CD56dim), and NK cells expressing the activation marker, NKG2D. This implies NK cells are activated in the earliest stages of PD.
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Affiliation(s)
- J Holbrook
- John Van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0PY, UK.
| | - B Patel
- John Van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0PY, UK
| | - M Camacho
- John Van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0PY, UK
| | - L Kahanawita
- John Van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0PY, UK
| | - J Greenland
- John Van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0PY, UK
| | - C H Williams-Gray
- John Van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0PY, UK
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Almgren H, Camacho M, Hanganu A, Kibreab M, Camicioli R, Ismail Z, Forkert ND, Monchi O. Machine learning-based prediction of longitudinal cognitive decline in early Parkinson's disease using multimodal features. Sci Rep 2023; 13:13193. [PMID: 37580407 PMCID: PMC10425414 DOI: 10.1038/s41598-023-37644-6] [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: 11/03/2022] [Accepted: 06/25/2023] [Indexed: 08/16/2023] Open
Abstract
Patients with Parkinson's Disease (PD) often suffer from cognitive decline. Accurate prediction of cognitive decline is essential for early treatment of at-risk patients. The aim of this study was to develop and evaluate a multimodal machine learning model for the prediction of continuous cognitive decline in patients with early PD. We included 213 PD patients from the Parkinson's Progression Markers Initiative (PPMI) database. Machine learning was used to predict change in Montreal Cognitive Assessment (MoCA) score using the difference between baseline and 4-years follow-up data as outcome. Input features were categorized into four sets: clinical test scores, cerebrospinal fluid (CSF) biomarkers, brain volumes, and genetic variants. All combinations of input feature sets were added to a basic model, which consisted of demographics and baseline cognition. An iterative scheme using RReliefF-based feature ranking and support vector regression in combination with tenfold cross validation was used to determine the optimal number of predictive features and to evaluate model performance for each combination of input feature sets. Our best performing model consisted of a combination of the basic model, clinical test scores and CSF-based biomarkers. This model had 12 features, which included baseline cognition, CSF phosphorylated tau, CSF total tau, CSF amyloid-beta1-42, geriatric depression scale (GDS) scores, and anxiety scores. Interestingly, many of the predictive features in our model have previously been associated with Alzheimer's disease, showing the importance of assessing Alzheimer's disease pathology in patients with Parkinson's disease.
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Affiliation(s)
- Hannes Almgren
- Department of Clinical Neurosciences, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
| | - Milton Camacho
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Department of Radiology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Alexandru Hanganu
- Département de Psychologie, Université de Montréal, Pavillon Marie-Victorin, 90 Vincent d'Indy Ave, Montreal, QC, H2V 2S9, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, 4565 chemin Queen Mary, Montreal, QC, H3W 1W5, Canada
| | - Mekale Kibreab
- Department of Clinical Neurosciences, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Richard Camicioli
- Division of Neurology, Department of Medicine, and Neuroscience and Mental Health Institute, University of Alberta, 7-112 Clinical Sciences Building 11350 83rd Avenue, Edmonton, AB, T6G 2G3, Canada
| | - Zahinoor Ismail
- Department of Clinical Neurosciences, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Department of Psychiatry, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Nils D Forkert
- Department of Clinical Neurosciences, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Department of Radiology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
- Alberta Children's Hospital Research Institute, Heritage Medical Research Building, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada
| | - Oury Monchi
- Department of Clinical Neurosciences, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, 4565 chemin Queen Mary, Montreal, QC, H3W 1W5, Canada
- Department of Radiology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
- Département de radiologie, radio-oncologie et médecine nucléaire, Faculté de médecine, Université de Montréal, Pavillon Roger-Gaudry, 2900 Boulevard. Édouard-Montpetit, Montreal, QC, H3T 1A4, Canada
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Camacho M, Wilms M, Mouches P, Almgren H, Souza R, Camicioli R, Ismail Z, Monchi O, Forkert ND. Explainable classification of Parkinson's disease using deep learning trained on a large multi-center database of T1-weighted MRI datasets. Neuroimage Clin 2023; 38:103405. [PMID: 37079936 PMCID: PMC10148079 DOI: 10.1016/j.nicl.2023.103405] [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: 08/31/2022] [Revised: 02/13/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
INTRODUCTION Parkinson's disease (PD) is a severe neurodegenerative disease that affects millions of people. Early diagnosis is important to facilitate prompt interventions to slow down disease progression. However, accurate PD diagnosis can be challenging, especially in the early disease stages. The aim of this work was to develop and evaluate a robust explainable deep learning model for PD classification trained from one of the largest collections of T1-weighted magnetic resonance imaging datasets. MATERIALS AND METHODS A total of 2,041 T1-weighted MRI datasets from 13 different studies were collected, including 1,024 datasets from PD patients and 1,017 datasets from age- and sex-matched healthy controls (HC). The datasets were skull stripped, resampled to isotropic resolution, bias field corrected, and non-linearly registered to the MNI PD25 atlas. The Jacobian maps derived from the deformation fields together with basic clinical parameters were used to train a state-of-the-art convolutional neural network (CNN) to classify PD and HC subjects. Saliency maps were generated to display the brain regions contributing the most to the classification task as a means of explainable artificial intelligence. RESULTS The CNN model was trained using an 85%/5%/10% train/validation/test split stratified by diagnosis, sex, and study. The model achieved an accuracy of 79.3%, precision of 80.2%, specificity of 81.3%, sensitivity of 77.7%, and AUC-ROC of 0.87 on the test set while performing similarly on an independent test set. Saliency maps computed for the test set data highlighted frontotemporal regions, the orbital-frontal cortex, and multiple deep gray matter structures as most important. CONCLUSION The developed CNN model, trained on a large heterogenous database, was able to differentiate PD patients from HC subjects with high accuracy with clinically feasible classification explanations. Future research should aim to investigate the combination of multiple imaging modalities with deep learning and on validating these results in a prospective trial as a clinical decision support system.
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Affiliation(s)
- Milton Camacho
- Biomedical Engineering Program, University of Calgary, Canada; Department of Radiology, University of Calgary, Canada.
| | - Matthias Wilms
- Department of Radiology, University of Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Canada
| | - Pauline Mouches
- Biomedical Engineering Program, University of Calgary, Canada; Department of Radiology, University of Calgary, Canada
| | - Hannes Almgren
- Department of Clinical Neurosciences, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Canada
| | - Raissa Souza
- Biomedical Engineering Program, University of Calgary, Canada; Department of Radiology, University of Calgary, Canada
| | - Richard Camicioli
- Neuroscience and Mental Health Institute and Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - Zahinoor Ismail
- Department of Clinical Neurosciences, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Canada; Department of Psychiatry, University of Calgary, Canada
| | - Oury Monchi
- Department of Clinical Neurosciences, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Canada; Department of Radiology, Radio-oncology and Nuclear Medicine, Université de Montréal, Quebec, Canada; Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Québec, Canada
| | - Nils D Forkert
- Department of Radiology, University of Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Canada; Department of Clinical Neurosciences, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Canada; Department of Electrical and Software Engineering, University of Calgary, Canada
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Almgren H, Hanganu A, Camacho M, Kibreab M, Camicioli R, Ismail Z, Forkert ND, Monchi O. Motor symptoms in Parkinson's disease are related to the interplay between cortical curvature and thickness. Neuroimage Clin 2023; 37:103300. [PMID: 36580712 PMCID: PMC9827056 DOI: 10.1016/j.nicl.2022.103300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/08/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Brain atrophy in Parkinson's disease occurs to varying degrees in different brain regions, even at the early stage of the disease. While cortical morphological features are often considered independently in structural brain imaging studies, research on the co-progression of different cortical morphological measurements could provide new insights regarding the progression of PD. This study's aim was to examine the interplay between cortical curvature and thickness as a function of PD diagnosis, motor symptoms, and cognitive performance. METHODS A total of 359 de novo PD patients and 159 healthy controls (HC) from the Parkinson's Progression Markers Initiative (PPMI) database were included in this study. Additionally, an independent cohort from four databases (182 PD, 132 HC) with longer disease durations was included to assess the effects of PD diagnosis in more advanced cases. Pearson correlation was used to determine subject-specific associations between cortical curvature and thickness estimated from T1-weighted MRI images. General linear modeling (GLM) was then used to assess the effect of PD diagnosis, motor symptoms, and cognitive performance on the curvature-thickness association. Next, longitudinal changes in the curvature-thickness correlation as well as the predictive effect of the cortical curvature-thickness association on changes in motor symptoms and cognitive performance across four years were investigated. Finally, Akaike information criterion (AIC) was used to build a GLM to model PD motor symptom severity cross-sectionally. RESULTS A significant interaction effect between PD motor symptoms and age on the curvature-thickness correlation was found (βstandardized = 0.11; t(350) = 2.12; p = 0.03). This interaction effect showed that motor symptoms in older patients were related to an attenuated curvature-thickness association. No significant effect of PD diagnosis was observed for the PPMI database (β = 0.03; t(510) = 0.35; p = 0.72). However, in patients with a longer disease duration, a significant effect of diagnosis on the curvature-thickness association was found (βstandardized = 0.31; t(306.7) = 3.49; p = 0.0006). Moreover, rigidity, but not tremor, in PD was significantly related to the curvature-thickness correlation (βstandardized = 0.11, t(350) = 2.24, p = 0.03; βstandardized = -0.03, t(350) = -0.58, p = 0.56, respectively). The curvature-thickness association was attenuated over time in both PD and HC, but the two groups did not show a significantly different effect (βstandardized = 0.03, t(184.7) = 0.78, p = 0.44). No predictive effects of the CC-CT correlation on longitudinal changes in cognitive performance or motor symptoms were observed (all p-values > 0.05). The best cross-sectional model for PD motor symptoms included the curvature-thickness correlation, cognitive performance, and putamen dopamine transporter (DAT) binding, which together explained 14 % of variance. CONCLUSION The association between cortical curvature and thickness is related to PD motor symptoms and age. This research shows the potential of modeling the curvature-thickness interplay in PD.
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Affiliation(s)
- Hannes Almgren
- Department of Clinical Neurosciences, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 1N4, Canada.
| | - Alexandru Hanganu
- Département de Psychologie, Université de Montréal, Pavillon Marie-Victorin, 90 Vincent d'Indy Ave, Montréal, QC H2V 2S9, Canada; Centre de recherche de l'Institut universitaire de gériatrie de Montréal, 4565 Chemin Queen Mary, Montréal, QC H3W 1W5, Canada
| | - Milton Camacho
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 1N4, Canada; Department of Radiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Mekale Kibreab
- Department of Clinical Neurosciences, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 1N4, Canada
| | - Richard Camicioli
- Division of Neurology, Department of Medicine, and Neuroscience and Mental Health Institute, University of Alberta, 7-112 Clinical Sciences Building 11350 83(rd) Avenue, Edmonton, Alberta, AB T6G 2G3, Canada
| | - Zahinoor Ismail
- Department of Clinical Neurosciences, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 1N4, Canada; Department of Psychiatry, University of Calgary, 3280 Hospital Dr NW, Calgary, AB T2N 4Z6, Canada
| | - Nils D Forkert
- Department of Clinical Neurosciences, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 1N4, Canada; Department of Radiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Heritage Medical Research Building, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1, Canada
| | - Oury Monchi
- Department of Clinical Neurosciences, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 1N4, Canada; Centre de recherche de l'Institut universitaire de gériatrie de Montréal, 4565 Chemin Queen Mary, Montréal, QC H3W 1W5, Canada; Department of Radiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; Département de radiologie, radio-oncologie et médecine nucléaire, Faculté de médecine, Université de Montréal, Pavillon Roger-Gaudry, 2900 boulevard, Édouard-Montpetit, Montréal, QC H3T 1A4, Canada.
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De la Cadena E, Camacho M, Vaca F, Enríquez S, Eleizalde MC, Arrivillaga-Henríquez J, Mendoza M, Navarro JC, Ramírez-Iglesias JR. Molecular identification of Trypanosoma theileri in cattle from the Ecuadorian Amazon. Vet Parasitol Reg Stud Reports 2023; 37:100824. [PMID: 36623904 DOI: 10.1016/j.vprsr.2022.100824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/20/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022]
Abstract
Trypanosoma theileri is a cosmopolitan opportunistic haemoparasite described in wild and domestic ruminants, and also in arthropod vectors. The presence of this parasite has been reported in several South American countries, including Amazonian regions. Despite the importance of livestock production, Ecuador possesses scarce studies about trypanosomosis and no T. theileri reports in its territory. Here, we showed molecular evidences of the presence of T. theileri in cattle from a province located in the Ecuadorian Amazon. Bovine blood samples were collected from 2014 to 2019, during campaigns to detect haemoparasites in the Ecuadorian provinces of Orellana and Sucumbíos. DNA was extracted from the buffy coat and used in PCR assays with three different molecular markers, ITS1, 18S and Cathepsin L-like. T. theileri was detected only in the Sucumbíos province, with a specific molecular prevalence of 8.6% (3/35) using the three primers and an additional animal detected as positive (11.4% prevalence) only by the ITS1 marker. DNA sequences derived from the generated amplicons were subjected to phylogenetics maximum parsimony and maximum likelihood analysis, which indicate the presence of TthI and TthII genotypes circulating in the evaluated animals. Molecular surveillance should be continually implemented in Ecuador in order to deepen the epidemiological and evolutionary knowledge about T. theileri as well other haemoparasites in the amazon parts of the country.
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Affiliation(s)
- E De la Cadena
- Research Group of Emerging and Neglected Diseases, Ecoepidemiology and Biodiversity, Health Science Faculty, Universidad Internacional SEK (UISEK), Quito 170120, Ecuador; Program of Master in Biomedicine, Health Sciences Faculty, Universidad Internacional SEK (UISEK), Quito 170120, Ecuador
| | - M Camacho
- Research Group of Emerging and Neglected Diseases, Ecoepidemiology and Biodiversity, Health Science Faculty, Universidad Internacional SEK (UISEK), Quito 170120, Ecuador; Program of Master in Biomedicine, Health Sciences Faculty, Universidad Internacional SEK (UISEK), Quito 170120, Ecuador
| | - F Vaca
- Unidad de Entomología Aplicada, Instituto de Investigaciones en Zoonosis (CIZ), Universidad Central del Ecuador, Quito, Ecuador
| | - S Enríquez
- Unidad de Entomología Aplicada, Instituto de Investigaciones en Zoonosis (CIZ), Universidad Central del Ecuador, Quito, Ecuador
| | - M C Eleizalde
- Centro de Estudios Biomédicos y Veterinarios (CEBIV), Instituto de Estudios Científicos y Tecnológicos (IDECYT), Universidad Nacional Experimental Simón Rodríguez (UNESR), Apartado Postal 47925, Caracas, Venezuela
| | - J Arrivillaga-Henríquez
- Unidad de Entomología Aplicada, Instituto de Investigaciones en Zoonosis (CIZ), Universidad Central del Ecuador, Quito, Ecuador; Línea de Salud Ambiental, Calidad y Biodiversidad, Área Ambiente y Territorio, THC-FACSO, Universidad Central del Ecuador, Quito, Ecuador
| | - M Mendoza
- Centro de Estudios Biomédicos y Veterinarios (CEBIV), Instituto de Estudios Científicos y Tecnológicos (IDECYT), Universidad Nacional Experimental Simón Rodríguez (UNESR), Apartado Postal 47925, Caracas, Venezuela
| | - J C Navarro
- Research Group of Emerging and Neglected Diseases, Ecoepidemiology and Biodiversity, Health Science Faculty, Universidad Internacional SEK (UISEK), Quito 170120, Ecuador; Program of Master in Biomedicine, Health Sciences Faculty, Universidad Internacional SEK (UISEK), Quito 170120, Ecuador
| | - J R Ramírez-Iglesias
- Research Group of Emerging and Neglected Diseases, Ecoepidemiology and Biodiversity, Health Science Faculty, Universidad Internacional SEK (UISEK), Quito 170120, Ecuador; Program of Master in Biomedicine, Health Sciences Faculty, Universidad Internacional SEK (UISEK), Quito 170120, Ecuador.
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Mindt MR, Ashford MT, Zhu D, Cham H, Aaronson A, Conti C, Deng X, Alaniz R, Sorce J, Cypress C, Griffin P, Flenniken D, Camacho M, Fockler J, Truran D, Mackin RS, Hill C, Weiner MW, Byrd D, Turner Ii RW, Nosheny RL. The Community Engaged Digital Alzheimer's Research (CEDAR) Study: A Digital Intervention to Increase Research Participation of Black American Participants in the Brain Health Registry. J Prev Alzheimers Dis 2023; 10:847-856. [PMID: 37874107 PMCID: PMC10598330 DOI: 10.14283/jpad.2023.32] [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] [Indexed: 10/25/2023]
Abstract
BACKGROUND Although Black/African American older adults bear significant inequities in prevalence, incidence, and outcomes of Alzheimer's disease and related dementias, they are profoundly under-included in Alzheimer's Disease research. Community-Engaged Research (e.g., equitable community/science partnerships) is an evidence-based approach for improving engagement of underrepresented populations into Alzheimer's Disease research, but has lacked scalability to the national level. As internet use among older adults from underrepresented populations continues to grow, internet-based research shows promise as a feasible, valid approach to engagement and longitudinal assessment. The Community Engaged Digital Alzheimer's Research (CEDAR) study utilizes a community-engaged research approach to increase the engagement and research participation of Black/African American adults in the Brain Health Registry (BHR) and Alzheimer Disease clinical research. OBJECTIVES To describe the methods and evaluate the feasibility of the CEDAR culturally-informed digital platform within BHR. DESIGN All Black/African American participants in BHR were invited to enroll in CEDAR and to consider serving on a newly convened Community-Scientific Partnership Board to guide the study. The community board guided the development a culturally-informed cadre of engagement materials and strategies to increase research participation. Engagement strategies included incentives for study task completion, culturally-informed communications (e.g., landing page, emails and social media), resources about brain health, and video and written testimonials by CEDAR participants. SETTING BHR, an Internet-based registry and cohort. PARTICIPANTS BHR participants self-identifying as Black/African American were invited to enroll. All participants who signed an online informed consent document were enrolled. MEASUREMENTS We report the number of participants invited, enrolled, completed tasks, and volunteered to join the community board. We compared the demographics, cognitive profile, and baseline BHR task completion rates between CEDAR participants and all those invited to join the study. RESULTS Of 3738 invited, 349 (9.34%) enrolled in CEDAR. 134 (37% of CEDAR participants) volunteered to join the community board, of which 19 were selected for the community board. Compared to those invited, the CEDAR cohort had a higher percentage of female participants (84.5%) and a lower percentage of participants who identify as belonging to more than one ethnocultural group (21.8%). Compared to those did not enroll in CEDAR, those enrolled in CEDAR had a higher percentage of participants completing all BHR tasks (22%) and a higher percentage of participants completing at least one cognitive test (76%). Those enrolled in CEDAR also had a higher percentage of participants having an enrolled study partner (18%). CONCLUSIONS A culturally-informed Community-Engaged Research approach, including a remotely-convened community board, to engagement of Black/African American participants in an online research registry is feasible. This approach can be adapted for use in various clinical studies and other settings. Future studies will evaluate the effectiveness of the engagement strategies.
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Affiliation(s)
- M R Mindt
- Rachel Nosheny, 4150 Clement Street, 114M, San Francisco, CA. 94121, USA, Telephone: 415-221-4810, Email address: Fax number: 415-221-4810
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Meler E, Martinez-Portilla RJ, Caradeux J, Mazarico E, Gil-Armas C, Boada D, Martinez J, Carrillo P, Camacho M, Figueras F. Severe smallness as predictor of adverse perinatal outcome in suspected late small-for-gestational-age fetuses: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2022; 60:328-337. [PMID: 35748873 DOI: 10.1002/uog.24977] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/04/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate the performance of severe smallness in the prediction of adverse perinatal outcome among fetuses with suspected late-onset small-for-gestational age (SGA). METHODS A systematic search was performed to identify relevant studies in PubMed, Web of Science and Scopus. Late-onset SGA was defined as estimated fetal weight (EFW) or abdominal circumference (AC) < 10th percentile diagnosed at or after 32 weeks' gestation, while severe SGA was defined as EFW or AC < 3rd percentile or < 2 SD. Random-effects modeling was used to generate hierarchical summary receiver-operating-characteristics (HSROC) curves. The performance of severe SGA (as a presumptive diagnosis) in predicting adverse perinatal outcome among singleton pregnancies with suspected late-onset SGA was expressed as area under the HSROC curve (AUC), sensitivity, specificity and positive/negative likelihood ratios. The association between suspected severe SGA and adverse perinatal outcome was also assessed by random-effects modeling using the Mantel-Haenszel method and presented as odds ratio (OR). The non-exposed group was defined as non-severe SGA (EFW ≥ 3rd centile). RESULTS Twelve cohort studies were included in this systematic review and meta-analysis. The studies included a total of 3639 fetuses with suspected late-onset SGA, of which 1246 had suspected severe SGA. Significant associations were found between suspected severe SGA and composite adverse perinatal outcome (OR, 1.97 (95% CI, 1.33-2.92)), neonatal intensive care unit admission (OR, 2.87 (95% CI, 1.84-4.47)) and perinatal death (OR, 4.26 (95% CI, 1.07-16.93)). However, summary ROC curves showed limited performance of suspected severe SGA in predicting perinatal outcomes, with AUCs of 60.9%, 66.9%, 53.6%, 57.2%, 54.6% and 64.9% for composite adverse perinatal outcome, neonatal intensive care unit admission, neonatal acidosis, Cesarean section for intrapartum fetal compromise, low Apgar score and perinatal death, respectively. CONCLUSION Although suspected severe SGA was associated with a higher risk of perinatal complications, it performed poorly as a standalone parameter in predicting adverse perinatal outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Meler
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Universitat de Barcelona, Barcelona, Spain
| | - R J Martinez-Portilla
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Universitat de Barcelona, Barcelona, Spain
- Clinical Research Branch, National Institute of Perinatology, Mexico City, Mexico
| | - J Caradeux
- Fetal Medicine Unit, Clínica Santa María, Santiago, Chile
| | - E Mazarico
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Universitat de Barcelona, Barcelona, Spain
| | - C Gil-Armas
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Universitat de Barcelona, Barcelona, Spain
- National Maternal Perinatal Institute, Lima, Peru
| | - D Boada
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Universitat de Barcelona, Barcelona, Spain
| | - J Martinez
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Universitat de Barcelona, Barcelona, Spain
| | - P Carrillo
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Universitat de Barcelona, Barcelona, Spain
| | - M Camacho
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Universitat de Barcelona, Barcelona, Spain
| | - F Figueras
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Universitat de Barcelona, Barcelona, Spain
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Barnes M, Camacho M, Anderson W. P073 IDENTIFICATION OF INDUCIBLE LARYNGEAL OBSTRUCTION BY SPEECH LANGUAGE PATHOLOGY IN A SEVERE PEDIATRIC ASTHMA CLINIC. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Puig N, Camps-Renom P, Aguilera-Simón A, Camacho M, Jiménez-Altayó F, Sanchez-Quesada J, Jiménez-Xarrié E, Benitez S. Altered properties of plasma low-density lipoprotein (LDL) in ischemic stroke patients with carotid atherosclerosis. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.418] [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: 11/25/2022]
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Camacho M, Macleod AD, Maple-Grødem J, Evans JR, Breen DP, Cummins G, Wijeyekoon RS, Greenland JC, Alves G, Tysnes OB, Lawson RA, Barker RA, Williams-Gray CH. Early constipation predicts faster dementia onset in Parkinson's disease. NPJ Parkinsons Dis 2021; 7:45. [PMID: 34039994 PMCID: PMC8154963 DOI: 10.1038/s41531-021-00191-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/26/2021] [Indexed: 02/04/2023] Open
Abstract
Constipation is a common but not a universal feature in early PD, suggesting that gut involvement is heterogeneous and may be part of a distinct PD subtype with prognostic implications. We analysed data from the Parkinson's Incidence Cohorts Collaboration, composed of incident community-based cohorts of PD patients assessed longitudinally over 8 years. Constipation was assessed with the MDS-UPDRS constipation item or a comparable categorical scale. Primary PD outcomes of interest were dementia, postural instability and death. PD patients were stratified according to constipation severity at diagnosis: none (n = 313, 67.3%), minor (n = 97, 20.9%) and major (n = 55, 11.8%). Clinical progression to all three outcomes was more rapid in those with more severe constipation at baseline (Kaplan-Meier survival analysis). Cox regression analysis, adjusting for relevant confounders, confirmed a significant relationship between constipation severity and progression to dementia, but not postural instability or death. Early constipation may predict an accelerated progression of neurodegenerative pathology.
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Affiliation(s)
- M Camacho
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
| | - A D Macleod
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - J Maple-Grødem
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
- Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
| | - J R Evans
- Nottingham University Hospital NHS Trust, Nottingham, UK
| | - D P Breen
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - G Cummins
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - R S Wijeyekoon
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - J C Greenland
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - G Alves
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
- Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
| | - O B Tysnes
- Department of Neurology, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - R A Lawson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - R A Barker
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Wellcome Trust-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - C H Williams-Gray
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Siddiqui E, Okoh A, Tibuakuu M, Hirji S, Hameed I, Osho A, Singh S, Grewal J, Montgomery M, Camacho M, Bravo C. Racial Differences in In-Hospital Outcomes after the Use of Temporary Mechanical Circulatory Support as a Bridge to Heart Transplant. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1136] [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: 10/21/2022] Open
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Bandyopadhyay A, Kaneshiro KN, Camacho M. 0893 Myofunctional Therapy in Children With Mild Obstructive Sleep Apnea: A Meta-Analysis. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
OSA affects 2-4% of children and untreated OSA can have adverse behavior and quality of life outcomes. 40% of children can have residual obstructive sleep apnea (OSA)despite first line treatment (adenotonsillectomy). Alternative modalities of treatment for OSA are limited. Myofunctional therapy comprises of exercises targeting upper airway muscles that can improve facial growth and have been shown to treat OSA in adults. There is paucity of data on the role of myofunctional therapy (MT) in children. The objective of this study was to systematically review the literature for articles evaluating myofunctional therapy (MT) as treatment for OSA in children and to perform a meta-analysis on the polysomnographic and mouth breathing data.
Methods
Medline, Embase, CINAHL, Scopus, Web of Science and Cochrane were searched from inception through October 1st, 2019. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was followed.
Results
Eight studies (91 patients) reported polysomnography and/or mouth breathing outcomes. The pre- and post-MT apnea hypopnea indices (AHI) decreased from a mean ± standard deviation (M ± SD) of 3.75± 3.14/h to 2.08 ± 2.48/h, mean difference (MD) -1.6 [95% confidence interval (CI) -2.42, -0.78], P =0.0001. Mean oxygen saturations improved from 96.03 ± 1.1% to 96.67 ± 0.95%, MD 0.42 (95% CI 0.21, 0.63), P <0.0001. Lowest oxygen saturations improved from 86.6 ± 7.3% to 90.94 ± 3.05%, MD 1.01 (95% CI 0.25, 1.77), P = 0.009. Mouth breathing decreased in all three studies reporting subjective outcomes.
Conclusion
Current literature demonstrates that myofunctional therapy decreases apnea-hypopnea index by approximately 45% in children with mild obstructive sleep apnea. Mean oxygen saturations, lowest oxygen saturations and mouth breathing outcomes improved in children. Myofunctional therapy could serve as an adjunct to other obstructive sleep apnea treatments.
Support
None
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Affiliation(s)
- A Bandyopadhyay
- Indiana University School of Medicine, Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Indianapolis, IN
| | | | - M Camacho
- Tripler Army Medical Center, Honolulu, HI
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Garza D, Camacho M, Gauly M, Holtz W. Vitrification of Mouse Blastocysts by Open or Closed System and Warming in Sucrose-containing or Sucrose-free Diluent. Cryo Letters 2020; 41:135-139. [PMID: 33988642] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Cryopreservation of embryos is of considerable relevance for the implementation of embryo transfer programs and the establishment of embryo banks in several mammalian species. OBJECTIVE The present investigation compares two different vitrification systems and two different warming solutions. MATERIALS AND METHODS Vitrification was performed using Open Pulled Straw (OPS) or CVM RingFibre plug (CVM) devices. Warming was carried out either in a warming solution containing 0.33 M sucrose or in a solution devoid of sucrose. RESULTS Differences between vitrification systems were not significant. Warming in sucrose-containing diluent resulted in an expansion rate of 64%, as compared to 86% in a solution devoid of sucrose; reported hatching rates were 45% vs. 9%, respectively (p<0.05). Upon transfer, implantation rates for OPS- and CVM were 50% and 27%, respectively, compared with 55% for freshly collected embryos. The implantation rate after warming was 43% for sucrose-containing and 33% for sucrose-free medium. CONCLUSION a) both vitrification systems are suitable for vitrifying mouse blastocysts; b) warming in sucrose-free diluent yields better embryo survival rates than in diluent containing 0.33 M sucrose.
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Affiliation(s)
- D Garza
- Department of Animal Science, Georg-August-University Goettingen, Albrecht-Thaer-Weg 3, 37075 Goettingen, Germany. Facultad de Medicina Veterinaria y Zootecnia, Universidad Autonoma de Nuevo Leon, Francisco Villa S/N, 66050, Escobedo, Nuevo Leon, Mexico
| | - M Camacho
- Department of Animal Science, Georg-August-University Goettingen, Albrecht-Thaer-Weg 3, 37075 Goettingen, Germany
| | - M Gauly
- Faculty of Science and Technology, Free University of Bolzano, Universitaetsplatz 5, 39100 Bozen, Italy
| | - W Holtz
- Department of Animal Science, Georg-August-University Goettingen, Albrecht-Thaer-Weg 3, 37075 Goettingen, Germany.
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Rodríguez-Herrero V, Payá G, Bautista V, Vegara A, Cortés-Molina M, Camacho M, Esclapez J, Bonete MJ. Essentiality of the glnA gene in Haloferax mediterranei: gene conversion and transcriptional analysis. Extremophiles 2020; 24:433-446. [PMID: 32296946 DOI: 10.1007/s00792-020-01169-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 11/27/2019] [Accepted: 03/27/2020] [Indexed: 11/26/2022]
Abstract
Glutamine synthetase is an essential enzyme in ammonium assimilation and glutamine biosynthesis. The Haloferax mediterranei genome has two other glnA-type genes (glnA2 and glnA3) in addition to the glutamine synthetase gene glnA. To determine whether the glnA2 and glnA3 genes can replace glnA in nitrogen metabolism, we generated deletion mutants of glnA. The glnA deletion mutants could not be generated in a medium without glutamine, and thus, glnA is an essential gene in H. mediterranei. The glnA deletion mutant was achieved by adding 40 mM glutamine to the selective medium. This conditional HM26-ΔglnA mutant was characterised with different approaches in the presence of distinct nitrogen sources and nitrogen starvation. Transcriptomic analysis was performed to compare the expression profiles of the strains HM26-ΔglnA and HM26 under different growth conditions. The glnA deletion did not affect the expression of glnA2, glnA3 and nitrogen assimilation genes under nitrogen starvation. Moreover, the results showed that glnA, glnA2 and glnA3 were not expressed under the same conditions. These results indicated that glnA is an essential gene for H. mediterranei and, therefore, glnA2 and glnA3 cannot replace glnA in the conditions analysed.
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Affiliation(s)
- V Rodríguez-Herrero
- División de Bioquímica Y Biología Molecular, Departamento de Agroquímica Y Bioquímica, Universidad de Alicante, Carretera de San Vicente del Raspeig s/n, San Vicente del Raspeig, 03690, Alicante, Spain
| | - G Payá
- División de Bioquímica Y Biología Molecular, Departamento de Agroquímica Y Bioquímica, Universidad de Alicante, Carretera de San Vicente del Raspeig s/n, San Vicente del Raspeig, 03690, Alicante, Spain
| | - V Bautista
- División de Bioquímica Y Biología Molecular, Departamento de Agroquímica Y Bioquímica, Universidad de Alicante, Carretera de San Vicente del Raspeig s/n, San Vicente del Raspeig, 03690, Alicante, Spain
| | - A Vegara
- División de Bioquímica Y Biología Molecular, Departamento de Agroquímica Y Bioquímica, Universidad de Alicante, Carretera de San Vicente del Raspeig s/n, San Vicente del Raspeig, 03690, Alicante, Spain
| | - M Cortés-Molina
- Departamento de Matemática Aplicada, Universidad de Alicante, Carretera de San Vicente del Raspeig s/n, San Vicente del Raspeig, 03690, Alicante, Spain
| | - M Camacho
- División de Bioquímica Y Biología Molecular, Departamento de Agroquímica Y Bioquímica, Universidad de Alicante, Carretera de San Vicente del Raspeig s/n, San Vicente del Raspeig, 03690, Alicante, Spain
| | - J Esclapez
- División de Bioquímica Y Biología Molecular, Departamento de Agroquímica Y Bioquímica, Universidad de Alicante, Carretera de San Vicente del Raspeig s/n, San Vicente del Raspeig, 03690, Alicante, Spain
| | - M J Bonete
- División de Bioquímica Y Biología Molecular, Departamento de Agroquímica Y Bioquímica, Universidad de Alicante, Carretera de San Vicente del Raspeig s/n, San Vicente del Raspeig, 03690, Alicante, Spain.
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Camacho M, Garza D, Gauly M, Holtz W. Superovulation of Boer goats with different synchronization regimens at different times of the year in the northern temperate zone. Small Rumin Res 2019. [DOI: 10.1016/j.smallrumres.2019.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fugar S, Okoh AK, Eshun D, Yirerong J, Appiah LT, Mbachi C, Legge T, Camacho M, Russo MJ. National Trends and Outcomes of Patients Bridged to Transplant With Continuous Flow Left Ventricular Assist Devices. Transplant Proc 2019; 51:852-858. [PMID: 30979475 DOI: 10.1016/j.transproceed.2019.01.036] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 01/03/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Continuous flow left ventricular assist devices (CF-LVAD) are widely used as a bridge to transplantation (BTT) among patients with advanced heart failure. The primary outcome of the current study was to study the incidence of waitlist mortality and morbidity of CF-LVAD patients bridged to heart transplantation in the current BTT era and to determine the factors that increased their risk of delisting. METHODS Patients who were bridged to heart transplant with a CF-LVAD between April 2008 and September 2015 were identified from the United Network for Organ Sharing heart transplant registry. They were then categorized based on the development of complications. Cox proportional hazards and Kaplan-Meier survival curves were used for time-to-event analysis for the primary outcome. RESULTS Out of 7070 patients who were bridged to heart transplant, 2510 (36%) developed device-related complications. The primary outcome was present in 1631 of 7070 patients (23%). Independent predictors of primary outcome were age, ABO blood group, etiology of cardiomyopathy, and history of diabetes mellitus. Developing one device-related complication was associated with a hazard ratio (HR) of 2.59 of having the primary outcome. The HR increased to 3.45 when ≥2 of the defined complications occurred. In patients who developed the primary outcome, they most likely had a device infection (odds ratio 2.51). CONCLUSION Findings from the current study add to the existing literature about the incidence of morbidity and mortality in the current BTT era. Development of one device-related complication increases the risk of death or delisting among patients on the heart transplant waitlist; however, this risk almost doubles when 2 or more complications occur.
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Affiliation(s)
- S Fugar
- Department of Medicine, John H. Stroger Hospital of Cook County, Chicago, Illinois, USA.
| | - A K Okoh
- Department of Cardiothoracic Surgery, RWJ Barnabas Health, Newark Beth Israel Medical Center, Newark, New Jersey
| | - D Eshun
- Department of Medicine, Meharry Medical College, Nashville, Tennessee, USA
| | - J Yirerong
- Department of Internal Medicine, Brown University Memorial Hospital of Rhode Island, Providence, Rhode Island
| | - L T Appiah
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - C Mbachi
- Department of Medicine, John H. Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - T Legge
- Boston Consulting Group, Chicago, Illinois, USA
| | - M Camacho
- Department of Cardiothoracic Surgery, RWJ Barnabas Health, Newark Beth Israel Medical Center, Newark, New Jersey
| | - M J Russo
- Department of Cardiothoracic Surgery, RWJ Barnabas Health, Newark Beth Israel Medical Center, Newark, New Jersey
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Okoh A, Fugar S, Schulthies M, Russo M, Karanam R, Zucker M, Yanagida R, Camacho M. Temporary Mechanical Circulatory Support as a Bridge to Heart Transplantation: Insights from the UNOS Database. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Okoh A, Yanagida R, Schultheis M, Chaudari S, Fugar S, Nnaoma C, Chan O, Zucker M, Karanam R, Russo M, Camacho M. Impact of Baseline Mitral Regurgitation on Postoperative Outcomes After Left Ventricular Assist Device Implantation as Destination Therapy. Transplant Proc 2019; 51:859-864. [DOI: 10.1016/j.transproceed.2019.01.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/08/2018] [Accepted: 01/17/2019] [Indexed: 01/07/2023]
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Camacho M, Certal V, Modi R, Capasso R. Tissue-Sparing Uvulopalatopharyngoplasty for OSA: Conservative, Compassionate and Possibly just as Effective. Indian J Otolaryngol Head Neck Surg 2019; 71:5-6. [PMID: 30906703 DOI: 10.1007/s12070-015-0915-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/04/2015] [Accepted: 09/16/2015] [Indexed: 11/28/2022] Open
Abstract
A common surgical treatment for obstructive sleep apnea (OSA) is uvulopalatopharyngoplasty (UPPP). Unfortunately, traditional UPPP can cause a foreign body sensation, chronic discomfort and in rare cases, nasopharyngeal stenosis or velopharyngeal insufficiency. Modifications to traditional UPPP have been developed over the years to help decrease side effects, while trying to maintain or improve OSA outcomes. Conservative, tissue-sparing UPPP techniques include preservation of soft palate tissues (muscle and/or mucosa), avoidance of plication or conservative plication of the uvula, partial instead of complete uvulectomy, and suture plication of the palatopharyngeus-superior pharyngeal constrictor-palatoglossus muscles with complete preservation of surrounding tissues after tonsillectomy.
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Affiliation(s)
- M Camacho
- Sleep Medicine Division, Stanford Hospital and Clinics, US Army, 2nd floor, 450 Broadway St., Redwood City, CA 94063 USA.,6Tripler Army Medical Center, Honolulu, HI USA
| | - V Certal
- Department of Otorhinolaryngology, Sleep Medicine Centre-Hospital CUF, Porto, Portugal.,3CINTESIS - Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal
| | - R Modi
- Department of Otolaryngology-Head and Neck Surgery, Dr L H Hiranandani Hospital Mumbai, MH, India
| | - R Capasso
- 5Sleep Surgery Division, Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA USA
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Navas Madroñal M, Vila L, Fité J, Martinez-Gonzalez J, Rodriguez C, Camacho M, Galán M. Targeting endoplasmic reticulum stress as a therapy to manage abdominal aortic aneurysm disease. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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OKOH A, Chauhan D, Schultheis M, Karanam R, Gidea C, Camacho M, Zucker M, Russo M. Long Term Graft Survival and Immediate Post-Operative Complications Between Patients with Ischemic and Idiopathic Dilated Cardiomyopathy Undergoing Cardiac Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.836] [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: 10/17/2022] Open
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Fugar S, Okoh A, Eshun D, Schultheis M, Gidea C, Russo M, Zucker M, Camacho M. Outcomes of Patients Bridged with LVAD to a Repeat Heart Transplant as Compared to Medical Management: Analysis of the UNOS Database. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.666] [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: 10/17/2022] Open
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27
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Yanagida R, Camacho M, Okoh A, Gidea C, Strueber M, Zucker M. Survival Factors for Patients With Biventricular Failure on CentriMag Biventricular Support as Bridge to Decision or Transplant. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.241] [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: 10/17/2022] Open
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28
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Baran D, Menchavez E, Zucker M, Gidea C, Camacho M. One Tac Trial: Renal Function After Conversion from Twice Daily to Extended Release Tacrolimus. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1089] [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: 10/17/2022] Open
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29
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Baran D, Kapoor S, Vijaykumar S, Gidea C, Camacho M, Zucker M. TICTAC 10: Ten Year Follow-up of the Tacrolimus in Combination Tacrolimus Alone Compared Trial. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Zavala GA, García OP, Camacho M, Ronquillo D, Campos‐Ponce M, Doak C, Polman K, Rosado JL. Intestinal parasites: Associations with intestinal and systemic inflammation. Parasite Immunol 2018; 40:e12518. [PMID: 29364525 PMCID: PMC5901043 DOI: 10.1111/pim.12518] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 01/17/2018] [Indexed: 12/12/2022]
Abstract
The aim of the present study was to evaluate associations between intestinal parasitic infection with intestinal and systemic inflammatory markers in school-aged children with high rates of obesity. Plasma concentrations of C-Reactive Protein (CRP), leptin, TNF-α, IL-6 and IL-10 were measured as systemic inflammation markers and count of stool leukocytes as marker of intestinal inflammation in 291 children (6-10 years). Intestinal parasitic infection was measured by stool examination. Logistic regression analyses were performed to determine the odds of having high inflammatory markers for each parasite or group of parasites as compared to parasite-free children while adjusting for sex, age, mother's educational level and percentage of body fat. The prevalence of soil-transmitted helminths and intestinal protozoa infections was 12% and 36%, respectively. Parasitic infection was not associated with CRP, IL-6, IL-10 or TNF-α. Children infected with Ascaris lumbricoides (aOR: 5.91, 95% CI: 1.97-17.70) and Entamoeba coli (aOR: 8.46, 95% CI: 2.85-25.14) were more likely to have higher stool leucocytes than parasite-free children. Children with multiple infections (aOR: 10.60, 95% CI: 2.85-25.14) were more likely to have higher leptin concentrations than parasite-free children. Intestinal parasitic infection was not associated with systemic inflammation, but was associated with intestinal inflammation. Having multiple infections were associated with higher leptin concentrations.
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Affiliation(s)
- G. A. Zavala
- Facultad de Ciencias NaturalesUniversidad Autónoma de QuerétaroQuerétaroMexico
- Faculty of Earth & Life SciencesVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - O. P. García
- Facultad de Ciencias NaturalesUniversidad Autónoma de QuerétaroQuerétaroMexico
| | - M. Camacho
- Facultad de Ciencias NaturalesUniversidad Autónoma de QuerétaroQuerétaroMexico
| | - D. Ronquillo
- Facultad de Ciencias NaturalesUniversidad Autónoma de QuerétaroQuerétaroMexico
| | - M. Campos‐Ponce
- Faculty of Earth & Life SciencesVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - C. Doak
- Faculty of Earth & Life SciencesVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - K. Polman
- Faculty of Earth & Life SciencesVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Department of Biomedical SciencesInstitute of Tropical Medicine AntwerpAntwerpBelgium
| | - J. L. Rosado
- Facultad de Ciencias NaturalesUniversidad Autónoma de QuerétaroQuerétaroMexico
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Baran D, Copeland H, Copeland J, Gidea C, Camacho M. Forgotten Women: Use of Female Donors and Survival Outcomes. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.331] [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: 10/17/2022] Open
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Torre C, Zaghi S, Camacho M, Capasso R, Liu SY. Hypopharyngeal evaluation in obstructive sleep apnea with awake flexible laryngoscopy: Validation and updates to Cormack-Lehane and Modified Cormack-Lehane scoring systems. Clin Otolaryngol 2018; 43:823-827. [DOI: 10.1111/coa.13054] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2017] [Indexed: 11/28/2022]
Affiliation(s)
- C. Torre
- Division of Sleep Surgery; Department of Otolaryngology-Head & Neck Surgery; Miller School of Medicine; University of Miami; Miami FL USA
- UHealth Sleep Program; Miller School of Medicine; University of Miami; Miami FL USA
| | - S. Zaghi
- Division of Sleep Surgery; Department of Otolaryngology-Head & Neck Surgery; Stanford University School of Medicine; Stanford CA USA
| | - M. Camacho
- Division of Sleep Medicine; Department of Psychiatry; Stanford University Medical Center; Stanford CA USA
- Division of Sleep Surgery and Medicine; Tripler Army Medical Center Honolulu; Honolulu HI USA
| | - R. Capasso
- Division of Sleep Surgery; Department of Otolaryngology-Head & Neck Surgery; Stanford University School of Medicine; Stanford CA USA
| | - S. Y. Liu
- Division of Sleep Surgery; Department of Otolaryngology-Head & Neck Surgery; Stanford University School of Medicine; Stanford CA USA
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Marín-García M, Benseny-Cases N, Camacho M, Perrie Y, Suades J, Barnadas-Rodríguez R. Metallosomes for biomedical applications by mixing molybdenum carbonyl metallosurfactants and phospholipids. Dalton Trans 2018; 47:14293-14303. [DOI: 10.1039/c8dt01584h] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
New photo-CORM metallosomes with low cell toxicity were prepared from organometallic metallosurfactants and phospholipids.
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Affiliation(s)
- M. Marín-García
- Biophysics Unit/Center for Biophysical Studies
- Department of Biochemistry and Molecular Biology
- Faculty of Medicine
- Universitat Autònoma de Barcelona
- 08193 Cerdanyola
| | | | - M. Camacho
- Laboratory of Angiology
- Vascular Biology and Inflammation/Institute of Biomedical Research
- Hospital de la Santa Creu i de Sant Pau
- Universitat Autònoma de Barcelona
- 08025 Barcelona
| | - Y. Perrie
- Strathclyde Institute of Pharmacy and Biomedical Sciences
- University of Strathclyde
- Glasgow G4 0RE
- UK
| | - J. Suades
- Departament de Química
- Edifici C
- Universitat Autònoma de Barcelona
- 08193 Cerdanyola
- Spain
| | - R. Barnadas-Rodríguez
- Biophysics Unit/Center for Biophysical Studies
- Department of Biochemistry and Molecular Biology
- Faculty of Medicine
- Universitat Autònoma de Barcelona
- 08193 Cerdanyola
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Baran D, Stelling K, Pieretti J, Gidea C, Kapoor S, Zucker M, Cohen M, Martin T, Dinicola B, Camacho M. Percutaneous Axillary Balloon Pumps: Outcomes of Extended Support. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.300] [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] Open
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Itoh A, Pisani M, Baltalzar M, Balsara K, Masood M, Tepper S, Han J, Ranney D, Daneshmand M, Sun B, Kai M, Camacho M, Takayama H. Clinical Benefits and Complications in Patients with Percutaneous VAD versus Surgical LV Vent with ECLS: Multicenter REgiStry for Cardiogenic Shock - Utilization and Efficacy of Device Therapy (RESCUE). J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Takayama H, Han J, Baltazar-Garcia M, Lucas M, Kai M, Camacho M, Sun B, Ranney D, Daneshmand M, Itoh A. Contemporary ECMO Therapy for Postcardiotomy Shock: From REgiStry for Cardiogenic Shock: Utility and Efficacy of Device Therapy (RESCUE). J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.363] [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: 11/16/2022] Open
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Navarro-Torre S, Barcia-Piedras JM, Mateos-Naranjo E, Redondo-Gómez S, Camacho M, Caviedes MA, Pajuelo E, Rodríguez-Llorente ID. Assessing the role of endophytic bacteria in the halophyte Arthrocnemum macrostachyum salt tolerance. Plant Biol (Stuttg) 2017; 19:249-256. [PMID: 27770586 DOI: 10.1111/plb.12521] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 09/14/2016] [Accepted: 10/18/2016] [Indexed: 05/13/2023]
Abstract
There is an increasing interest to use halophytes for revegetation of salt affected ecosystems, as well as in understanding their mechanisms of salt tolerance. We hypothesized that bacteria from the phyllosphere of these plants might play a key role in its high tolerance to excessive salinity. Eight endophytic bacteria belonging to Bacillus and closely related genera were isolated from phyllosphere of the halophyte Arthrocnemum macrostachyum growing in salty agricultural soils. The presence of plant-growth promoting (PGP) properties, enzymatic activities and tolerance towards NaCl was determined. Effects of inoculation on seeds germination and adult plant growth under experimental NaCl treatments (0, 510 and 1030 mM NaCl) were studied. Inoculation with a consortium including the best performing bacteria improved considerably the kinetics of germination and the final germination percentage of A. macrostachyum seeds. At high NaCl concentrations (1030 mM), inoculation of plants mitigated the effects of high salinity on plant growth and physiological performance and, in addition, this consortium appears to have increased the potential of A. macrostachyum to accumulate Na+ in its shoots, thus improving sodium phytoextraction capacity. Bacteria isolated from A. macrostachyum phyllosphere seem to play an important role in plant salt tolerance under stressing salt concentrations. The combined use of A. macrostachyum and its microbiome can be an adequate tool to enhance plant adaptation and sodium phytoextraction during restoration of salt degraded soils.
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Affiliation(s)
- S Navarro-Torre
- Departamento de Microbiología y Parasitología, Facultad de Farmacia, Universidad de Sevilla, Sevilla, Spain
| | - J M Barcia-Piedras
- Departamento de Biología Vegetal y Ecología, Facultad de Biología, Universidad de Sevilla, Sevilla, Spain
- IFAPA, Centro Las Torres -Tomejil, Sevilla, Spain
| | - E Mateos-Naranjo
- Departamento de Biología Vegetal y Ecología, Facultad de Biología, Universidad de Sevilla, Sevilla, Spain
| | - S Redondo-Gómez
- Departamento de Biología Vegetal y Ecología, Facultad de Biología, Universidad de Sevilla, Sevilla, Spain
| | - M Camacho
- IFAPA, Centro Las Torres -Tomejil, Sevilla, Spain
| | - M A Caviedes
- Departamento de Microbiología y Parasitología, Facultad de Farmacia, Universidad de Sevilla, Sevilla, Spain
| | - E Pajuelo
- Departamento de Microbiología y Parasitología, Facultad de Farmacia, Universidad de Sevilla, Sevilla, Spain
| | - I D Rodríguez-Llorente
- Departamento de Microbiología y Parasitología, Facultad de Farmacia, Universidad de Sevilla, Sevilla, Spain
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Marín-García M, Benseny-Cases N, Camacho M, Suades J, Barnadas-Rodríguez R. Low-toxicity metallosomes for biomedical applications by self-assembly of organometallic metallosurfactants and phospholipids. Chem Commun (Camb) 2017; 53:8455-8458. [DOI: 10.1039/c7cc04945e] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
New photo-CORM metallosomes prepared by a straightforward method from organometallic metallosurfactants and phospholipids show a drastic diminution of cell toxicity.
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Affiliation(s)
- M. Marín-García
- Biophysics Unit/Center for Biophysical Studies
- Department of Biochemistry and Molecular Biology
- Faculty of Medicine
- Universitat Autònoma de Barcelona
- 08193 Cerdanyola
| | | | - M. Camacho
- Laboratory of Angiology
- Vascular Biology and Inflammation/Institute of Biomedical Research
- Hospital de la Santa Creu i de Sant Pau
- Universitat Autònoma de Barcelona
- 08025 Barcelona
| | - J. Suades
- Departament de Química
- Edifici C
- Universitat Autònoma de Barcelona
- 08193 Cerdanyola
- Spain
| | - R. Barnadas-Rodríguez
- Biophysics Unit/Center for Biophysical Studies
- Department of Biochemistry and Molecular Biology
- Faculty of Medicine
- Universitat Autònoma de Barcelona
- 08193 Cerdanyola
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Fernandez Puente P, Calamia V, Lourido L, Gonzalez L, Camacho M, Ruiz-Romero C, Blanco F. SAT0468 Differential Profile of Endogenous Peptides Detected by Targeted Proteomics in Cartilage Secretome, Synovial Fluid and Serum from Osteoarthritis Patients and Controls. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4970] [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: 11/04/2022]
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Calamia V, Mateo J, Fernández-Puente P, Lourido L, Camacho M, Oreiro N, Raga A, Acasuso M, Herrero M, Martinez H, Verges J, Ruiz-Romero C, Blanco F. SAT0447 Identification of Predictive Biomarkers of Therapeutic Response in Knee OA: The Moves Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3403] [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: 11/04/2022]
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41
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Torregrosa-Crespo J, Rodrigo-Baños M, Pire C, Garbayo I, Vilchez C, Esclapez J, Bautista V, Camacho M, Bonete M, Martínez-Espinosa R. Innovative applications of haloarchaea to waste water treatments and biotechnological uses of the biomass produced. N Biotechnol 2016. [DOI: 10.1016/j.nbt.2015.10.021] [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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42
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Baran D, Liaquat K, Pieretti J, Gidea C, Munagala M, Camacho M, Patel C, Divita M, Zucker M. Too Much Information: Interaction of Donor Sequence and Acceptance in the UNOS Database. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.237] [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: 10/22/2022] Open
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43
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Torregrosa-Crespo J, Martínez-Espinosa RM, Esclapez J, Bautista V, Pire C, Camacho M, Richardson DJ, Bonete MJ. Anaerobic Metabolism in Haloferax Genus: Denitrification as Case of Study. Adv Microb Physiol 2016; 68:41-85. [PMID: 27134021 DOI: 10.1016/bs.ampbs.2016.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A number of species of Haloferax genus (halophilic archaea) are able to grow microaerobically or even anaerobically using different alternative electron acceptors such as fumarate, nitrate, chlorate, dimethyl sulphoxide, sulphide and/or trimethylamine. This metabolic capability is also shown by other species of the Halobacteriaceae and Haloferacaceae families (Archaea domain) and it has been mainly tested by physiological studies where cell growth is observed under anaerobic conditions in the presence of the mentioned compounds. This work summarises the main reported features on anaerobic metabolism in the Haloferax, one of the better described haloarchaeal genus with significant potential uses in biotechnology and bioremediation. Special attention has been paid to denitrification, also called nitrate respiration. This pathway has been studied so far from Haloferax mediterranei and Haloferax denitrificans mainly from biochemical point of view (purification and characterisation of the enzymes catalysing the two first reactions). However, gene expression and gene regulation is far from known at the time of writing this chapter.
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Affiliation(s)
| | | | - J Esclapez
- Universidad de Alicante, Alicante, Spain
| | - V Bautista
- Universidad de Alicante, Alicante, Spain
| | - C Pire
- Universidad de Alicante, Alicante, Spain
| | - M Camacho
- Universidad de Alicante, Alicante, Spain
| | | | - M J Bonete
- Universidad de Alicante, Alicante, Spain
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Calvo I, Antón J, López Robledillo J, de Inocencio J, Gamir M, Merino R, Lacruz L, Camacho M, Rua M, Bustabad S, Díaz Cordovés-Rego G. Recommendations for the use of methotrexate in patients with juvenile idiopathic arthritis. Anales de Pediatría (English Edition) 2016. [DOI: 10.1016/j.anpede.2015.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Ruiz-Ortiz E, Gonzalez-Roca E, Mensa-Vilaro A, Rius J, Plaza S, Anton C, Calvo I, Modesto C, Anton J, Arnal C, Alvarez C, Alvarez-Coca J, Becerra E, Bilbao N, Camacho M, Crespo J, de Diego C, Diez-Garcia LF, Espinosa L, Garcia-Escriva D, de Gracia F, Gonzalez MI, Iglesias E, Izquierdo S, Lastra B, Llobet P, Lopez B, Lopez-Gonzalez V, Martinez R, Martin-Mateos MA, Merino R, Ortega L, Peiro ME, de Soto IP, Perez-Mendez C, Rodriguez-Valverde V, Ribes A, Ruiz A, Sanchez B, Santos JL, Sevilla B, Sotoca J, Vilas J, Villoria A, Yagüe J, Arostegui JI. Clinical and genetic features of Spanish patients with Mevalonate kinase deficiency. Pediatr Rheumatol Online J 2015. [PMCID: PMC4597073 DOI: 10.1186/1546-0096-13-s1-p36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Hernández P, Punchak M, Camacho M, Hepple P, McNerney R. Investigating the quality of expectorated sputum for tuberculosis diagnosis in Bolivia. Int J Tuberc Lung Dis 2015; 19:1065-7. [DOI: 10.5588/ijtld.14.0700] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Orriols M, Martí-Pàmies I, Guadall A, Varona S, Galán M, Escudero J, Michel J, Martin-Ventura J, Camacho M, Martínez-González J, Rodríguez C. Fibulin-5 is downregulated in abdominal aortic aneurysm: Involvement of epigenetic mechanisms. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.04.080] [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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Calvo I, Antón J, López Robledillo JC, de Inocencio J, Gamir ML, Merino R, Lacruz L, Camacho M, Rua MJ, Bustabad S, Díaz Cordovés-Rego G. [Recommendations for the use of methotrexate in patients with juvenile idiopathic arthritis]. An Pediatr (Barc) 2015; 84:177.e1-8. [PMID: 26077957 DOI: 10.1016/j.anpedi.2015.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 03/02/2015] [Revised: 05/04/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES To develop a consensus document of recommendations for the use of methotrexate (MTX) in patients with juvenile idiopathic arthritis (JIA). MATERIAL AND METHOD A group of eleven experts proposed several clinical questions on the use of MTX in patients with JIA. A systematic review was conducted and the evidence and recommendations for each question were extracted. The results were discussed and validated by the experts in a work session to establish the final recommendations. RESULTS MTX is recommended as the first drug for inducing remission in JIA, and its indication should be made according to the clinical category of the patient. Prior to treatment, it is recommended to perform a complete blood count, including white cells, levels of liver enzymes, serum creatinine, and other analytical parameters according to specific risk factors. Treatment should be initiated with a dose of 10-15 mg/m(2)/week. In cases of uveitis or polyarthritis, an initial dose of 15 mg/m(2)/week should be considered. For a better bioavailability and tolerability, it is preferable to administer MTX parenterally if the dose is ≥15 mg/m(2)/week. It is necessary to periodically perform an analytical monitoring of the patient and to assess possible alterations in liver enzymes to make changes if necessary. Combinations with biological agents may be necessary, as well as the concomitant addition of folic or folinic acid. CONCLUSIONS This document describes the main recommendations for the appropriate use of MTX in JIA patients, according to scientific evidence and clinical experience.
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Affiliation(s)
- I Calvo
- Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - J Antón
- Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España
| | | | | | - M L Gamir
- Hospital Universitario Ramón y Cajal, Madrid, España
| | - R Merino
- Hospital Universitario La Paz, Madrid, España
| | - L Lacruz
- Hospital Son Espases, Palma de Mallorca, España
| | - M Camacho
- Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M J Rua
- Hospital Universitario Cruces, San Vicente de Barakaldo, España
| | - S Bustabad
- Hospital Universitario de Canarias, San Cristóbal de La Laguna , Santa Cruz de Tenerife, España
| | - G Díaz Cordovés-Rego
- Hospital Materno Infantil del Hospital Regional Universitario de Málaga, Málaga, España
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Pinheiro Sá A, Camacho M. Com a ciclosporina na mira. Gal Clin 2015. [DOI: 10.22546/32/695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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50
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Dilmé JF, Bellmunt S, Camacho M, Solà-Villà D, Romero JM, Escudero JR, Vila L. Influence of Cardiovascular Risk Factors on Levels of Matrix Metalloproteinases 2 and 9 in Human Abdominal Aortic Aneurysms. J Vasc Surg 2014. [DOI: 10.1016/j.jvs.2014.08.098] [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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