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Kabir M, Thomas-Gibson S, Ahmad A, Kader R, Al-Hillawi L, Mcguire J, David L, Shah K, Rao R, Vega R, East JE, Faiz OD, Hart AL, Wilson A. Cancer Biology or Ineffective Surveillance? A multicentre retrospective analysis of colitis-associated post-colonoscopy colorectal cancers. J Crohns Colitis 2023:jjad189. [PMID: 37941424 DOI: 10.1093/ecco-jcc/jjad189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease (IBD) is associated with high rates of post-colonoscopy colorectal cancer (PCCRC), but further in-depth qualitative analyses are required to determine whether they result from inadequate surveillance or aggressive IBD cancer evolution. METHODS All IBD patients who had a colorectal cancer (CRC) diagnosed between January 2015 to July 2019 and a recent (<4 years) surveillance colonoscopy at one of four English hospital trusts underwent root cause analyses as recommended by the World Endoscopy Organisation to identify plausible PCCRC causative factors. RESULTS 61% (n=22/36) of the included IBD CRCs were PCCRCs. They developed in patients with high cancer risk factors (77.8%; n=28/36) requiring annual surveillance, yet 57.1% (n=20/35) had inappropriately delayed surveillance. Most PCCRCs developed in situations where (i) an endoscopically unresectable lesion was detected (40.9%; n=9/22), (ii) there was a deviation from the planned management pathway (40.9%; n=9/22) e.g. service, clinician or patient-related delays in acting on a detected lesion, or (iii) lesions were potentially missed as they were typically located within areas of active inflammation or post-inflammatory change (36.4%; n=8/22). CONCLUSIONS IBD PCCRC prevention will require more proactive strategies to reduce endoscopic inflammatory burden, improve lesion optical characterisation, adherence to recommended surveillance intervals and patient acceptance of prophylactic colectomy. However, the significant proportion appearing to originate from non-adenomatous-looking mucosa which fail to yield neoplasia on biopsy yet display aggressive cancer evolution highlight the limitations of current surveillance. Emerging molecular biomarkers may play a role in enhancing cancer risk stratification in future clinical practice.
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Affiliation(s)
- Misha Kabir
- Division of GI Services, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London
- Imperial College London, UK
| | | | - Ahmir Ahmad
- Imperial College London, UK
- Wolfson Endoscopy Unit, St Mark's Hospital, UK
| | - Rawen Kader
- Division of GI Services, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, UK
| | - Lulia Al-Hillawi
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, UK
- University of Oxford, Oxford, UK
| | - Joshua Mcguire
- Blizard Institute, Queen Mary University of London, UK
- Department of gastroenterology, Barts Health NHS Trust, London, UK
| | - Lewis David
- Department of gastroenterology, East and North Hertfordshire, UK
| | - Krishna Shah
- Department of gastroenterology, Imperial College Healthcare NHS Trust, UK
| | - Rohit Rao
- Department of gastroenterology, Barts Health NHS Trust, London, UK
| | - Roser Vega
- Division of GI Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - James E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Omar D Faiz
- Imperial College London, UK
- Department of Colorectal Surgery, St Mark's Hospital, UK
| | - Ailsa L Hart
- Imperial College London, UK
- IBD Unit, St Mark's Hospital, UK
| | - Ana Wilson
- Imperial College London, UK
- Wolfson Endoscopy Unit, St Mark's Hospital, UK
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2
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Inniss S, Fragkos KC, Whitley L, Wimpory R, Rebello E, Lisboa A, Khetan T, Hassan J, Simpson K, Bhagwanani A, Vega R, Parisi I, Harrow P, Seward E, McCartney S, Bloom S, Smith AM, Plumb A, Rahman FZ. Two-year real-world outcome data from a single tertiary centre shows reduced ustekinumab persistence in a non-bio-naïve Crohn's disease cohort with penetrating disease, -ostomies and sarcopenia. Ther Adv Chronic Dis 2023; 14:20406223231189072. [PMID: 37601038 PMCID: PMC10434845 DOI: 10.1177/20406223231189072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 07/03/2023] [Indexed: 08/22/2023] Open
Abstract
Background Ustekinumab was approved in 2016 for the treatment of moderate-severe Crohn's disease (CD). Clinical trials and real-world studies have suggested ustekinumab to be a safe and effective treatment; however, studies to date infrequently use imaging techniques to predict response to biologics in CD. Objectives We assessed the 2-year real-world effectiveness and safety of ustekinumab in a tertiary CD cohort with the use of novel imaging techniques. Design Retrospective cohort study. Methods Retrospective data were collected between 2016 and 2021. Study end points included ustekinumab persistence, biological and/or clinical response and remission at 12, 18 and 24 months. Statistical analysis included demographic and inferential analyses. Results In all, 131 CD patients [57.3% female, median age of 26.0 (21.0-37.0)] were included. Patients were non-bio naïve, and the majority received ustekinumab as third- or fourth-line treatment. At 24 months, 61.0% (80/131) persisted with ustekinumab [52.7% (69/131) steroid free]. Clinical response was reported in 55.2% (37/67), clinical remission in 85.7% (57/67), biological response in 46.8% (22/47) and biological remission in 31.9% (15/47) of patients at 24 months. The low outcome numbers were attributable to missing data. Improvements in routine disease markers, including C-reactive protein and Harvey-Bradshaw Index, were also reflected in magnetic resonance imaging-derived disease scores. The presence of penetrating CD, an -ostomy and sarcopenia were all predictors of poorer ustekinumab outcomes (p < 0.05). Conclusion Ustekinumab is effective in non-bio-naïve CD patients with non-stricturing, non-penetrating disease with an unremarkable safety profile but may be less effective in those with penetrating disease, -ostomies and sarcopenia.
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Affiliation(s)
- Saskia Inniss
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
- Eastman Dental Institute, University College London, London, UK
| | - Konstantinos C. Fragkos
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lisa Whitley
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rachel Wimpory
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Eleanor Rebello
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ana Lisboa
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tanvi Khetan
- UCL Medical School, University College London, London, UK
- Department of Radiology, University College London Hospital, London, UK
| | - Jasmine Hassan
- UCL Medical School, University College London, London, UK
- Department of Radiology, University College London Hospital, London, UK
| | - Kate Simpson
- Division of Medicine, University College London, London, UK
| | - Anisha Bhagwanani
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Roser Vega
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ioanna Parisi
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Paul Harrow
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Edward Seward
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sara McCartney
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stuart Bloom
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Andrew M. Smith
- Eastman Dental Institute, University College London, London, UK
| | - Andrew Plumb
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Farooq Z. Rahman
- Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, Ground Floor West, 250 Euston Road, London, NW1 2PG, UK
- Eastman Dental Institute, University College London, London, UK
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3
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Kader R, Cid‐Mejias A, Brandao P, Islam S, Hebbar S, Puyal JG, Ahmad OF, Hussein M, Toth D, Mountney P, Seward E, Vega R, Stoyanov D, Lovat LB. Polyp characterization using deep learning and a publicly accessible polyp video database. Dig Endosc 2023; 35:645-655. [PMID: 36527309 PMCID: PMC10570984 DOI: 10.1111/den.14500] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/13/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Convolutional neural networks (CNN) for computer-aided diagnosis of polyps are often trained using high-quality still images in a single chromoendoscopy imaging modality with sessile serrated lesions (SSLs) often excluded. This study developed a CNN from videos to classify polyps as adenomatous or nonadenomatous using standard narrow-band imaging (NBI) and NBI-near focus (NBI-NF) and created a publicly accessible polyp video database. METHODS We trained a CNN with 16,832 high and moderate quality frames from 229 polyp videos (56 SSLs). It was evaluated with 222 polyp videos (36 SSLs) across two test-sets. Test-set I consists of 14,320 frames (157 polyps, 111 diminutive). Test-set II, which is publicly accessible, 3317 video frames (65 polyps, 41 diminutive), which was benchmarked with three expert and three nonexpert endoscopists. RESULTS Sensitivity for adenoma characterization was 91.6% in test-set I and 89.7% in test-set II. Specificity was 91.9% and 88.5%. Sensitivity for diminutive polyps was 89.9% and 87.5%; specificity 90.5% and 88.2%. In NBI-NF, sensitivity was 89.4% and 89.5%, with a specificity of 94.7% and 83.3%. In NBI, sensitivity was 85.3% and 91.7%, with a specificity of 87.5% and 90.0%, respectively. The CNN achieved preservation and incorporation of valuable endoscopic innovations (PIVI)-1 and PIVI-2 thresholds for each test-set. In the benchmarking of test-set II, the CNN was significantly more accurate than nonexperts (13.8% difference [95% confidence interval 3.2-23.6], P = 0.01) with no significant difference with experts. CONCLUSIONS A single CNN can differentiate adenomas from SSLs and hyperplastic polyps in both NBI and NBI-NF. A publicly accessible NBI polyp video database was created and benchmarked.
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Affiliation(s)
- Rawen Kader
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
- Gastrointestinal ServicesUniversity College London HospitalLondonUK
| | | | | | - Shahraz Islam
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
| | | | - Juana González‐Bueno Puyal
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
- Odin Vision LtdLondonUK
| | - Omer F. Ahmad
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
- Gastrointestinal ServicesUniversity College London HospitalLondonUK
| | - Mohamed Hussein
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
- Gastrointestinal ServicesUniversity College London HospitalLondonUK
| | | | | | - Ed Seward
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
- Gastrointestinal ServicesUniversity College London HospitalLondonUK
| | - Roser Vega
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
- Gastrointestinal ServicesUniversity College London HospitalLondonUK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
| | - Laurence B. Lovat
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
- Gastrointestinal ServicesUniversity College London HospitalLondonUK
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4
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Ahmad OF, Mazomenos E, Chadebecq F, Kader R, Hussein M, Haidry RJ, Puyal JG, Brandao P, Toth D, Mountney P, Seward E, Vega R, Stoyanov D, Lovat LB. Identifying key mechanisms leading to visual recognition errors for missed colorectal polyps using eye-tracking technology. J Gastroenterol Hepatol 2023; 38:768-774. [PMID: 36652526 PMCID: PMC10601973 DOI: 10.1111/jgh.16127] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 01/04/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIM Lack of visual recognition of colorectal polyps may lead to interval cancers. The mechanisms contributing to perceptual variation, particularly for subtle and advanced colorectal neoplasia, have scarcely been investigated. We aimed to evaluate visual recognition errors and provide novel mechanistic insights. METHODS Eleven participants (seven trainees and four medical students) evaluated images from the UCL polyp perception dataset, containing 25 polyps, using eye-tracking equipment. Gaze errors were defined as those where the lesion was not observed according to eye-tracking technology. Cognitive errors occurred when lesions were observed but not recognized as polyps by participants. A video study was also performed including 39 subtle polyps, where polyp recognition performance was compared with a convolutional neural network. RESULTS Cognitive errors occurred more frequently than gaze errors overall (65.6%), with a significantly higher proportion in trainees (P = 0.0264). In the video validation, the convolutional neural network detected significantly more polyps than trainees and medical students, with per-polyp sensitivities of 79.5%, 30.0%, and 15.4%, respectively. CONCLUSIONS Cognitive errors were the most common reason for visual recognition errors. The impact of interventions such as artificial intelligence, particularly on different types of perceptual errors, needs further investigation including potential effects on learning curves. To facilitate future research, a publicly accessible visual perception colonoscopy polyp database was created.
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Affiliation(s)
- Omer F Ahmad
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
- Gastrointestinal ServicesUniversity College London HospitalLondonUK
| | - Evangelos Mazomenos
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
| | - Francois Chadebecq
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
| | - Rawen Kader
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
| | - Mohamed Hussein
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
| | - Rehan J Haidry
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
- Gastrointestinal ServicesUniversity College London HospitalLondonUK
| | - Juana González‐Bueno Puyal
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
- Odin Vision LtdLondonUK
| | - Patrick Brandao
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
- Odin Vision LtdLondonUK
| | | | | | - Ed Seward
- Gastrointestinal ServicesUniversity College London HospitalLondonUK
| | - Roser Vega
- Gastrointestinal ServicesUniversity College London HospitalLondonUK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
| | - Laurence B Lovat
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
- Gastrointestinal ServicesUniversity College London HospitalLondonUK
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5
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Parker J, Gupta S, Shenbagaraj L, Harborne P, Ramaraj R, Karandikar S, Mottershead M, Barbour J, Mohammed N, Lockett M, Lyons A, Vega R, Torkington J, Dolwani S. Outcomes of complex colorectal polyps managed by multi-disciplinary team strategies-a multi-centre observational study. Int J Colorectal Dis 2023; 38:28. [PMID: 36735059 PMCID: PMC9898359 DOI: 10.1007/s00384-022-04299-0] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Team management strategies for complex colorectal polyps are recommended by professional guidelines. Multi-disciplinary meetings are used across the UK with limited information regarding their impact. The aim of this multi-centre observational study was to assess procedures and outcomes of patients managed using these approaches. METHOD This was a retrospective, observational study of patients managed by six UK sites. Information was collected regarding procedures and outcomes including length of stay, adverse events, readmissions and cancers. RESULTS Two thousand one hundred ninety-two complex polyps in 2109 patients were analysed with increasing referrals annually. Most presented symptomatically and the mean polyp size was 32.1 mm. Primary interventions included endoscopic therapy (75.6%), conservative management (8.3%), colonic resection (8.1%), trans-anal surgery (6.8%) or combined procedures (1.1%). The number of primary colonic resections decreased over the study period without a reciprocal increase in secondary procedures or recurrence. Secondary procedures were required in 7.8%. The median length of stay for endoscopic procedures was 0 days with 77.5% completed as day cases. Median length of stay was 5 days for colonic resections. Overall adverse event and 30-day readmission rates were 9.0% and 3.3% respectively. Malignancy was identified in 8.8%. Benign polyp recurrence occurred in 13.1% with a median follow up of 30.4 months. Screening detected lesions were more likely to undergo bowel resection. Colonic resection was associated with longer stays, higher adverse events and more cancers on final histology. CONCLUSION Multi-disciplinary team management of complex polyps is safe and effective. Standardisation of organisation and quality monitoring is needed to continue positive effects on outcomes and services.
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Affiliation(s)
- J. Parker
- School of Medicine and Cardiff and Vale University Health Board, Cardiff University, Cardiff, UK
| | - S. Gupta
- Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | | | - P. Harborne
- Cardiff and Vale University Health Board, Cardiff, UK
| | - R. Ramaraj
- Cardiff and Vale University Health Board, Cardiff, UK
| | - S. Karandikar
- University Hospitals Birmingham Foundation NHS Trust, Birmingham, UK
| | - M. Mottershead
- University Hospitals Birmingham Foundation NHS Trust, Birmingham, UK
| | - J. Barbour
- Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - N. Mohammed
- Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, UK
| | | | - A. Lyons
- North Bristol NHS Trust, Bristol, UK
| | - R. Vega
- University College London Hospitals NHS Foundation Trust, London, UK
| | - J. Torkington
- Cardiff and Vale University Health Board, Cardiff, UK
| | - S. Dolwani
- School of Medicine and Cardiff and Vale University Health Board, Cardiff University, Cardiff, UK
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Kumar S, Plumb A, Mallett S, Bhatnagar G, Bloom S, Clarke CS, Hamlin J, Hart AL, Jacobs I, Travis S, Vega R, Halligan S, Taylor SA. METRIC-EF: magnetic resonance enterography to predict disabling disease in newly diagnosed Crohn's disease-protocol for a multicentre, non-randomised, single-arm, prospective study. BMJ Open 2022; 12:e067265. [PMID: 36192092 PMCID: PMC9535152 DOI: 10.1136/bmjopen-2022-067265] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Crohn's disease (CD) is characterised by discontinuous, relapsing enteric inflammation. Instituting advanced therapies at an early stage to suppress inflammation aims to prevent future complications such as stricturing or penetrating disease, and subsequent surgical resection. Therapeutics are effective but associated with certain side-effects and relatively expensive. There is therefore an urgent need for robust methods to predict which newly diagnosed patients will develop disabling disease, to identify patients who are most likely to benefit from early, advanced therapies. We aim to determine if magnetic resonance enterography (MRE) features at diagnosis improve prediction of disabling CD within 5 years of diagnosis. METHODS AND ANALYSIS We describe the protocol for a multicentre, non-randomised, single-arm, prospective study of adult patients with newly diagnosed CD. We will use patients already recruited to the METRIC study and extend their clinical follow-up, as well as a separate group of newly diagnosed patients who were not part of the METRIC trial (MRE within 3 months of diagnosis), to ensure an adequate sample size. Follow-up will extend for at least 4 years. The primary outcome is to evaluate the comparative predictive ability of prognostic models incorporating MRE severity scores (Magnetic resonance Enterography Global Score (MEGS), simplified MAgnetic Resonance Index of Activity (sMaRIA) and Lémann Index) versus models using standard characteristics alone to predict disabling CD (modified Beaugerie definition) within 5 years of new diagnosis. ETHICS AND DISSEMINATION This study protocol achieved National Health Service Research Ethics Committee (NHS REC), London-Hampstead Research Ethics Committee approval (IRAS 217422). Our findings will be disseminated via conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER ISRCTN76899103.
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Affiliation(s)
- Shankar Kumar
- Centre for Medical Imaging, University College London, London, UK
| | - Andrew Plumb
- Centre for Medical Imaging, University College London, London, UK
| | - Sue Mallett
- Centre for Medical Imaging, University College London, London, UK
| | | | - Stuart Bloom
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Caroline S Clarke
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - John Hamlin
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ailsa L Hart
- Inflammatory Bowel Disease Unit, St Mark's Hospital and Academic Institute, London, UK
| | | | - Simon Travis
- Kennedy Institute and Translational Gastroenterology Unit, University of Oxford and Biomedical Research Centre, Oxford, UK
| | - Roser Vega
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
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Ortiz-Romero PL, Jiménez LM, Muniesa C, Estrach T, Servitje O, de Misa RF, Gallardo F, Martín OS, Riveiro-Falkenbach E, Díaz NG, Vega R, Lora D, Postigo C, Jiménez B, Sánchez-Beato M, Vaqué JP, Peralto JLR, de la Cámara AG, De la Cruz J, Pinilla MAP. Final report of PIMTO-MF clinical trial: multicenter, phase II trial for treatment of early MF with topical pimecrolimus. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00641-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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8
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Ahmad OF, González-Bueno Puyal J, Brandao P, Kader R, Abbasi F, Hussein M, Haidry RJ, Toth D, Mountney P, Seward E, Vega R, Stoyanov D, Lovat LB. Performance of artificial intelligence for detection of subtle and advanced colorectal neoplasia. Dig Endosc 2022; 34:862-869. [PMID: 34748665 DOI: 10.1111/den.14187] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/22/2021] [Accepted: 11/05/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES There is uncertainty regarding the efficacy of artificial intelligence (AI) software to detect advanced subtle neoplasia, particularly flat lesions and sessile serrated lesions (SSLs), due to low prevalence in testing datasets and prospective trials. This has been highlighted as a top research priority for the field. METHODS An AI algorithm was evaluated on four video test datasets containing 173 polyps (35,114 polyp-positive frames and 634,988 polyp-negative frames) specifically enriched with flat lesions and SSLs, including a challenging dataset containing subtle advanced neoplasia. The challenging dataset was also evaluated by eight endoscopists (four independent, four trainees, according to the Joint Advisory Group on gastrointestinal endoscopy [JAG] standards in the UK). RESULTS In the first two video datasets, the algorithm achieved per-polyp sensitivities of 100% and 98.9%. Per-frame sensitivities were 84.1% and 85.2%. In the subtle dataset, the algorithm detected a significantly higher number of polyps (P < 0.0001), compared to JAG-independent and trainee endoscopists, achieving per-polyp sensitivities of 79.5%, 37.2% and 11.5%, respectively. Furthermore, when considering subtle polyps detected by both the algorithm and at least one endoscopist, the AI detected polyps significantly faster on average. CONCLUSIONS The AI based algorithm achieved high per-polyp sensitivities for advanced colorectal neoplasia, including flat lesions and SSLs, outperforming both JAG independent and trainees on a very challenging dataset containing subtle lesions that could have been overlooked easily and contribute to interval colorectal cancer. Further prospective trials should evaluate AI to detect subtle advanced neoplasia in higher risk populations for colorectal cancer.
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Affiliation(s)
- Omer F Ahmad
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Gastrointestinal Services, University College London Hospital, London, UK
| | - Juana González-Bueno Puyal
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London
- Odin Vision Ltd, London, UK
| | - Patrick Brandao
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London
- Odin Vision Ltd, London, UK
| | - Rawen Kader
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Faisal Abbasi
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Mohamed Hussein
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Rehan J Haidry
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Gastrointestinal Services, University College London Hospital, London, UK
| | | | | | - Ed Seward
- Gastrointestinal Services, University College London Hospital, London, UK
| | - Roser Vega
- Gastrointestinal Services, University College London Hospital, London, UK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London
| | - Laurence B Lovat
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Gastrointestinal Services, University College London Hospital, London, UK
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9
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Curtius K, Kabir M, Al Bakir I, Choi CHR, Hartono JL, Johnson M, East JE, Lindsay JO, Vega R, Thomas-Gibson S, Warusavitarne J, Wilson A, Graham TA, Hart A. Multicentre derivation and validation of a colitis-associated colorectal cancer risk prediction web tool. Gut 2022; 71:705-715. [PMID: 33990383 PMCID: PMC8921573 DOI: 10.1136/gutjnl-2020-323546] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/24/2021] [Accepted: 04/18/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Patients with ulcerative colitis (UC) diagnosed with low-grade dysplasia (LGD) have increased risk of developing advanced neoplasia (AN: high-grade dysplasia or colorectal cancer). We aimed to develop and validate a predictor of AN risk in patients with UC with LGD and create a visual web tool to effectively communicate the risk. DESIGN In our retrospective multicentre validated cohort study, adult patients with UC with an index diagnosis of LGD, identified from four UK centres between 2001 and 2019, were followed until progression to AN. In the discovery cohort (n=246), a multivariate risk prediction model was derived from clinicopathological features using Cox regression. Validation used data from three external centres (n=198). The validated model was embedded in a web tool to calculate patient-specific risk. RESULTS Four clinicopathological variables were significantly associated with AN progression in the discovery cohort: endoscopically visible LGD >1 cm (HR 2.7; 95% CI 1.2 to 5.9), unresectable or incomplete endoscopic resection (HR 3.4; 95% CI 1.6 to 7.4), moderate/severe histological inflammation within 5 years of LGD diagnosis (HR 3.1; 95% CI 1.5 to 6.7) and multifocality (HR 2.9; 95% CI 1.3 to 6.2). In the validation cohort, this four-variable model accurately predicted future AN cases with overall calibration Observed/Expected=1.01 (95% CI 0.64 to 1.52), and achieved 100% specificity for the lowest risk group over 13 years of available follow-up. CONCLUSION Multicohort validation confirms that patients with large, unresected, multifocal LGD and recent moderate/severe inflammation are at highest risk of developing AN. Personalised risk prediction provided via the Ulcerative Colitis-Cancer Risk Estimator ( www.UC-CaRE.uk ) can support treatment decision-making.
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Affiliation(s)
- Kit Curtius
- Centre for Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Misha Kabir
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK
| | - Ibrahim Al Bakir
- Centre for Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK
| | - Chang Ho Ryan Choi
- Department of Gastroenterology & Hepatology, St George Hospital, Sydney, New South Wales, Australia
| | - Juanda L Hartono
- Division of Gastroenterology, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Michael Johnson
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - James E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - James O Lindsay
- Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
- Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Roser Vega
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Siwan Thomas-Gibson
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Janindra Warusavitarne
- Department of Surgery and Cancer, Imperial College London, London, UK
- Colorectal Surgery and Lennard-Jones Intestinal Failure Unit, St Mark's Hospital and Academic Institute, London, UK
| | - Ana Wilson
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK
| | - Trevor A Graham
- Centre for Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Ailsa Hart
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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10
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Miller C, Kwok H, Harrow P, Vega R, Seward E, Mehta S, Rahman F, McCartney S, Parisi I, Lim SH, Sharma E, Samaan MA, Bancil A, Kok KB, Shalabi A, Johnston EL, Katarey D, Taherzadeh N, Murray C, Sharip MT, Carter MJ, Radhakrishnan ST, Peake S, Khakoo I, Wahed M, Povlsen S, Patel M, DuBois P, Finkel J, Onnie C, Bloom S. Comparative effectiveness of a second-line biologic in patients with ulcerative colitis: vedolizumab followed by an anti-TNF versus anti-TNF followed by vedolizumab. Frontline Gastroenterol 2022; 13:392-401. [PMID: 36051959 PMCID: PMC9380760 DOI: 10.1136/flgastro-2021-101906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/26/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Sequential drug treatment with biological agents in ulcerative colitis (UC) is becoming increasingly complex. There are few studies comparing head-to-head outcomes in second-line treatments. The study assesses whether using anti-tumour necrosis factor (anti-TNF)-α therapy following the α4β7 integrin blocker vedolizumab (VDZ) or VDZ after an anti-TNF has more favourable clinical outcomes in UC in a real-world outpatient setting. METHODS Patients with UC who were exposed to first-line anti-TNF (adalimumab or infliximab) or VDZ who subsequently switched to the alternate class between May 2013 and August 2020 were identified by reviewing patient databases at 10 hospitals. Data were collected retrospectively using patient records. Baseline demographics, disease activity indices, biochemical markers, endoscopic Mayo score, colectomy rates, treatment persistence and urgent hospital utilisation composite endpoint (UHUC) rates were examined over a 52-week period. RESULTS Second-line week 52 treatment persistence was higher in the VDZ group (71/81, 89%) versus the anti-TNF group (15/34, 44%; p=0.0001), as were week 52 colectomy-free survival (VDZ: 77/80, 96%, vs anti-TNF: 26/32, 81%; p=0.009), week 52 UHUC survival (VDZ: 68/84, 81%, vs anti-TNF: 20/34, 59%; p=0.002) and week 52 corticosteroid-free clinical remission (CFCR) rates (VDZ: 22/34, 65%, vs anti-TNF: 4/20, 20%; p=0.001). CONCLUSION Compared with second-line anti TNF usage, the VDZ second-line cohort had significantly higher 52-week treatment persistence, UHUC survival, higher colectomy-free survival rates and higher week 52 CFCR. These data suggest that VDZ is an effective biologic in UC as a second-line therapy after anti-TNF exposure. It highlights the effect of biological order on clinically important outcomes.
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Affiliation(s)
- Charles Miller
- Department of Gastroenterology, University College Hospital, London, UK
| | - Hanson Kwok
- Department of Gastroenterology, University College Hospital, London, UK
| | - Paul Harrow
- Department of Gastroenterology, University College Hospital, London, UK
| | - Roser Vega
- Department of Gastroenterology, University College Hospital, London, UK
| | - Edward Seward
- Department of Gastroenterology, University College Hospital, London, UK
| | - Shameer Mehta
- Department of Gastroenterology, University College Hospital, London, UK
| | - Farooq Rahman
- Department of Gastroenterology, University College Hospital, London, UK
| | - Sara McCartney
- Department of Gastroenterology, University College Hospital, London, UK
| | - Ioanna Parisi
- Department of Gastroenterology, University College Hospital, London, UK
| | - Samuel Hsiang Lim
- Department of Gastroenterology, Guy's and Thomas' Hospital, London, UK
| | - Esha Sharma
- Department of Gastroenterology, Guy's and Thomas' Hospital, London, UK
| | - Mark A Samaan
- Department of Gastroenterology, Guy's and Thomas' Hospital, London, UK
| | - Aaron Bancil
- Department of Gastroenterology, Royal London Hospital, London, UK
| | - Klaartje Bel Kok
- Department of Gastroenterology, Royal London Hospital, London, UK
| | - Ahmed Shalabi
- Department of Gastroenterology, West Middlesex Hospital, London, UK
| | - Emma L Johnston
- Department of Gastroenterology, West Middlesex Hospital, London, UK
| | - Dev Katarey
- Department of Gastroenterology, Royal Free Hospital London, London, UK
| | - Nina Taherzadeh
- Department of Gastroenterology, Royal Free Hospital London, London, UK
| | - Charles Murray
- Department of Gastroenterology, Royal Free Hospital London, London, UK
| | | | - Martyn J Carter
- Department of Gastroenterology, Lister Hospital, Stevenage, UK
| | - Shiva T Radhakrishnan
- Departments of Gastroenterology and Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Simon Peake
- Departments of Gastroenterology and Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Imran Khakoo
- Departments of Gastroenterology, Chelsea and Westminster Hospital, London, UK
| | - Mahmood Wahed
- Departments of Gastroenterology, Chelsea and Westminster Hospital, London, UK
| | | | - Mehul Patel
- Department of Gastroenterology, King's College Hospital, London, UK
| | - Patrick DuBois
- Department of Gastroenterology, King's College Hospital, London, UK
| | - Jemima Finkel
- Department of Gastroenterology, Whittington Hospital, London, UK
| | - Clive Onnie
- Department of Gastroenterology, Whittington Hospital, London, UK
| | - Stuart Bloom
- Department of Gastroenterology, University College Hospital, London, UK
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11
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Smith G, Laskaratos FM, Mitchison M, Vega R. A rare endoscopic finding of a traditional serrated adenoma with osseous metaplasia in the rectum. Clin Res Hepatol Gastroenterol 2021; 45:101547. [PMID: 33069637 DOI: 10.1016/j.clinre.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/05/2020] [Accepted: 09/19/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Grace Smith
- Gastroenterology Department, University College London Hospitals NHS Foundation Trust, 235 Euston Rd, London, NW1 2BU, UK
| | - Faidon-Marios Laskaratos
- Gastroenterology Department, University College London Hospitals NHS Foundation Trust, 235 Euston Rd, London, NW1 2BU, UK.
| | - Miriam Mitchison
- Histopathology Department, University College London Hospitals NHS Foundation Trust, 235 Euston Rd, London, NW1 2BU, UK
| | - Roser Vega
- Gastroenterology Department, University College London Hospitals NHS Foundation Trust, 235 Euston Rd, London, NW1 2BU, UK
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12
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Barile J, Vega R, De Los Ríos-Escalante P. First report the role of benthic macroinvertebrates as preys for native fish in Toltén river (38° S, Araucania region Chile). BRAZ J BIOL 2020; 81:845-853. [PMID: 32965340 DOI: 10.1590/1519-6984.232661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/27/2020] [Indexed: 11/22/2022] Open
Abstract
The Toltén river is located in the 137 years old Araucania region, Chile (38° S), and is characterized by low alterations through human interference due agriculture and towns in its surrounding basin, the presence of native fishes and salmonids, and by its lake effluent regime originated from Villarrica lake. The aim of the present study was to make a review of ecological role of the benthic inland water macroinvertebrates as preys for native fishes of the River Toltén, in order to understand their importance in the ecosystem of the river. The literature revealed that the main prey for native fishes are Chironomidae larvae, nevertheless there are not specific reports for Tolten river. The exposed results are similar with similar native species for Patagonia, and these native species would have prey for introduced salmonids, or these species would have prey competition with introduced salmonids in according to the literature descriptions for Argentinean and Chilean Patagonia.
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Affiliation(s)
- J Barile
- Universidad Católica de Temuco - UCTemuco, Departamento de Ciencias Agropecuarias y Acuicolas, Facultad de Recursos Naturales, Temuco, Chile
| | - R Vega
- Universidad Católica de Temuco - UCTemuco, Departamento de Ciencias Agropecuarias y Acuicolas, Facultad de Recursos Naturales, Temuco, Chile
| | - P De Los Ríos-Escalante
- Universidad Católica de Temuco- UCTemuco, Departamento de Ciencias Biológicas y Químicas, Facultad de Recursos Naturales, Temuco, Chile
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13
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Herrera-Calderon O, Vega R. Optimization of the extraction of phenolic compounds and antioxidant activity from the roots of Waltheria ovata using the response surface methodology. Food Res 2020. [DOI: 10.26656/fr.2017.4(6).211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Waltheria ovata is a medicinal plant belonging to the Sterculiaceae genus. Natural
products of Waltheria ovata could be used in the food industry as natural antioxidants due
to its high content of polyphenols according to the literature. The main objective in this
research was to optimize the extraction of phenolic compounds and the antioxidant
activity from Waltheria ovata roots using response surface methodology (RSM). The total
phenolic content in different extracts was determined by spectrophotometric method
(Folin-Ciocalteu reagent) and the antioxidant activity by using DPPH assay. To optimize
the conditions for total phenolic content and antioxidant activity were used three
independent variables: solvent/sample ratio (1:10, 1:20 and 1:30 g/mL), temperature (40,
50, and 60°C) and time (40, 50 and 60 mins). The results showed that total phenolic
content and antioxidant activity in the experiments ranged from 8.7 to 12.1 mg GAE/g and
76.1% to 96.7%, respectively. The coefficients of determination (R2
values) for phenolic
content and antioxidant activity were 0.86 and 0.91, respectively. Under the optimum
conditions of 1:20 g/mL, 60°C and 55 mins of extraction, the values for total phenolic
content and antioxidant activity were 0.448±0.02 mg GAE/g and 87.00±2.0%,
respectively. These data showed that the experimental responses were reasonably close to
the predicted responses (0.444 mg GAE/g and 84.67%). Therefore, the results showed that
Waltheria ovata can be used as antioxidant in foods.
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14
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Jackson G, Cutrona S, White B, Reardon C, Orvek E, Nevedal A, Lindquist J, Gifford A, King H, DeLaughter K, Henderson B, Vega R, Damschroder L. Identifying, Replicating, and Spreading Health care Innovations across a Nation‐Wide Health care System: VHA Diffusion of Excellence. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- G. Jackson
- Durham Veterans Affairs Health Care System Durham NC United States
- Duke University Durham NC United States
| | - S. Cutrona
- Bedford VA Medical Center Bedford MA United States
- University of Massachusetts Medical School Worcester MA United States
| | - B. White
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Affairs Health Care System Durham NC United States
| | - C. Reardon
- VA Ann Arbor Healthcare System Ann Arbor MI United States
| | - E. Orvek
- Bedford VA Medical Center Bedford MA United States
- University of Massachusetts Medical School Worcester MA United States
| | - A. Nevedal
- VA Palo Alto Health Care System Menlo Park CA United States
| | - J. Lindquist
- Durham Veterans Affairs (VA) Health Care System Durham NC United States
| | - A. Gifford
- VA Boston Healthcare System Boston MA United States
- Boston University Boston MA United States
| | - H. King
- Duke University Durham NC United States
- Durham Veterans Affairs (VA) Health Care System Durham NC United States
| | - K. DeLaughter
- Bedford VA Medical Center Bedford MA United States
- University of Massachusetts Medical School Worcester MA United States
| | - B. Henderson
- United States Veterans Health Administration Innovation Ecosystem Washington DC United States
| | - R. Vega
- Veterans Health Administration (VHA) Innovation Ecosystem Washington DC United States
| | - L. Damschroder
- VA Ann Arbor Healthcare System Ann Arbor MI United States
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15
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Orrego M, Besa P, Orrego F, Amenabar D, Vega R, Irribarra L, Espinosa J, Vial R, Phillips V, Irarrázaval S. Medial opening wedge high tibial osteotomy: more than ten years of experience with Puddu plate technique supports its indication. Int Orthop 2020; 44:2021-2026. [PMID: 32474719 DOI: 10.1007/s00264-020-04614-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/11/2020] [Accepted: 05/07/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the short-term and long-term results of patients who underwent a medial opening wedge high tibial osteotomy (MOW-HTO) for unicompartmental medial knee joint osteoarthritis. METHODS A retrospective review was conducted of patients with MOW-HTO using a Puddu plate®, with more than ten year follow-up. The degree of correction, initial chondral damage, number of meniscal lesions, preoperative and 1-year postoperative functional scale scores (IKDC and Lysholm), and arthroplasty conversion rates at the ten year follow-up were registered. We assumed early indication when patients underwent the operation before they were 40 years old and delayed ≥ 40. Functional outcomes were analyzed by adjusting for pre-operative values. Fisher's exact test was used to study the association between the arthroplasty conversion rates and the timing of indication. RESULTS Fifty-five patients were included, 37 of whom were male (67%). Twenty-nine patients had early indications for surgery (53%). All patients completed ten year follow-up. All patients improved IKDC (p < 0.01) and Lysholm (p < 0.01) scores compared to their presurgical scores at the one year post-operative evaluation. We had six minor complications, none requiring revision surgery. We had three conversions to arthroplasty, all in the late indication group, not statistically significant different. Linear regression showed that early indication was associated with a higher IKDC score when adjusting for the Outerbridge chondral damage score, the number of meniscal lesions, and sex (p < 0.01). CONCLUSION All patients improved functional scores one year after surgery. Early indication (i.e., younger than 40 years of age) was independently associated with better functional outcomes than late indication at one year follow-up.
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Affiliation(s)
- M Orrego
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - P Besa
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - F Orrego
- School of Medicine, Universidad de Los Andes, Santiago, Chile
| | - D Amenabar
- Departament of Orthopedic Surgery, School of Medicine, Universidad de los Andes, Santiago, Chile
| | - R Vega
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - L Irribarra
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J Espinosa
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - R Vial
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - V Phillips
- School of Medicine, Universidad de Los Andes, Santiago, Chile
| | - Sebastián Irarrázaval
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.
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16
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Encina F, De Los Ríos P, Vega R, Mardones A. Standard culture of Paratanytarsus grimmii Schneider, 1885 (Diptera: Chironomidae), for its use in toxicity bioassays. BRAZ J BIOL 2019; 80:735-740. [PMID: 31800760 DOI: 10.1590/1519-6984.218707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 07/18/2019] [Indexed: 11/22/2022] Open
Abstract
The management and use of native species under laboratory conditions is the main difficult for species proposal for its use in bioassays. The present study showed the results about management under controlled conditions of Paratanytarsus grimmii (Diptera: Chironomidae), that is a parthenogenetic species with wide geographical distribution. It obtained its eggs from a pre Andean river from Araucania region (39° S), and it determined the conditions for larval rearing under artificial food, adults getting (manipulation), eggs (hatching sincronization) and larvae getting after hatching. The P.grimmii life cycle had larvae that late 23 days in get the pupa stage (stage I to IV), the adult within the next 48 hours deposits the eggs that hatched at 72 hours. It stablished laboratory conditions: incubation room temperature, water pH, and artificial feeding, photoperiod and larvae and eggs management techniques. In according to obtained results it managed all life cycles under laboratory conditions that can propose the use of this species as potential biological material for toxicity bioassays.
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Affiliation(s)
- F Encina
- Departamento de Ciencias Ambientales, Facultad de Recursos Naturales, Universidad Católica de Temuco, Casilla 15-D, Temuco, Chile.,Núcleo de Estudios Ambientales, Universidad Católica de Temuco, Casilla 15-D, Temuco, Chile
| | - P De Los Ríos
- Núcleo de Estudios Ambientales, Universidad Católica de Temuco, Casilla 15-D, Temuco, Chile.,Departamento de Ciencias Biológicas y Químicas, Facultad de Recursos Naturales, Universidad Católica de Temuco, Casilla 15-D, Temuco, Chile
| | - R Vega
- Departamento de Ciencias Agropecuarias y Acuicolas, Facultad de Recursos Naturales, Universidad Católica de Temuco, Casilla 15-D, Temuco, Chile.,Núcleo de Producción Alimentaria, Universidad Católica de Temuco, Casilla 15-D, Temuco, Chile
| | - A Mardones
- Departamento de Ciencias Agropecuarias y Acuicolas, Facultad de Recursos Naturales, Universidad Católica de Temuco, Casilla 15-D, Temuco, Chile.,Núcleo de Producción Alimentaria, Universidad Católica de Temuco, Casilla 15-D, Temuco, Chile
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17
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Mardones A, Vega R, Encina F, Pichara C, González K, De Los Rios P, Peña B. Assessing the growth of Arctic charr (Salvelinus alpinus) (Linnaeus, 1758) in four salinities, under experimental conditions. BRAZ J BIOL 2019; 80:907-913. [PMID: 31800771 DOI: 10.1590/1519-6984.226331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 07/30/2019] [Indexed: 11/22/2022] Open
Abstract
Studies in Salvelinus alpinus, Arctic charr, indicate that it has a low capacity to hyposmorregulatory or adaption to sea in winter periods in Arctic waters. The investigation finds to determinate the rank optimum of salinity to can cultivate this species at Chile. The weight adequate was determined to join on the sea by analysis of gill Na+, K+-ATPase activity, that it was found between the ranks 80-130 g, with 14.5 U/mg. It underwent evaluation of fish growth of 72 g salinities from 0 (control), 18, 25 and 33 g/L (sea water) for 94 days. The results indicate that the largest increases were obtained in brackish water. T18 g/L and T25 g/L achieved growth of 25% and 19% on day 94 and term sampling respectively. It is important to mention that the 8% that survived in seawater introduced percentages growth 16.6% equivalent to brackish water and control. These results suggest that Salvelinus alpinus can grow in seawater, with levels of Na+, K+-ATPase similar to those submitted by Salmo salar with a weight not less than 80 g.
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Affiliation(s)
- A Mardones
- Departamento de Ciencias Agropecuarias y Acuícolas, Universidad Católica de Temuco, Temuco, Chile.,Núcleo de Investigación en Producción Alimentaria, Universidad Católica de Temuco, Temuco, Chile
| | - R Vega
- Departamento de Ciencias Agropecuarias y Acuícolas, Universidad Católica de Temuco, Temuco, Chile.,Núcleo de Investigación en Producción Alimentaria, Universidad Católica de Temuco, Temuco, Chile
| | - F Encina
- Departamento de Ciencias Ambientales, Universidad Católica de Temuco, Temuco, Chile.,Núcleo de Estudios Ambientales, Universidad Católica de Temuco, Temuco, Chile
| | - C Pichara
- Departamento de Ciencias Agropecuarias y Acuícolas, Universidad Católica de Temuco, Temuco, Chile
| | - K González
- Departamento de Ciencias Biológicas y Químicas, Universidad Católica de Temuco, Temuco, Chile
| | - P De Los Rios
- Núcleo de Estudios Ambientales, Universidad Católica de Temuco, Temuco, Chile.,Departamento de Ciencias Biológicas y Químicas, Universidad Católica de Temuco, Temuco, Chile
| | - B Peña
- Departamento de Ciencias Agropecuarias y Acuícolas, Universidad Católica de Temuco, Temuco, Chile
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18
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Mardones A, González M, Rivas-Mancilla C, Vega R, Augsburger A, Encina F, De los Ríos P. Determination of acute toxicity of ammonium in juvenile Patagonian blenny (Eleginops maclovinus). BRAZ J BIOL 2019; 79:646-650. [DOI: 10.1590/1519-6984.186991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/22/2018] [Indexed: 11/22/2022] Open
Abstract
Abstract Deionized ammonium (NH3) acute toxicity (LC50-96h) in Patagonian blenny juveniles (Eleginops maclovinus) was assessed. Concentrations of deionized ammonium in salt water were prepared by using 24.09 ± 2.1 g ammonium chloride (NH4Cl). Fish were exposed in triplicates to different ammonium concentrations: 0.05; 0.094; 0.175; 0.325 and 0.605 mg NH3 L-1. Additionally, a control group was included. Experimental fish were kept at a photoperiod of 16:8h. Average temperatures were 16.24 ± 1.40 °C. Oxygen concentration was 7.16 ± 0.40 mg L -1. Water pH was 7.89 ± 0.2. LC50-96 h, was estimated by using Probit statistical method (95% intervals) using EPA software (1993). Juveniles of E. maclovinus showed a LC50-96h of 0.413mg NH3 L-1 value, different from most marine species. This study presents the first record of ammonium toxicity in marine species of Chile.
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Affiliation(s)
- A. Mardones
- Universidad Católica de Temuco, Chile; UC Temuco, Chile
| | | | | | - R. Vega
- Universidad Católica de Temuco, Chile; UC Temuco, Chile
| | | | - F. Encina
- Universidad Católica de Temuco, Chile; UC Temuco, Chile
| | - P. De los Ríos
- Universidad Católica de Temuco, Chile; Universidad Católica de Temuco, Chile
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19
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Di Caro S, Fini L, Vega R, Fragkos KC, Dolwani S, Green J, Smith LA, Beckett C, Cameron E, Banks M. Multicentre randomised controlled trial comparing standard and high resolution optical technologies in colorectal cancer screening. Frontline Gastroenterol 2019; 10:244-252. [PMID: 31281625 PMCID: PMC6583579 DOI: 10.1136/flgastro-2018-101130] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/02/2019] [Accepted: 02/09/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The UK bowel cancer screening programme (BCSP) has been established for the early detection of colorectal cancer offering colonoscopy to patients screened positive by faecal occult blood tests. In this multisite, prospective, randomised controlled trial, we aimed to compare the performance of Standard Definition Olympus Lucera (SD-OL) with Scope Guide and the High Definition Pentax HiLine (HD-PHL). PATIENTS AND METHODS Subjects undergoing a colonoscopy as part of the UK National BCSP at four UK sites were randomised to an endoscopy list run using either SD-OL or HD-PHL. Primary endpoints were polyp and adenoma detection rate (PDR and ADR, respectively) as well as polyp size, morphology and histology characteristics. RESULTS 262 subjects (168 males, mean age 66.3±4.3 years) were colonoscoped (133 patients with HD-PHL while 129 with SD-OL). PDR and ADR were comparable within the two optical systems. The HD-PHL group resulted in a PDR 55.6% and ADR 43.6%; the SD-OL group had PDR 56.6% and ADR 45.7%. HD-PHL was significantly superior to SD-OL in detection of flat adenomas (18.6% vs 5.2%, p<0.001), but not detection of pedunculated or sessile polyps. Patient comfort, use of sedation and endoscopist perception of procedural difficulty resulted similar despite the use of Scope Guide with SD-OL. CONCLUSION PDR and ADR were not significantly different between devices. The high-resolution colonoscopy system HD-PHL may improve polyp detection as compared with standard resolution technology in detecting flat adenomas. This advantage may have clinically significant implications for missed lesion rates and post-colonoscopy interval colorectal cancer rates.
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Affiliation(s)
- Simona Di Caro
- GI Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lucia Fini
- Department of Internal Medicine, Gastroenterology and Digestive Endoscopy Unit, Ospedale di Busto Arsizio, Busto Arsizio, Italy
| | - Roser Vega
- GI Services, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Sunil Dolwani
- Gastroenterology, Cardiff and Vale NHS Trust, Cardiff, UK
| | - John Green
- Gastroenterology, Cardiff and Vale NHS Trust, Cardiff, UK
| | - Lesley-Ann Smith
- Department of Gastroenterology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Conrad Beckett
- Department of Gastroenterology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ewen Cameron
- Department of Gastroenterology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Matthew Banks
- GI Services, University College London Hospitals NHS Foundation Trust, London, UK
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20
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Baker AM, Cross W, Curtius K, Al Bakir I, Choi CHR, Davis HL, Temko D, Biswas S, Martinez P, Williams MJ, Lindsay JO, Feakins R, Vega R, Hayes SJ, Tomlinson IPM, McDonald SAC, Moorghen M, Silver A, East JE, Wright NA, Wang LM, Rodriguez-Justo M, Jansen M, Hart AL, Leedham SJ, Graham TA. Evolutionary history of human colitis-associated colorectal cancer. Gut 2019; 68:985-995. [PMID: 29991641 PMCID: PMC6580738 DOI: 10.1136/gutjnl-2018-316191] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/01/2018] [Accepted: 06/02/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE IBD confers an increased lifetime risk of developing colorectal cancer (CRC), and colitis-associated CRC (CA-CRC) is molecularly distinct from sporadic CRC (S-CRC). Here we have dissected the evolutionary history of CA-CRC using multiregion sequencing. DESIGN Exome sequencing was performed on fresh-frozen multiple regions of carcinoma, adjacent non-cancerous mucosa and blood from 12 patients with CA-CRC (n=55 exomes), and key variants were validated with orthogonal methods. Genome-wide copy number profiling was performed using single nucleotide polymorphism arrays and low-pass whole genome sequencing on archival non-dysplastic mucosa (n=9), low-grade dysplasia (LGD; n=30), high-grade dysplasia (HGD; n=13), mixed LGD/HGD (n=7) and CA-CRC (n=19). Phylogenetic trees were reconstructed, and evolutionary analysis used to reveal the temporal sequence of events leading to CA-CRC. RESULTS 10/12 tumours were microsatellite stable with a median mutation burden of 3.0 single nucleotide alterations (SNA) per Mb, ~20% higher than S-CRC (2.5 SNAs/Mb), and consistent with elevated ageing-associated mutational processes. Non-dysplastic mucosa had considerable mutation burden (median 47 SNAs), including mutations shared with the neighbouring CA-CRC, indicating a precancer mutational field. CA-CRCs were often near triploid (40%) or near tetraploid (20%) and phylogenetic analysis revealed that copy number alterations (CNAs) began to accrue in non-dysplastic bowel, but the LGD/HGD transition often involved a punctuated 'catastrophic' CNA increase. CONCLUSIONS Evolutionary genomic analysis revealed precancer clones bearing extensive SNAs and CNAs, with progression to cancer involving a dramatic accrual of CNAs at HGD. Detection of the cancerised field is an encouraging prospect for surveillance, but punctuated evolution may limit the window for early detection.
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Affiliation(s)
- Ann-Marie Baker
- Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - William Cross
- Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kit Curtius
- Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ibrahim Al Bakir
- Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Inflammatory Bowel Disease Unit, St Mark’s Hospital, London, UK
| | - Chang-Ho Ryan Choi
- Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Inflammatory Bowel Disease Unit, St Mark’s Hospital, London, UK
| | | | - Daniel Temko
- Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Department of Computer Science, University College London, London, UK
- Centre for Mathematics and Physics in the Life Sciences and Experimental Biology (CoMPLEX), University College London, London, UK
| | - Sujata Biswas
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Pierre Martinez
- Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Marc J Williams
- Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Centre for Mathematics and Physics in the Life Sciences and Experimental Biology (CoMPLEX), University College London, London, UK
- Department of Cell and Developmental Biology, University College London, London, UK
| | - James O Lindsay
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Roger Feakins
- Department of Histopathology, The Royal London Hospital, London, UK
| | - Roser Vega
- Department of Gastroenterology, University College London Hospital, London, UK
| | - Stephen J Hayes
- Department of Histopathology, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Ian P M Tomlinson
- Cancer Genetics and Evolution Laboratory, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Stuart A C McDonald
- Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Morgan Moorghen
- Inflammatory Bowel Disease Unit, St Mark’s Hospital, London, UK
| | - Andrew Silver
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - James E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Nicholas A Wright
- Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Lai Mun Wang
- Cellular Pathology, John Radcliffe Hospital, Oxford, UK
| | | | - Marnix Jansen
- Department of Histopathology, University College London Hospital, London, UK
| | - Ailsa L Hart
- Inflammatory Bowel Disease Unit, St Mark’s Hospital, London, UK
| | - Simon J Leedham
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Trevor A Graham
- Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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21
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Samaan MA, Forsyth K, Segal JP, De Jong D, Vleugels JLA, Elkady S, Kabir M, Campbell S, Kok K, Armstrong DG, Penez L, Arenaza AP, Seward E, Vega R, Mehta S, Rahman F, McCartney S, Bloom S, Patel K, Pollok R, Westcott E, Darakhshan A, Williams A, Koumoutsos I, Ray S, Mawdsley J, Anderson S, Sanderson JD, Dekker E, D'Haens GR, Hart A, Irving PM. Current Practices in Ileal Pouch Surveillance for Patients With Ulcerative Colitis: A Multinational, Retrospective Cohort Study. J Crohns Colitis 2019; 13:735-743. [PMID: 30590513 DOI: 10.1093/ecco-jcc/jjy225] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS There are no universally accepted guidelines regarding surveillance of ulcerative colitis [UC] patients after restorative proctocolectomy and ileal pouch-anal anastomosis [IPAA]. There also exists a lack of validated quality assurance standards for performing pouchoscopy. To better understand IPAA surveillance practices in the face of this clinical equipoise, we carried out a retrospective cohort study at five inflammatory bowel disease [IBD] referral centres. METHODS Records of patients who underwent IPAA for UC or IBD unclassified [IBDU] were reviewed, and patients with <1-year follow-up after restoration of intestinal continuity were excluded. Criteria for determining the risk of pouch dysplasia formation were collected as well as the use of pouchoscopy, biopsies, and completeness of reports. RESULTS We included 272 patients. Median duration of pouch follow-up was 10.5 [3.3-23.6] years; 95/272 [35%] had never undergone pouchoscopy for any indication; 191/272 [70%] had never undergone pouchoscopy with surveillance as the specific indication; and 3/26 [12%] high-risk patients had never undergone pouchoscopy. Two cases of adenocarcinoma were identified, occurring in the rectal cuff of low-risk patients. Patients under the care of surgeons appeared more likely to undergo surveillance, but rates of incomplete reporting were higher among surgeons [78%] than gastroenterologists [54%, p = 0.002]. CONCLUSIONS We observed wide variation in surveillance of UC/IBDU-IPAA patients. In addition, the rate of neoplasia formation among 'low-risk' patients was higher than may have been expected. We therefore concur with previous recommendations that pouchoscopy be performed at 1 year postoperatively, to refine risk-stratification based on clinical factors alone. Reports should document findings in all regions of the pouch and biopsies should be taken.
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Affiliation(s)
- Mark A Samaan
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Katrina Forsyth
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jonathan P Segal
- Department of Gastroenterology, St Mark's Hospital, London, UK.,Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Djuna De Jong
- Department of Gastroenterology, Amsterdam University Medical Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Jasper L A Vleugels
- Department of Gastroenterology, Amsterdam University Medical Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Soad Elkady
- Department of Gastroenterology, St Mark's Hospital, London, UK.,Faculty of Medicine, Department of Internal Medicine, Gastroenterology unit, University of Alexandria, Alexandria, Egypt
| | - Misha Kabir
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Samantha Campbell
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Klaartje Kok
- Department of Gastroenterology, Barts Health NHS Foundation Trust, London, UK
| | - David G Armstrong
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Lawrence Penez
- Department of Gastroenterology, St Mark's Hospital, London, UK
| | - Aitor P Arenaza
- Department of Gastroenterology, St Mark's Hospital, London, UK
| | - Edward Seward
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Roser Vega
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Shameer Mehta
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Farooq Rahman
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sara McCartney
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stuart Bloom
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kamal Patel
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Richard Pollok
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Edward Westcott
- Department of Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Amir Darakhshan
- Department of Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew Williams
- Department of Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ioannis Koumoutsos
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Shuvra Ray
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joel Mawdsley
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Simon Anderson
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jeremy D Sanderson
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Evelien Dekker
- Department of Gastroenterology, Amsterdam University Medical Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Geert R D'Haens
- Department of Gastroenterology, Amsterdam University Medical Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Ailsa Hart
- Department of Gastroenterology, St Mark's Hospital, London, UK.,Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Peter M Irving
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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22
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Vega R, Ríos PDL, Encina F, Norambuena JA, Barile J, Mardones A. First report of inventory and role of macroinvertebrates and fish in Cautín river (38° S, Araucania region Chile). BRAZ J BIOL 2019; 80:215-228. [PMID: 31066767 DOI: 10.1590/1519-6984.203511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/23/2018] [Indexed: 11/22/2022] Open
Abstract
The Cautin river is located in the 137 years old Araucania region, Chile (38°S), and is characterized by alterations through human interference due agriculture and towns in its surrounding basin, the presence of salmonids, and by its mixed regime, originated from snow melting in summer and rains in winter. The aim of the present study was to make a review of the inventory and ecological role of the benthic inland water macroinvertebrates of the River Cautin, in order to understand their importance in the ecosystem of the river. The fauna of this river includes a fauna composed of endemic and introduced fish, which has, however, been only poorly studied until now. The literature revealed the presence of abundant populations of Diptera, Trichoptera and Ephemeroptera larval stages, and few crustaceans specifically amphipods and freshwater crabs along the river's course. Many of these macroinvertebrates are prey for both introduced salmonids and native fishes. Similar results have been reported for other southern Argentinean and Chilean Patagonian rivers.
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Affiliation(s)
- R Vega
- Departamento de Ciencias Agropecuarias y Acuicolas, Facultad de Recursos Naturales, Universidad Católica de Temuco - UCTemuco, Casilla 15-D, Temuco, Chile.,Núcleo de Producción Alimentaria, Universidad Católica de Temuco - UCTemuco, Temuco, Chile
| | - P De Los Ríos
- Departamento de Ciencias Biológicas y Químicas, Facultad de Recursos Naturales, Universidad Católica de Temuco - UCTemuco, Casilla 15-D, Temuco, Chile.,Núcleo de Estudios Ambientales, Universidad Católica de Temuco - UCTemuco, Temuco, Chile
| | - F Encina
- Núcleo de Estudios Ambientales, Universidad Católica de Temuco - UCTemuco, Temuco, Chile.,Departamento de Ciencias Ambientales, Facultad de Recursos Naturales, Universidad Católica de Temuco - UCTemuco, Casilla 15-D, Temuco, Chile
| | - J A Norambuena
- Departamento de Ciencias Ambientales, Facultad de Recursos Naturales, Universidad Católica de Temuco - UCTemuco, Casilla 15-D, Temuco, Chile
| | - J Barile
- Departamento de Ciencias Agropecuarias y Acuicolas, Facultad de Recursos Naturales, Universidad Católica de Temuco - UCTemuco, Casilla 15-D, Temuco, Chile
| | - A Mardones
- Departamento de Ciencias Agropecuarias y Acuicolas, Facultad de Recursos Naturales, Universidad Católica de Temuco - UCTemuco, Casilla 15-D, Temuco, Chile.,Núcleo de Producción Alimentaria, Universidad Católica de Temuco - UCTemuco, Temuco, Chile
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23
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Sadovnichii VA, Aleksandrov VV, Aleksandrova OV, Vega R, Konovalenko IS, Soto E, Tikhonova KV, Gordillo Domingez JL, Gonzalez Petlacalco O. Galvanic Correction of Pilot’s Vestibular Activity during Visual Flight Control. ACTA ACUST UNITED AC 2019. [DOI: 10.3103/s0027133019010011] [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] [Indexed: 11/30/2022]
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24
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González-Medina G, Ruiz P, Guia D, Bueno G, Vega R, Martins A. Risk of fall: a preliminary study to understand the differences between Portuguese and Spanish community dwelling adults aged 50 or over to develop an action plan for an effective fall prevention. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz034.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - P Ruiz
- Nursing and Physiotherapy Department, University of Cádiz, Spain
| | - D Guia
- ESTeSC - Coimbra Health School, Instituto Politécnico de Coimbra, Portugal
| | - G Bueno
- ESTeSC - Coimbra Health School, Instituto Politécnico de Coimbra, Portugal
- University of Brasilia, Brazil
| | - R Vega
- Health Sciences Department, University of Jaén, Spain
| | - A Martins
- ESTeSC - Coimbra Health School, Instituto Politécnico de Coimbra, Portugal
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25
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Ahmad OF, Soares AS, Mazomenos E, Brandao P, Vega R, Seward E, Stoyanov D, Chand M, Lovat LB. Artificial intelligence and computer-aided diagnosis in colonoscopy: current evidence and future directions. Lancet Gastroenterol Hepatol 2018; 4:71-80. [PMID: 30527583 DOI: 10.1016/s2468-1253(18)30282-6] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/10/2018] [Accepted: 08/20/2018] [Indexed: 12/15/2022]
Abstract
Computer-aided diagnosis offers a promising solution to reduce variation in colonoscopy performance. Pooled miss rates for polyps are as high as 22%, and associated interval colorectal cancers after colonoscopy are of concern. Optical biopsy, whereby in-vivo classification of polyps based on enhanced imaging replaces histopathology, has not been incorporated into routine practice because it is limited by interobserver variability and generally only meets accepted standards in expert settings. Real-time decision-support software has been developed to detect and characterise polyps, and also to offer feedback on the technical quality of inspection. Some of the current algorithms, particularly with recent advances in artificial intelligence techniques, match human expert performance for optical biopsy. In this Review, we summarise the evidence for clinical applications of computer-aided diagnosis and artificial intelligence in colonoscopy.
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Affiliation(s)
- Omer F Ahmad
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London, UK; Gastrointestinal Services, University College London Hospital, London, UK.
| | - Antonio S Soares
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Evangelos Mazomenos
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London, UK
| | - Patrick Brandao
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London, UK
| | - Roser Vega
- Gastrointestinal Services, University College London Hospital, London, UK
| | - Edward Seward
- Gastrointestinal Services, University College London Hospital, London, UK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London, UK
| | - Manish Chand
- Division of Surgery & Interventional Science, University College London, London, UK; Gastrointestinal Services, University College London Hospital, London, UK
| | - Laurence B Lovat
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London, UK; Division of Surgery & Interventional Science, University College London, London, UK; Gastrointestinal Services, University College London Hospital, London, UK
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26
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Schiff ER, Frampton M, Ben-Yosef N, Avila BE, Semplici F, Pontikos N, Bloom SL, McCartney SA, Vega R, Lovat LB, Wood E, Hart A, Israeli E, Crespi D, Furman MA, Mann S, Murray CD, Segal AW, Levine AP. Rare coding variant analysis in a large cohort of Ashkenazi Jewish families with inflammatory bowel disease. Hum Genet 2018; 137:723-734. [PMID: 30167848 PMCID: PMC6153494 DOI: 10.1007/s00439-018-1927-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/31/2018] [Indexed: 02/08/2023]
Abstract
Rare variants are thought to contribute to the genetics of inflammatory bowel disease (IBD), which is more common amongst the Ashkenazi Jewish (AJ) population. A family-based approach using exome sequencing of AJ individuals with IBD was employed with a view to identify novel rare genetic variants for this disease. Exome sequencing was performed on 960 Jewish individuals including 513 from 199 multiplex families with up to eight cases. Rare, damaging variants in loci prioritized by linkage analysis and those shared by multiple affected individuals within the same family were identified. Independent evidence of association of each variant with disease was assessed. A number of candidate variants were identified, including in genes involved in the immune system. The ability to achieve statistical significance in independent case/control replication data was limited by power and was only achieved for variants in the well-established Crohn's disease gene, NOD2. This work demonstrates the challenges of identifying disease-associated rare damaging variants from exome data, even amongst a favorable cohort of familial cases from a genetic isolate. Further research of the prioritized rare candidate variants is required to confirm their association with the disease.
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Affiliation(s)
- E R Schiff
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
| | - M Frampton
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
| | - N Ben-Yosef
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
- Inflammatory Bowel Disease Unit, Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - B E Avila
- Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
| | - F Semplici
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
| | - N Pontikos
- UCL Genetics Institute, Division of Biosciences, University College London, London, UK
| | - S L Bloom
- Department of Gastroenterology, University College London Hospital, London, UK
| | - S A McCartney
- Department of Gastroenterology, University College London Hospital, London, UK
| | - R Vega
- Department of Gastroenterology, University College London Hospital, London, UK
| | - L B Lovat
- Research Department of Tissue and Energy, Division of Surgery and Interventional Science, University College London, London, UK
| | - E Wood
- Gastroenterology Department, Homerton University Hospital, London, UK
| | - A Hart
- Gastroenterology Department, St Mark's Hospital, London, UK
| | - E Israeli
- Inflammatory Bowel Disease Unit, Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - D Crespi
- Centre for Paediatric Gastroenterology, Royal Free Hospital, London, UK
| | - M A Furman
- Centre for Paediatric Gastroenterology, Royal Free Hospital, London, UK
| | - S Mann
- Gastroenterology Department, Barnet General Hospital, London, UK
| | - C D Murray
- Centre for Gastroenterology, Royal Free Hospital, London, UK
| | - A W Segal
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
| | - A P Levine
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK.
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Mardones A, Gajardo V, Pizarro MI, Augsburger A, Vega R, Encina F, Pichara C, Escalante PDLR. Evaluation of survival and metamorphosis of larvae of Caligus rogercresseyi (Boxshall and Bravo, 2000) (Crustacea, Copepoda) in Chile, depending on temperature, salinity and oxygen. BRAZ J BIOL 2018; 79:174-179. [PMID: 30066732 DOI: 10.1590/1519-6984.173162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 09/21/2017] [Indexed: 11/21/2022] Open
Abstract
The present study assessed the percentage of survival and metamorphosis of larval stages of Caligus rogercresseyi (Boxshall and Bravo, 2000) nauplius I, nauplius II to and nauplius II to copepodite, conducting bioassays in triplicate with 50 larvae each, nauplius I or nauplius II, at temperature of 12 °C, 15 °C and 18 °C; salinity 20, 23, 25, 2729, 31, 33 and 35 g/L and oxygen saturation with ranges between 30-60%, 90-100% and 190 - 200%. Bioassays were performed in station Quillaipe of Fundación Chile, Puerto Montt, Chile. It is concluded that the temperature is inversely proportional to the time of metamorphosis and survival of the larvae of Caligus rogercresseyi . In salinity is observed that increased this, greater is the percentage of survival and metamorphosis is faster, while the larvae do not survive less than 20g/L. Oxygen saturation ranges indicate that the larvae do not survive at saturations between 30-60%, and it had no differences between 90-100% saturation and 190-200%.
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Affiliation(s)
- A Mardones
- Departamento de Ciencias Agropecuarias y Acuícolas, Facultad de Recursos Naturales, Universidad Católica de Temuco, Casilla 15-D, Temuco, Chile.,Núcleo de Investigación en Producción Alimentaria, Facultad de Recursos Naturales, Universidad Católica de Temuco, Temuco, Chile
| | - V Gajardo
- Departamento de Ciencias Agropecuarias y Acuícolas, Facultad de Recursos Naturales, Universidad Católica de Temuco, Casilla 15-D, Temuco, Chile
| | - M I Pizarro
- Departamento de Ciencias Agropecuarias y Acuícolas, Facultad de Recursos Naturales, Universidad Católica de Temuco, Casilla 15-D, Temuco, Chile
| | - A Augsburger
- Universidad Santo Tomás, Sede Puerto Montt, Chile
| | - R Vega
- Departamento de Ciencias Agropecuarias y Acuícolas, Facultad de Recursos Naturales, Universidad Católica de Temuco, Casilla 15-D, Temuco, Chile.,Núcleo de Investigación en Producción Alimentaria, Facultad de Recursos Naturales, Universidad Católica de Temuco, Temuco, Chile
| | - F Encina
- Departamento de Ciencias Biológicas y Químicas, Facultad de Recursos Naturales, Universidad Católica de Temuco, Casilla 15-D, Temuco, Chile.,Núcleo de Estudios Ambientales, Facultad de Recursos Naturales, Universidad Católica de Temuco, Temuco, Casilla 15-D, Temuco, Chile
| | - C Pichara
- Departamento de Ciencias Agropecuarias y Acuícolas, Facultad de Recursos Naturales, Universidad Católica de Temuco, Casilla 15-D, Temuco, Chile
| | - P De Los Ríos Escalante
- Departamento de Ciencias Biológicas y Químicas, Facultad de Recursos Naturales, Universidad Católica de Temuco, Casilla 15-D, Temuco, Chile.,Núcleo de Estudios Ambientales, Facultad de Recursos Naturales, Universidad Católica de Temuco, Temuco, Casilla 15-D, Temuco, Chile
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Mehta S, Rodriguez D, Botelho R, Fernandez F, Dusilek C, Cardoso R, Lacativa M, Perin M, Feres F, Abizaid A, Campos C, Vega R, Bojanini F, Alcocer M, Estrada A. P4491Telemedicine-guided STEMI networks - Pragmatic and cost-effective strategies for population-based AMI care in developing countries. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - D Rodriguez
- Lumen Foundation, Miami, United States of America
| | - R Botelho
- Triangulo Heart Institute, Uberlandia, Brazil
| | | | - C Dusilek
- Hospital de Santa Marcelina, Sao Paulo, Brazil
| | - R Cardoso
- Unimed-Rio Hospital, Rio de Janeiro, Brazil
| | - M Lacativa
- Hospital do Coração de Duque de Caxias, Rio de Janeiro, Brazil
| | - M Perin
- Hospital Santa Marcelina, Sao Paulo, Brazil
| | - F Feres
- Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil
| | - A Abizaid
- Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil
| | - C Campos
- Hospital Santa Marcelina, Sao Paulo, Brazil
| | - R Vega
- ITMS Colombia, Bogota, Colombia
| | - F Bojanini
- Unidad de Cardiología del Camino Universitario Adelita de Char, Barranquilla, Colombia, Barranquilla, Colombia
| | - M Alcocer
- Instituto del Corazon de Queretaro, Queretaro, Mexico
| | - A Estrada
- Instituto Metropolitano del Corazon, Tuxtla, Mexico
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Mehta S, Rodriguez D, Botelho R, Fernandez F, Torres MA, Aboushi H, Vidal LC, Tellez M, Dusilek C, Perin M, Cade J, Campos C, Vega R, Bojanini F, Alcocer M. P2547Economic forecasting of Latin America Telemedicine Network (LATIN). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - D Rodriguez
- Lumen Foundation, Miami, United States of America
| | - R Botelho
- Triangulo Heart Institute, Uberlandia, Brazil
| | | | - M A Torres
- Lumen Foundation, Miami, United States of America
| | - H Aboushi
- Lumen Foundation, Miami, United States of America
| | - L C Vidal
- Lumen Foundation, Miami, United States of America
| | - M Tellez
- Lumen Foundation, Miami, United States of America
| | - C Dusilek
- Hospital Santa Marcelina, Sao Paulo, Brazil
| | - M Perin
- Hospital Santa Marcelina, Sao Paulo, Brazil
| | - J Cade
- Hospital do Rozio, Campo Largo, Brazil
| | - C Campos
- Hospital Santa Marcelina, Sao Paulo, Brazil
| | - R Vega
- ITMS Colombia, Bogota, Colombia
| | - F Bojanini
- Unidad de Cardiología del Camino Universitario Adelita de Char, Barranquilla, Colombia
| | - M Alcocer
- instituto del Corazon de Queretaro, Queretaro, Mexico
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Mehta S, Rodriguez D, Botelho R, Fernandez F, Torres M, Vidal LC, Aboushi H, Tellez M, Dusilek C, Cade J, Campos C, Vega R, Bojaninni F, Alcocer M, Estrada A. P3159Economic impact of avoiding unnecessary transfer & hospitalization - results from Latin AmericaTtelemedicine Infarct Network (LATIN). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - D Rodriguez
- Lumen Foundation, Miami, United States of America
| | - R Botelho
- Triangulo Heart Institute, Uberlandia, Brazil
| | | | - M Torres
- Lumen Foundation, Miami, United States of America
| | - L C Vidal
- Lumen Foundation, Miami, United States of America
| | - H Aboushi
- Lumen Foundation, Miami, United States of America
| | - M Tellez
- Lumen Foundation, Miami, United States of America
| | - C Dusilek
- Hospital do Rocio, Campo Largo, Brazil
| | - J Cade
- Hospital Santa Marcelina, Sao Paulo, Brazil
| | - C Campos
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - R Vega
- ITMS Colombia, Bogota, Colombia
| | - F Bojaninni
- Unidad de Cardiología del Camino Universitario Adelita de Char, Barranquilla, Colombia
| | - M Alcocer
- Instituto del Corazon de Queretaro, Queretaro, Mexico
| | - A Estrada
- Instituto Cardiovascular Metropolitano de Tuxtla, Tuxtla, Mexico
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Vega R, Zambrano H, Rivera L, Ordoñez C, Jaramillo E, Martínez J. Frequency of Pulmonary and Non-Pulmonary TB infections detected by Real-Time PCR in a single Reference Center in Guayaquil, Ecuador. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.4192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Mehta S, Rodriguez D, Botelho R, Fernandez F, Torres MA, Aboushi H, Vidal LC, Tellez M, Perin MA, Cardoso R, Vega R, Bojanini F, Corral J, Alcocer M, Estrada A. P4568Utilizing telemedicine platforms to construct population-based AMI management - Results from half a million patient encounters in Latin America Telemedicine Infarct Network (LATIN). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - D Rodriguez
- Lumen Foundation, Miami, United States of America
| | - R Botelho
- Triangulo Heart Institute, Uberlandia, Brazil
| | | | - M A Torres
- Lumen Foundation, Miami, United States of America
| | - H Aboushi
- Lumen Foundation, Miami, United States of America
| | - L C Vidal
- Lumen Foundation, Miami, United States of America
| | - M Tellez
- Lumen Foundation, Miami, United States of America
| | - M A Perin
- Hospital Santa Marcelina, Sao Paulo, Brazil
| | - R Cardoso
- Unimed-Rio Hospital, Rio de Janeiro, Brazil
| | - R Vega
- ITMS Colombia, Bogota, Colombia
| | - F Bojanini
- Unidad de Cardiología del Camino Universitario Adelita de Char, Barranquilla, Colombia
| | - J Corral
- Lumen Foundation, Miami, United States of America
| | - M Alcocer
- instituto del Corazon de Queretaro, Queretaro, Mexico
| | - A Estrada
- Instituto Metropolitano del Corazon, Tuxtla, Mexico
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Schiff ER, Frampton M, Semplici F, Bloom SL, McCartney SA, Vega R, Lovat LB, Wood E, Hart AL, Crespi D, Furman MA, Mann S, Murray CD, Segal AW, Levine AP. A New Look at Familial Risk of Inflammatory Bowel Disease in the Ashkenazi Jewish Population. Dig Dis Sci 2018; 63:3049-3057. [PMID: 30178286 PMCID: PMC6182437 DOI: 10.1007/s10620-018-5219-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/18/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS The inflammatory bowel diseases (IBD) are particularly common among the Ashkenazi Jewish (AJ) population. Population-specific estimates of familial risk are important for counseling; however, relatively small cohorts of AJ IBD patients have been analyzed for familial risk to date. This study aimed to recruit a new cohort of AJ IBD patients, mainly from the UK, to determine the familial occurrence of disease. METHODS A total of 864 AJ IBD patients were recruited through advertisements, hospital clinics, and primary care. Participants were interviewed about their Jewish ancestry, disease phenotype, age of diagnosis, and family history of disease. Case notes were reviewed. RESULTS The 864 probands comprised 506 sporadic and 358 familial cases, the latter with a total of 625 affected relatives. Of the UK cases, 40% had a positive family history with 25% having at least one affected first-degree relative. These percentages were lower among those recruited through hospital clinics and primary care (33% for all relatives and 22% among first-degree relatives). Examining all probands, the relative risk of IBD for offspring, siblings, and parents was 10.5, 7.4, and 4, respectively. Age of diagnosis was significantly lower in familial versus sporadic patients with Crohn's disease. CONCLUSIONS This study reports familial risk estimates for a significant proportion of the AJ IBD population in the UK. The high rate of a positive family history in this cohort may reflect the greater genetic burden for IBD among AJs. These data are of value in predicting the likelihood of future recurrence of IBD in AJ families.
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Affiliation(s)
- Elena R. Schiff
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
| | - Matthew Frampton
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
| | - Francesca Semplici
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
| | - Stuart L. Bloom
- Department of Gastroenterology, University College London Hospital, London, UK
| | - Sara A. McCartney
- Department of Gastroenterology, University College London Hospital, London, UK
| | - Roser Vega
- Department of Gastroenterology, University College London Hospital, London, UK
| | - Laurence B. Lovat
- Department of Gastroenterology, University College London Hospital, London, UK ,Research Department of Tissue and Energy, Division of Surgery and Interventional Science, University College London, London, UK
| | - Eleanor Wood
- Gastroenterology Department, Homerton University Hospital, London, UK
| | - Ailsa L. Hart
- Gastroenterology Department, St Mark’s Hospital, London, UK
| | - Daniel Crespi
- Centre for Paediatric Gastroenterology, Royal Free Hospital, London, UK
| | - Mark A. Furman
- Centre for Paediatric Gastroenterology, Royal Free Hospital, London, UK
| | - Steven Mann
- Gastroenterology Department, Barnet General Hospital, London, UK
| | | | - Anthony W. Segal
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
| | - Adam P. Levine
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
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Mehta S, Ferre A, Botelho R, Fernandes F, Vega R, Bojanini F, Corral J, Rodriguez D, Cardoso R, Perin M, Campos C. P3408Telemedicine + STEMI systems of care: novel solution to massively expand access to AMI care in developing countries. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3408] [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: 11/12/2022] Open
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Mehta S, Ferre A, Botelho R, Fernandes F, Vega R, Bojanini F, Corral J, Rodriguez D, Cardoso R, Perin M, Campos C. 4143Telemedicine increases access, accuracy & cost-effectiveness of population based AMI care: results of the Latin America telemedicine infarct network (LATIN). Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.4143] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Valentin MO, Ruiz JC, Vega R, Martín C, Matesanz R. Implementation of a National Priority Allocation System for Hypersensitized Patients in Spain, Based on Virtual Crossmatch: Initial Results. Transplant Proc 2017; 48:2871-2875. [PMID: 27932095 DOI: 10.1016/j.transproceed.2016.09.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/12/2016] [Accepted: 09/01/2016] [Indexed: 12/21/2022]
Abstract
Access to kidney transplantation for patients with high levels of antibodies against HLA is a major challenge. This issue makes it difficult to detect compatible donors for those patients in a certain geographical area. Consequently, hypersensitized patients remain on the waiting list for long periods and their quality of life deteriorates. Our purpose was to increase access to transplantation for highly sensitized patients by developing a national priority allocation system based on virtual crossmatch. Between June 15, 2015, and May 15, 2016, 675 patients on the kidney transplant waiting list with calculated panel-reactive antibodies ≥98% and undergoing dialysis for at least 12 months were included in the study; 86.1% of the patients had previously received at least one transplant. Solid-phase immunoassays were used to identify class I and II HLA antibodies in all patients. Participating hospitals assigned to the program one of the kidneys of every identified brain-dead real donor between 18 and 70 years old. Survival data were collected for the recipients transplanted between June 15, 2015, and December 31, 2015. In all, 475 (290 male and 185 female) brain-dead donors were assigned to the program. Virtual crossmatch was negative for 191 (41%) donors, 149 offers were accepted, and 102 (21.8%) kidneys were transplanted. At the end of the study, patient and graft survival were both 93.4%. The implementation of a national prioritization system based on virtual crossmatch increased access to transplantation for highly sensitized patients, with excellent results in terms of patient and graft survival.
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Affiliation(s)
- M O Valentin
- Spanish National Transplant Organization (ONT); Working Group PATHI.
| | - J C Ruiz
- Nephrology Department, Hospital Marques de Valdecilla, Santander, Spain; Working Group PATHI
| | - R Vega
- Spanish National Transplant Organization (ONT); Working Group PATHI
| | - C Martín
- Spanish National Transplant Organization (ONT); Working Group PATHI
| | - R Matesanz
- Spanish National Transplant Organization (ONT)
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Mahmood H, Plumb A, Vega R, Windsor A. Incidental finding - the discovery of a bronchopulmonary foregut malformation through investigations for Crohn's disease. J Radiol Case Rep 2017; 11:10-19. [PMID: 28567181 PMCID: PMC5439451 DOI: 10.3941/jrcr.v11i4.3002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pulmonary sequestration (PMS) is a rare bronchopulmonary malformation. It has an incidence of between 0.15% to 1.7%. Likewise, cystic adenomatoid malformation (CCAM) is another relatively rare category of a bronchopulmonary malformation with a reported incidence of between 1 in 25,000 to 1 in 35,000. Moreover, a bronchopulmonary malformation with features allied to both of these forms is considered an even rarer entity. In general, bronchopulmonary malformations present with a range of non-specific symptoms. Radiological features can be non-specific yet distinctive when related to clinical features. Ultimately, definitive diagnosis depends upon histological assessment of lung tissue. We present an adult female with radiological features of both pulmonary sequestration and cystic adenomatoid malformation. This was an incidental finding unrelated to the patients presenting complaint. This case highlights the importance of using a structured and systematic approach when interpreting medical imagery.
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Affiliation(s)
- Humza Mahmood
- Princess Alexandra Hospital, Hamstel Road, Harlow, CM20 1QX, UK
| | - Andrew Plumb
- Department of Radiology, University College Hospital, 235 Euston Road, Fitzrovia, London, NW1 2BU, UK
| | - Roser Vega
- Department of Gastrointestinal services, University College Hospital, 235 Euston Road, Fitzrovia, London, NW1 2BU, UK
| | - Alastair Windsor
- Department of Gastrointestinal services, University College Hospital, 235 Euston Road, Fitzrovia, London, NW1 2BU, UK
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Fogarty PF, Blair A, Vega R, Matthai WH, Gimotty PA. Interventional therapies and in-hospital outcomes in acute coronary syndromes complicated by von Willebrand disease. Haemophilia 2016; 23:400-407. [PMID: 27976460 DOI: 10.1111/hae.13149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2016] [Indexed: 01/05/2023]
Abstract
INTRODUCTION von Willebrand disease (VWD) is one of the most common inherited bleeding disorders. AIM Investigate the impact of the VWD bleeding tendency on in-hospital management of acute coronary syndromes (ACS). METHODS Using discharge data from the National Inpatient Sample (NIS), the features of presentation and in-hospital treatment among ACS hospital discharges with and without a VWD diagnosis were investigated. A total of 264 case discharges and 705 860 control discharges were identified. RESULTS AND CONCLUSIONS There was a significantly higher percentage of women among the case discharges compared to the control discharges (59.5% and 39.4%, respectively; P < 0.001). The rate of medical therapy alone [i.e. avoidance of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)] was significantly higher among unstable angina cases than controls (55.0% vs. 46.4%; P = 0.01), and among cases undergoing PCI, bare-metal stents (BMS) were utilized in preference to drug-eluting stents (DES) (adjusted OR = 3.5); P < 0.001). No difference in in-hospital death was identified, but reported bleeding among discharges that underwent CABG was higher in cases compared to controls (12.9% vs. 5.2%; P = 0.047). Although medical and interventional management of ACS appears to be well tolerated in the majority of hospitalized patients with VWD, the gender ratio is reversed, interventions and DES are utilized less frequently and procedure-related bleeding may be increased, calling for further study.
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Affiliation(s)
- P F Fogarty
- Penn Comprehensive Hemophilia and Thrombosis Program, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - A Blair
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA, USA
| | - R Vega
- Penn Comprehensive Hemophilia and Thrombosis Program, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - W H Matthai
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - P A Gimotty
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA, USA
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Sood SL, James AH, Ragni MV, Shapiro AD, Witmer C, Vega R, Bolgiano D, Konkle BA. A prospective study of von Willebrand factor levels and bleeding in pregnant women with type 1 von Willebrand disease. Haemophilia 2016; 22:e562-e564. [DOI: 10.1111/hae.13086] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 11/29/2022]
Affiliation(s)
- S. L. Sood
- Hematology/Oncology; University of Michigan; Ann Arbor MI USA
| | - A. H. James
- Department of OB/GYN; Duke University Medical Center; Durham NC USA
| | - M. V. Ragni
- Department of Medicine; Division Hematology/Oncology; University of Pittsburgh and Hemophilia Center of Western Pennsylvania; Pittsburgh PA USA
| | - A. D. Shapiro
- Indiana Hemophilia and Thrombosis Center; Indianapolis IN USA
| | - C. Witmer
- Hematology; The Children's Hospital of Philadelphia; Philadelphia PA USA
- University of Pennsylvania; Philadelphia PA USA
| | - R. Vega
- University of Pennsylvania; Philadelphia PA USA
| | | | - B. A. Konkle
- Bloodworks Northwest; Seattle WA USA
- Department of Medicine; Division of Hematology; University of Washington; Seattle WA USA
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Ali Munive A, Varon Vega FA, Hernandez Parra A, Molina F, Poveda M, Meza RA, Castro H, Urbina Z, Mercado J, Martinez J, Mayorga M, Pareja M, Cepeda E, Sanchez M, Vega R, Camargo F, Vergara J. Epidemiology, clinical differences and outcomes of tracheobronchitis and pneumonia associated to mechanical ventilation in intensive care units of latin america (LATINNAVE). Intensive Care Med Exp 2015. [PMCID: PMC4798223 DOI: 10.1186/2197-425x-3-s1-a703] [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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41
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Prezzi D, Bhatnagar G, Vega R, Makanyanga J, Halligan S, Taylor SA. Monitoring Crohn's disease during anti-TNF-α therapy: validation of the magnetic resonance enterography global score (MEGS) against a combined clinical reference standard. Eur Radiol 2015; 26:2107-17. [PMID: 26433956 DOI: 10.1007/s00330-015-4036-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 09/14/2015] [Accepted: 09/17/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To assess the ability of magnetic resonance enterography global score (MEGS) to characterise Crohn's disease (CD) response to anti-TNF-α therapy. METHODS Thirty-six CD patients (median age 26 years, 20 males) commencing anti-TNF-α therapy with concomitant baseline MRI enterography (MRE) were identified retrospectively. Patients' clinical course was followed and correlated with subsequent MREs. Scan order was randomised and MEGS (a global activity score) was applied by two blinded radiologists. A physician's global assessment of the disease activity (remission, mild, moderate or severe) at the time of MRE was assigned. The cohort was divided into clinical responders and non-responders and MEGS compared according to activity status and treatment response. Interobserver agreement was assessed. RESULTS Median MEGS decreased significantly between baseline and first follow-up in responders (28 versus 6, P < 0.001) but was unchanged in non-responders (26 versus 18, P = 0.28). The median MEGS was significantly lower in clinical remission (9) than in moderate (14) or severe (29) activity (P < 0.001). MEGS correlated significantly with clinical activity (r = 0.53; P < 0.001). Interobserver Bland-Altman limits of agreement (BA LoA) were -19.7 to 18.5. CONCLUSIONS MEGS decreases significantly in clinical responders to anti-TNF-α therapy but not in non-responders, demonstrates good interobserver agreement and moderate correlation with clinical disease activity. KEY POINTS • MRI scores of Crohn's activity are used increasingly in clinical practice and therapeutic trials. • Such scores have been advocated as biomarkers of therapeutic response. • MEGS reflects clinical response to anti-TNF-α therapy and the clinical classification of disease activity. • MEGS demonstrates good interobserver agreement.
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Affiliation(s)
- Davide Prezzi
- Centre for Medical Imaging, University College London, 3rd floor east, 250 Euston Rd, London, NW1 2PG, UK.,Department of Cancer Imaging, King's College London, St Thomas' Hospital, 4th floor Lambeth Wing, London, SE1 7EH, UK
| | - Gauraang Bhatnagar
- Centre for Medical Imaging, University College London, 3rd floor east, 250 Euston Rd, London, NW1 2PG, UK
| | - Roser Vega
- Gastrointestinal Services, University College Hospital, Ground floor west, 250 Euston Road, London, NW1 2PG, UK
| | - Jesica Makanyanga
- Centre for Medical Imaging, University College London, 3rd floor east, 250 Euston Rd, London, NW1 2PG, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, 3rd floor east, 250 Euston Rd, London, NW1 2PG, UK
| | - Stuart Andrew Taylor
- Centre for Medical Imaging, University College London, 3rd floor east, 250 Euston Rd, London, NW1 2PG, UK.
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Bhatnagar G, Dikaios N, Prezzi D, Vega R, Halligan S, Taylor SA. Changes in dynamic contrast-enhanced pharmacokinetic and diffusion-weighted imaging parameters reflect response to anti-TNF therapy in Crohn's disease. Br J Radiol 2015; 88:20150547. [PMID: 26402217 DOI: 10.1259/bjr.20150547] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To investigate the effect of tumour necrosis factor (TNF)-α antagonists on MRI dynamic contrast-enhanced (DCE) and diffusion-weighted imaging (DWI) parameters in Crohn's disease (CD). METHODS 42 patients with CD (median age 24 years; 22 females) commencing anti-TNF-α therapy with baseline and follow-up (median 51 weeks) 1.5-T MR enterography (MRE) were retrospectively identified. MRE included DCE (n = 20) and/or multi-b-value DWI (n = 17). Slope of enhancement (SoE), maximum enhancement (ME), area under the time-intensity curve (AUC), Ktrans (transfer constant), ve (fractional volume of the extravascular-extracellular space), apparent diffusion coefficient (ADC) and ADCfast/slow were derived from the most inflamed bowel segments. A physician global assessment of disease activity (remission, mild, moderate and severe) at the time of MRE was assigned, and the cohort was divided into responders and non-responders. Data were compared using Mann-Whitney U test and analysis of variance. RESULTS Follow-up Ktrans, ME, SoE, AUC and ADCME changed significantly in clinical responders but not in non-responders, baseline {[median [interquartile range (IQR)]: 0.42 (0.38), 1.24 (0.52), 0.18 (0.17), 17.68 (4.70) and 1.56 mm(2) s(-1) (0.39 mm(2) s(-1)) vs follow-up [median (IQR): 0.15 (0.22), 0.50 (0.54), 0.07 (0.1), 14.73 (2.06) and 2.14 mm(2) s(-1) (0.62 mm(2) s(-1)), for responders, respectively, p = 0.006 to p = 0.037}. SoE was higher and ME and AUC lower for patients in remission than for those with severe activity [mean (standard deviation): 0.55 (0.46), 0.49 (0.28), 14.32 (1.32)] vs [0.32 (0.37), 2.21 (2.43) and 23.05 (13.66), respectively p = 0.017 to 0.033]. ADC was significantly higher for patients in remission [2.34 mm(2) s(-1) (0.67 mm(2) s(-1))] than for those with moderate [1.59 mm(2) s(-1) (0.26 mm(2) s(-1))] (p = 0.005) and severe disease [1.63 mm(2) s(-1) (0.21 mm(2) s(-1))] (p = 0.038). CONCLUSION DCE and DWI parameters change significantly in responders to TNF-α antagonists and are significantly different according to clinically defined disease activity status. ADVANCES IN KNOWLEDGE DCE and DWI parameters change significantly in responders to TNF-α antagonists in CD, suggesting an effect on bowel wall vascularity.
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Affiliation(s)
| | - Nikolaos Dikaios
- 1 Centre for Medical Imaging, University College London, London, UK
| | - Davide Prezzi
- 1 Centre for Medical Imaging, University College London, London, UK.,2 Department of Cancer Imaging, King's College London, UCL CMI, London, UK
| | - Roser Vega
- 3 Gastroenterology Department, University College London Hospitals, UCLH, London, UK
| | - Steve Halligan
- 1 Centre for Medical Imaging, University College London, London, UK
| | - Stuart A Taylor
- 1 Centre for Medical Imaging, University College London, London, UK
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Plumb AA, Menys A, Russo E, Prezzi D, Bhatnagar G, Vega R, Halligan S, Orchard TR, Taylor SA. Magnetic resonance imaging-quantified small bowel motility is a sensitive marker of response to medical therapy in Crohn's disease. Aliment Pharmacol Ther 2015; 42:343-55. [PMID: 26059751 DOI: 10.1111/apt.13275] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 03/26/2015] [Accepted: 05/21/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Magnetic resonance enterography (MRE) can measure small bowel motility, reduction in which reflects inflammatory burden in Crohn's Disease (CD). However, it is unknown if motility improves with successful treatment. AIM To determine if changes in segmental small bowel motility reflect response to anti-TNFα therapy after induction and longer term. METHODS A total of 46 patients (median 29 years, 19 females) underwent MRE before anti-TNFα treatment; 35 identified retrospectively underwent repeat MRE after median 55 weeks of treatment and 11 recruited prospectively after median 12 weeks. Therapeutic response was defined by physician global assessment (retrospective group) or a ≥3 point drop in the Harvey-Bradshaw Index (prospective group), C-reactive protein (CRP) and the MaRIA score. Two independent radiologists measured motility using an MRE image-registration algorithm. We compared motility changes in responders and nonresponders using the Mann-Whitney test. RESULTS Anti-TNFα responders had significantly greater improvements in motility (median = 73.4% increase from baseline) than nonresponders (median = 25% reduction, P < 0.001). Improved MRI-measured motility was 93.1% sensitive (95%CI: 78.0-98.1%) and 76.5% specific (95% CI: 52.7-90.4%) for anti-TNFα response. Patients with CRP normalisation (<5 mg/L) had significantly greater improvements in motility (median = 73.4% increase) than those with persistently elevated CRP (median = 5.1%, P = 0.035). Individuals with post-treatment MaRIA scores of <11 had greater motility improvements (median = 94.7% increase) than those with post-treatment MaRIA score >11 (median 15.2% increase, P = 0.017). CONCLUSIONS Improved MRI-measured small bowel motility accurately detects response to anti-TNFα therapy for Crohn's disease, even as early as 12 weeks. Motility MRI may permit early identification of nonresponse to anti-TNFα agents, allowing personalised treatment.
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Affiliation(s)
- A A Plumb
- Centre for Medical Imaging, University College London, London, UK
| | - A Menys
- Centre for Medical Imaging, University College London, London, UK
| | - E Russo
- Department of Gastroenterology, Imperial College London, London, UK
| | - D Prezzi
- Centre for Medical Imaging, University College London, London, UK.,Department of Cancer Imaging, King's College London, London, UK
| | - G Bhatnagar
- Centre for Medical Imaging, University College London, London, UK
| | - R Vega
- Department of Gastroenterology, University College London Hospitals NHS Trust, London, UK
| | - S Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - T R Orchard
- Department of Gastroenterology, Imperial College London, London, UK
| | - S A Taylor
- Centre for Medical Imaging, University College London, London, UK
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del Puerto-Nevado L, Rojo F, Zazo S, Caramés C, Rubio G, Vega R, Chamizo C, Casado V, Martínez-Useros J, Rincón R, Rodríguez-Remírez M, Borrero-Palacios A, Cristóbal I, Madoz-Gúrpide J, Aguilera O, García-Foncillas J. Active angiogenesis in metastatic renal cell carcinoma predicts clinical benefit to sunitinib-based therapy. Br J Cancer 2014; 110:2700-7. [PMID: 24786599 PMCID: PMC4037833 DOI: 10.1038/bjc.2014.225] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/27/2014] [Accepted: 04/04/2014] [Indexed: 01/15/2023] Open
Abstract
Background: Sunitinib represents a widely used therapy for metastatic renal cell carcinoma patients. Even so, there is a group of patients who show toxicity without clinical benefit. In this work, we have analysed pivotal molecular targets involved in angiogenesis (vascular endothelial growth factor (VEGF)-A, VEGF receptor 2 (KDR), phosphorylated (p)KDR and microvascular density (MVD)) to test their potential value as predictive biomarkers of clinical benefit in sunitinib-treated renal cell carcinoma patients. Methods: Vascular endothelial growth factor-A, KDR and pKDR-Y1775 expression as well as CD31, for MVD visualisation, were determined by immunohistochemistry in 48 renal cell carcinoma patients, including 23 metastatic cases treated with sunitinib. Threshold was defined for each biomarker, and univariate and multivariate analyses for progression-free survival (PFS) and overall survival (OS) were carried out. Results: The HistoScore mean value obtained for VEGF-A was 121.6 (range, 10–300); for KDR 258.5 (range, 150–300); for pKDR-Y1775 10.8 (range, 0–65) and the mean value of CD31-positive structures for MVD visualisation was 49 (range, 10–126). Statistical differences for PFS (P=0.01) and OS (P=0.007) were observed for pKDR-Y1775 in sunitinib-treated patients. Importantly, pKDR-Y1775 expression remained significant after multivariate Cox analysis for PFS (P=0.01; HR: 5.35, 95% CI, 1.49–19.13) and for OS (P=0.02; HR: 5.13, 95% CI, 1.25–21.05). Conclusions: Our results suggest that the expression of phosphorylated (i.e., activated) KDR in tumour stroma might be used as predictive biomarker for the clinical outcome in renal cell carcinoma first-line sunitinib-treated patients.
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Affiliation(s)
- L del Puerto-Nevado
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital 'Fundación Jiménez Díaz', Avenida Reyes Católicos, 2, 28040 Madrid, Spain
| | - F Rojo
- Department of Pathology, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital 'Fundación Jiménez Díaz', Avenida Reyes Católicos, 2, 28040 Madrid, Spain
| | - S Zazo
- Department of Pathology, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital 'Fundación Jiménez Díaz', Avenida Reyes Católicos, 2, 28040 Madrid, Spain
| | - C Caramés
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital 'Fundación Jiménez Díaz', Avenida Reyes Católicos, 2, 28040 Madrid, Spain
| | - G Rubio
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital 'Fundación Jiménez Díaz', Avenida Reyes Católicos, 2, 28040 Madrid, Spain
| | - R Vega
- Department of Pathology, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital 'Fundación Jiménez Díaz', Avenida Reyes Católicos, 2, 28040 Madrid, Spain
| | - C Chamizo
- Department of Pathology, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital 'Fundación Jiménez Díaz', Avenida Reyes Católicos, 2, 28040 Madrid, Spain
| | - V Casado
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital 'Fundación Jiménez Díaz', Avenida Reyes Católicos, 2, 28040 Madrid, Spain
| | - J Martínez-Useros
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital 'Fundación Jiménez Díaz', Avenida Reyes Católicos, 2, 28040 Madrid, Spain
| | - R Rincón
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital 'Fundación Jiménez Díaz', Avenida Reyes Católicos, 2, 28040 Madrid, Spain
| | - M Rodríguez-Remírez
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital 'Fundación Jiménez Díaz', Avenida Reyes Católicos, 2, 28040 Madrid, Spain
| | - A Borrero-Palacios
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital 'Fundación Jiménez Díaz', Avenida Reyes Católicos, 2, 28040 Madrid, Spain
| | - I Cristóbal
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital 'Fundación Jiménez Díaz', Avenida Reyes Católicos, 2, 28040 Madrid, Spain
| | - J Madoz-Gúrpide
- Department of Pathology, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital 'Fundación Jiménez Díaz', Avenida Reyes Católicos, 2, 28040 Madrid, Spain
| | - O Aguilera
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital 'Fundación Jiménez Díaz', Avenida Reyes Católicos, 2, 28040 Madrid, Spain
| | - J García-Foncillas
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital 'Fundación Jiménez Díaz', Avenida Reyes Católicos, 2, 28040 Madrid, Spain
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Varley CD, Deodhar AA, Ehst BD, Bakke A, Blauvelt A, Vega R, Yamashita S, Winthrop KL. Persistence of Staphylococcus aureus colonization among individuals with immune-mediated inflammatory diseases treated with TNF- inhibitor therapy. Rheumatology (Oxford) 2013; 53:332-7. [DOI: 10.1093/rheumatology/ket351] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Rodríguez BEA, Pinzón Z, Huaman BJ, Mansur M, Vega R, Ortega S, Osuna-Ramírez I, Loya-Montiel I, Arambu N, Morales-Miranda S. P3.175 Prevalence of HIV, Syphilis, Drugs Use and Sexual Risk Behaviours Among Prisoners in Guatemala, 2012. Sex Transm Infect 2013. [DOI: 10.1136/sextrans-2013-051184.0632] [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: 11/04/2022] Open
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47
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Huamán B, Alvarez B, Loya-Montiel I, Osuna-Ramírez I, Pinzón Z, Mansur M, Ortega S, Vega R, Morales-Miranda S. P3.044 HIV Risk Behaviors, in Juvenile Delinquents and in Family Abandonment Situations. Guatemala, 2012. Sex Transm Infect 2013. [DOI: 10.1136/sextrans-2013-051184.0504] [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: 11/04/2022] Open
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Rubio N, Almanza A, Mercado F, Arévalo MÁ, Garcia-Segura LM, Vega R, Soto E. Upregulation of voltage-gated Ca2+ channels in mouse astrocytes infected with Theiler's murine encephalomyelitis virus (TMEV). Neuroscience 2013; 247:309-18. [PMID: 23742846 DOI: 10.1016/j.neuroscience.2013.05.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 05/15/2013] [Accepted: 05/20/2013] [Indexed: 11/25/2022]
Abstract
Theiler's murine encephalomyelitis virus (TMEV) induces demyelination in susceptible strains of mice through a CD4(+) Th1 T cell-mediated immunopathological process. TMEV infection produces a syndrome in mice that resembles multiple sclerosis. In this work, we focused on the increased expression of the genes encoding voltage-gated Ca(2+) channel subunits in SJL/J mouse astrocytes infected in culture with a BeAn strain of TMEV. Affymetrix DNA murine genome U74v2 DNA microarray hybridized with cRNA from mock- and TMEV-infected astrocytes revealed the upregulation of four sequences encoding Ca(2+)-binding and Ca(2+) channel subunit proteins. The DNA hybridization results were further validated using conventional RT-PCR and quantitative RT-PCR, demonstrating the increased expression of mRNA encoding channel subunit proteins. Western blotting also showed the increased synthesis of L- and N-type channel subunit specific proteins after infection. The reduced expression and the functional upregulation of functional voltage-gated Ca(2+) channels in mock- and TMEV-infected cells, respectively, was demonstrated using voltage clamp experiments. TMEV infection in mouse astrocytes induced a Ca(2+) current with a density proportional to the amount of viral particles used for infection. The use of Ca(2+) channel blockers, nimodipine and ω-conotoxin-GVIA, showed that both functional L- and N-type Ca(2+) channels were upregulated in infected astrocytes. The upregulation of Ca(2+) channels in astrocytes after TMEV infection provides insight into the molecular processes and potential role of astrocyte Ca(2+) dysregulation in the pathophysiology of encephalomyelitis and is important for the development of novel therapeutic strategies leading to prevention of neurodegeneration.
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Affiliation(s)
- N Rubio
- Instituto Cajal, CSIC, Madrid, Spain
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Cervantes B, Vega R, Limón A, Soto E. Identity, expression and functional role of the sodium-activated potassium current in vestibular ganglion afferent neurons. Neuroscience 2013; 240:163-75. [PMID: 23466807 DOI: 10.1016/j.neuroscience.2013.02.052] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 02/19/2013] [Accepted: 02/20/2013] [Indexed: 10/27/2022]
Abstract
Vestibular afferent neurons (VANs) transmit information from the vestibular end organs to the central nuclei. This information is encoded within the firing pattern of these cells and is heavily influenced by the K⁺ conductances expressed by vestibular neurons. In the present study, we describe the presence of a previously unidentified Na⁺-activated K⁺ conductance (KNa) in these cells. We observed that the blocking of Na⁺ channels by tetrodotoxin (TTX) or the substitution of choline for Na⁺ in the extracellular solution during voltage clamp pulses resulted in the reduction of a sustained outward current that was dependent on the Na⁺ current. Furthermore, increases in the intracellular concentration of Na⁺ that were made by blocking the Na⁺/K⁺ ATPase with ouabain increased the amplitude of the outward current, and reduction of the intracellular Cl⁻ concentration reduced the TTX-sensitive outward current. The substitution of Li⁺ for Na⁺ in the extracellular solution significantly reduced the amplitude of the outward current in voltage clamp pulses and decreased the afterhyperpolarization (AHP) of the action potentials in current clamp experiments. These electrophysiological results are consistent with the presence of mRNA transcripts for the KNa subunits Slick and Slack in the vestibular ganglia and in the sensory epithelium, which were detected using reverse-transcription polymerase chain reaction (RT-PCR). These results are also consistent with the immunolabeling of Slick and Slack protein in isolated vestibular neurons, in the vestibular ganglion and in the vestibular sensory epithelium. These results indicate that KNa channels are expressed in VANs and in their terminals. Furthermore, these data indicate that these channels may contribute to the firing pattern of vestibular neurons.
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Affiliation(s)
- B Cervantes
- Instituto de Fisiología, Universidad Autónoma de Puebla, 14 Sur 6301, Puebla C.P. 72570, Pue., Mexico
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Sewell GW, Hannun YA, Han X, Koster G, Bielawski J, Goss V, Smith PJ, Rahman FZ, Vega R, Bloom SL, Walker AP, Postle AD, Segal AW. Lipidomic profiling in Crohn's disease: abnormalities in phosphatidylinositols, with preservation of ceramide, phosphatidylcholine and phosphatidylserine composition. Int J Biochem Cell Biol 2012; 44:1839-46. [PMID: 22728312 PMCID: PMC3778899 DOI: 10.1016/j.biocel.2012.06.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 06/08/2012] [Accepted: 06/12/2012] [Indexed: 11/23/2022]
Abstract
Crohn's disease is a chronic inflammatory condition largely affecting the terminal ileum and large bowel. A contributing cause is the failure of an adequate acute inflammatory response as a result of impaired secretion of pro-inflammatory cytokines by macrophages. This defective secretion arises from aberrant vesicle trafficking, misdirecting the cytokines to lysosomal degradation. Aberrant intestinal permeability is also well-established in Crohn's disease. Both the disordered vesicle trafficking and increased bowel permeability could result from abnormal lipid composition. We thus measured the sphingo- and phospholipid composition of macrophages, using mass spectrometry and stable isotope labelling approaches. Stimulation of macrophages with heat-killed Escherichia coli resulted in three main changes; a significant reduction in the amount of individual ceramide species, an altered composition of phosphatidylcholine, and an increased rate of phosphatidylcholine synthesis in macrophages. These changes were observed in macrophages from both healthy control individuals and patients with Crohn's disease. The only difference detected between control and Crohn's disease macrophages was a reduced proportion of newly-synthesised phosphatidylinositol 16:0/18:1 over a defined time period. Shotgun lipidomics analysis of macroscopically non-inflamed ileal biopsies showed a significant decrease in this same lipid species with overall preservation of sphingolipid, phospholipid and cholesterol composition.
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Key Words
- cct, phosphocholine cytidylyltransferase
- cd, crohn's disease
- gwas, genome-wide association study
- hc, healthycontrol
- hkec, heat-killed escherichia coli
- pa, phosphatidic acid
- pc, phosphatidylcholine
- pi, phosphatidylinositol
- ps, phosphatidylserine
- tnf, tumor necrosis factor
- crohn's disease
- macrophage
- lipids
- ceramide
- sphingolipid
- phospholipid
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Affiliation(s)
- Gavin W. Sewell
- Division of Medicine, UCL, 5 University Street, London, United Kingdom
| | - Yusuf A. Hannun
- Department of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Xianlin Han
- Sanford-Burnham Medical Research Institute, Orlando, FL, United States
| | - Grielof Koster
- Division of Infection, Inflammation & Immunity, University of Southampton, School of Medicine, Southampton General Hospital, Mailpoint 803, South Block, Tremona Road, Southampton, United Kingdom
| | - Jacek Bielawski
- Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, SC, United States
| | - Victoria Goss
- Division of Infection, Inflammation & Immunity, University of Southampton, School of Medicine, Southampton General Hospital, Mailpoint 803, South Block, Tremona Road, Southampton, United Kingdom
| | - Philip J. Smith
- Division of Medicine, UCL, 5 University Street, London, United Kingdom
| | - Farooq Z. Rahman
- Department of Gastroenterology, University College Hospital, 235 Euston Road, London, United Kingdom
| | - Roser Vega
- Department of Gastroenterology, University College Hospital, 235 Euston Road, London, United Kingdom
| | - Stuart L. Bloom
- Department of Gastroenterology, University College Hospital, 235 Euston Road, London, United Kingdom
| | - Ann P. Walker
- Division of Medicine, UCL, 5 University Street, London, United Kingdom
| | - Anthony D. Postle
- Division of Infection, Inflammation & Immunity, University of Southampton, School of Medicine, Southampton General Hospital, Mailpoint 803, South Block, Tremona Road, Southampton, United Kingdom
| | - Anthony W. Segal
- Division of Medicine, UCL, 5 University Street, London, United Kingdom
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