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Inge MM, Miller R, Hook H, Bray D, Keenan JL, Zhao R, Gilmore TD, Siggers T. Rapid profiling of transcription factor-cofactor interaction networks reveals principles of epigenetic regulation. bioRxiv 2024:2024.04.05.588333. [PMID: 38617258 PMCID: PMC11014505 DOI: 10.1101/2024.04.05.588333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Transcription factor (TF)-cofactor (COF) interactions define dynamic, cell-specific networks that govern gene expression; however, these networks are understudied due to a lack of methods for high-throughput profiling of DNA-bound TF-COF complexes. Here we describe the Cofactor Recruitment (CoRec) method for rapid profiling of cell-specific TF-COF complexes. We define a lysine acetyltransferase (KAT)-TF network in resting and stimulated T cells. We find promiscuous recruitment of KATs for many TFs and that 35% of KAT-TF interactions are condition specific. KAT-TF interactions identify NF-κB as a primary regulator of acutely induced H3K27ac. Finally, we find that heterotypic clustering of CBP/P300-recruiting TFs is a strong predictor of total promoter H3K27ac. Our data supports clustering of TF sites that broadly recruit KATs as a mechanism for widespread co-occurring histone acetylation marks. CoRec can be readily applied to different cell systems and provides a powerful approach to define TF-COF networks impacting chromatin state and gene regulation.
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Affiliation(s)
- MM Inge
- Department of Biology, Boston University, Boston, MA, USA
- Biological Design Center, Boston University, Boston, MA, USA
- These authors contributed equally
| | - R Miller
- Department of Biology, Boston University, Boston, MA, USA
- Bioinformatics Program, Boston University, Boston, MA, USA
- Biological Design Center, Boston University, Boston, MA, USA
- These authors contributed equally
| | - H Hook
- Department of Biology, Boston University, Boston, MA, USA
| | - D Bray
- Department of Biology, Boston University, Boston, MA, USA
- Bioinformatics Program, Boston University, Boston, MA, USA
| | - JL Keenan
- Department of Biology, Boston University, Boston, MA, USA
- Bioinformatics Program, Boston University, Boston, MA, USA
| | - R Zhao
- Department of Biology, Boston University, Boston, MA, USA
| | - TD Gilmore
- Department of Biology, Boston University, Boston, MA, USA
| | - T Siggers
- Department of Biology, Boston University, Boston, MA, USA
- Bioinformatics Program, Boston University, Boston, MA, USA
- Biological Design Center, Boston University, Boston, MA, USA
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Wiles MD, Benson I, Edwards L, Miller R, Tait F, Wynn-Hebden A. Management of acute cervical spinal cord injury in the non-specialist intensive care unit: a narrative review of current evidence. Anaesthesia 2024; 79:193-202. [PMID: 38088443 DOI: 10.1111/anae.16198] [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] [Accepted: 11/23/2023] [Indexed: 01/11/2024]
Abstract
Each year approximately one million people suffer spinal cord injury, which has significant physical, psychosocial and economic impacts on patients and their families. Spinal cord rehabilitation centres are a well-established part of the care pathway for patients with spinal cord injury and facilitate improvements in functional independence and reductions in healthcare costs. Within the UK, however, there are a limited number of spinal cord injury centres, which delays admission. Patients and their families often perceive that they are not receiving specialist care while being treated in non-specialist units. This review aimed to provide clinicians who work in non-specialist spinal injury centres with a summary of contemporary studies relevant to the critical care management of patients with cervical spinal cord injury. We undertook a targeted literature review including guidelines, systematic reviews, meta-analyses, clinical trials and randomised controlled trials published in English between 1 June 2017 and 1 June 2023. Studies involving key clinical management strategies published before this time, but which have not been updated or repeated, were also included. We then summarised the key management themes: acute critical care management approaches (including ventilation strategies, blood pressure management and tracheostomy insertion); respiratory weaning techniques; management of pain and autonomic dysreflexia; and rehabilitation.
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Affiliation(s)
- M D Wiles
- Academic Department of Anaesthesia and Peri-operative Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Centre for Applied Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - I Benson
- National Spinal Injuries Centre, Buckinghamshire Hospitals NHS Trust, Stoke Mandeville, UK
| | - L Edwards
- University of Nottingham, Nottingham, UK
| | - R Miller
- Critical Care Department, Northampton General Hospital, Northampton, UK
| | - F Tait
- Critical Care Department, Northampton General Hospital, Northampton, UK
| | - A Wynn-Hebden
- Department of Anaesthesia and Critical Care, University Hospitals of Leicester NHS Trust, Leicester, UK
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Peterson K, Lord W, Miller R, McCoy M, Dwyer T, Fortney A, Laverty S. A Comparative Investigation of Equine-Related and Bovine-Related Human Fatalities in Oklahoma. Am J Forensic Med Pathol 2024:00000433-990000000-00157. [PMID: 38300715 DOI: 10.1097/paf.0000000000000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
ABSTRACT This study examined 71 cases, where 45 cases were equine-related and 26 were bovine-related. Data for this study were collected by examining cases between 2000 and 2022 from the Oklahoma Office of the Chief Medical Examiner database.A majority of the equine-related fatality cases involved males aged 0 to 18 and 60 to 69 years, with sustained injuries of the head, neck, and thoracic regions while being mounted. These injuries were most often inflicted by being kicked or resulted from blunt force of impact. A majority of the bovine-related fatality cases involved males aged 60 to 79 years, with sustained injuries of the head, neck, and thoracic regions while being unmounted. These injuries were most often inflicted by being butted, trampled, or resulted from blunt force of impact. Of the total cases, approximately 42% of the causes of death were blunt force trauma of the head/neck and nearly 34% were multiple blunt force injuries. Only 3 mechanisms of death were discussed.There are distinct similarities in the most prominent gender, cause of sustained injury, and location of injury between equine- and bovine-related fatalities in Oklahoma. This study lends significant support to the need for increased awareness of safe handling practices and safety precaution education for both equine and bovine activities.
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Affiliation(s)
- Kaylan Peterson
- From the W. Roger Webb Forensic Science Institute, University of Central Oklahoma
| | - Wayne Lord
- Department of Biology, University of Central Oklahoma
| | - Ross Miller
- Oklahoma Office of the Chief Medical Examiner
| | - Mark McCoy
- From the W. Roger Webb Forensic Science Institute, University of Central Oklahoma
| | - Timothy Dwyer
- Department of Funeral Services, University of Central Oklahoma
| | - Amber Fortney
- From the W. Roger Webb Forensic Science Institute, University of Central Oklahoma
| | - Sean Laverty
- Department of Mathematics and Statistics, University of Central Oklahoma, Edmond, TX
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Fotopoulou C, Hall M, Lord R, Miller R, Sundar S, Roebuck N, Fildes L, Wesselbaum A, McCormack S, Hickey J, Ledermann J. Perspectives of Healthcare Professionals on the Management and Treatment of Advanced Ovarian Cancer in the UK: Results From the KNOW-OC Survey. Clin Oncol (R Coll Radiol) 2024; 36:e1-e10. [PMID: 37923688 DOI: 10.1016/j.clon.2023.10.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 06/01/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
AIMS New treatment options for advanced ovarian cancer have the potential to significantly change the treatment pathway in the UK. Understanding the structures and responsibilities of multidisciplinary teams/tumour boards (MDT) and regional variations will enable services to adapt more effectively to these changes. MATERIALS AND METHODS The KNOW-OC survey was conducted in 2020 to understand the views of a selected group of 66 healthcare professionals (HCPs) involved in advanced ovarian cancer care in UK hospitals. RESULTS The results showed that MDT involvement in the management of advanced ovarian cancer varied depending on pathway stage and line of relapse, with 98.5% of HCPs responding that the MDT was involved in decisions at initial presentation, but only 40.9% for patients with multiple relapses. The MDT was mostly responsible for determining whether the patients would undergo primary or interval cytoreductive surgery according to 75.8% of respondents, and most HCPs (80.3%) stated that tumour dissemination patterns were the most important factor influencing this decision. The most commonly assessed biomarkers at the time of the survey were CA125, gBRCA and tBRCA. Homologous recombination deficiency was viewed as the second most important factor for determining prognosis, but few centres had access to testing at the time of survey completion. The use of active surveillance was expected to decrease in favour of first-line targeted therapies. Nearly all (98.5%) HCPs agreed there is a role for secondary cytoreductive surgery for the treatment of recurrence (for carefully selected patients). CONCLUSIONS The results highlighted UK-specific geographical variation in the views of HCPs on MDT involvement and specific practices, such as molecular biomarker testing, and the overall treatment approach. Together, these findings improve the understanding of reported clinical practice across the UK for ovarian cancer and provide insight into decision-making associated with updates to recommendations for best practice (e.g. European Society for Medical Oncology/European Society of Gynaecological Oncology consensus statements) and the introduction of new treatment options.
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Affiliation(s)
- C Fotopoulou
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK.
| | - M Hall
- Mount Vernon Cancer Centre, Northwood, UK
| | - R Lord
- Clatterbridge Cancer Centre, Liverpool, UK
| | - R Miller
- University College London, London, UK
| | - S Sundar
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | | | | | | | | | - J Ledermann
- University College London Cancer Institute and UCL Hospitals, London, UK
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Bykov AG, Panaeva MA, Milyaeva OY, Michailov AV, Rafikova AR, Guzman E, Rubio R, Miller R, Noskov BA. Structural changes in layers of lipid mixtures at low surface tensions. Chem Phys Lipids 2024; 258:105365. [PMID: 38092233 DOI: 10.1016/j.chemphyslip.2023.105365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/21/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
Layers of pulmonary lipids on an aqueous substrate at non-equilibrium conditions can decrease the surface tension of water to quite low values. This is connected with different relaxation processes occurring at the interface and the associated changes in the surface layer structure. Results of measurements by the combination of methods like surface rheology, ellipsometry, Brewster angle microscopy, and IRRAS for spread layers of lipid mixtures open a possibility to specify the dynamics of structural changes at conditions close to the physiological state. At sufficiently low surface tension values (below 5 mN/m) significant changes in the ellipsometric signal were observed for pure DPPC layers, which can be related to a transition from 2D to 3D structures caused by the layer folding. The addition of other lipids can accelerate the relaxation processes connected with squeezing-out of molecules or multilayer stacks formation hampering thereby a decrease of surface tension down to low values corresponding to the folding of the monolayer.
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Affiliation(s)
- A G Bykov
- St. Petersburg State University, St. Petersburg, the Russian Federation.
| | - M A Panaeva
- St. Petersburg State University, St. Petersburg, the Russian Federation
| | - O Y Milyaeva
- St. Petersburg State University, St. Petersburg, the Russian Federation
| | - A V Michailov
- St. Petersburg State University, St. Petersburg, the Russian Federation
| | - A R Rafikova
- St. Petersburg State University, St. Petersburg, the Russian Federation
| | - E Guzman
- Departamento de Química Física, Universidad Complutense de Madrid, Madrid, Spain; Instituto Pluridisciplinar, Universidad Complutense de Madrid, Madrid, Spain
| | - R Rubio
- Departamento de Química Física, Universidad Complutense de Madrid, Madrid, Spain; Instituto Pluridisciplinar, Universidad Complutense de Madrid, Madrid, Spain
| | - R Miller
- Institute for Soft Matter Physics, Technical University Darmstadt, 64289 Darmstadt, Germany
| | - B A Noskov
- St. Petersburg State University, St. Petersburg, the Russian Federation
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Staplin N, Haynes R, Judge PK, Wanner C, Green JB, Emberson J, Preiss D, Mayne KJ, Ng SYA, Sammons E, Zhu D, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu WJ, Kadowaki T, Nangaku M, Levin A, Cherney D, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Petrini M, Seidi S, Landray MJ, Baigent C, Herrington WG, Abat S, Abd Rahman R, Abdul Cader R, Abdul Hafidz MI, Abdul Wahab MZ, Abdullah NK, Abdul-Samad T, Abe M, Abraham N, Acheampong S, Achiri P, Acosta JA, Adeleke A, Adell V, Adewuyi-Dalton R, Adnan N, Africano A, Agharazii M, Aguilar F, Aguilera A, Ahmad M, Ahmad MK, Ahmad NA, Ahmad NH, Ahmad NI, Ahmad Miswan N, Ahmad Rosdi H, Ahmed I, Ahmed S, Ahmed S, Aiello J, Aitken A, AitSadi R, Aker S, Akimoto S, Akinfolarin A, Akram S, Alberici F, Albert C, Aldrich L, Alegata M, Alexander L, Alfaress S, Alhadj Ali M, Ali A, Ali A, Alicic R, Aliu A, Almaraz R, Almasarwah R, Almeida J, Aloisi A, Al-Rabadi L, Alscher D, Alvarez P, Al-Zeer B, Amat M, Ambrose C, Ammar H, An Y, Andriaccio L, Ansu K, Apostolidi A, Arai N, Araki H, Araki S, Arbi A, Arechiga O, Armstrong S, Arnold T, Aronoff S, Arriaga W, Arroyo J, Arteaga D, Asahara S, Asai A, Asai N, Asano S, Asawa M, Asmee MF, Aucella F, Augustin M, Avery A, Awad A, Awang IY, Awazawa M, Axler A, Ayub W, Azhari Z, Baccaro R, Badin C, Bagwell B, Bahlmann-Kroll E, Bahtar AZ, Baigent C, Bains D, Bajaj H, Baker R, Baldini E, Banas B, Banerjee D, Banno S, Bansal S, Barberi S, Barnes S, Barnini C, Barot C, Barrett K, Barrios R, Bartolomei Mecatti B, Barton I, Barton J, Basily W, Bavanandan S, Baxter A, Becker L, Beddhu S, Beige J, Beigh S, Bell S, Benck U, Beneat A, Bennett A, Bennett D, Benyon S, Berdeprado J, Bergler T, Bergner A, Berry M, Bevilacqua M, Bhairoo J, Bhandari S, Bhandary N, Bhatt A, Bhattarai M, Bhavsar M, Bian W, Bianchini F, Bianco S, Bilous R, Bilton J, Bilucaglia D, Bird C, Birudaraju D, Biscoveanu M, Blake C, Bleakley N, Bocchicchia K, Bodine S, Bodington R, Boedecker S, Bolduc M, Bolton S, Bond C, Boreky F, Boren K, Bouchi R, Bough L, Bovan D, Bowler C, Bowman L, Brar N, Braun C, Breach A, Breitenfeldt M, Brenner S, Brettschneider B, Brewer A, Brewer G, Brindle V, Brioni E, Brown C, Brown H, Brown L, Brown R, Brown S, Browne D, Bruce K, Brueckmann M, Brunskill N, Bryant M, Brzoska M, Bu Y, Buckman C, Budoff M, Bullen M, Burke A, Burnette S, Burston C, Busch M, Bushnell J, Butler S, Büttner C, Byrne C, Caamano A, Cadorna J, Cafiero C, Cagle M, Cai J, Calabrese K, Calvi C, Camilleri B, Camp S, Campbell D, Campbell R, Cao H, Capelli I, Caple M, Caplin B, Cardone A, Carle J, Carnall V, Caroppo M, Carr S, Carraro G, Carson M, Casares P, Castillo C, Castro C, Caudill B, Cejka V, Ceseri M, Cham L, Chamberlain A, Chambers J, Chan CBT, Chan JYM, Chan YC, Chang E, Chang E, Chant T, Chavagnon T, Chellamuthu P, Chen F, Chen J, Chen P, Chen TM, Chen Y, Chen Y, Cheng C, Cheng H, Cheng MC, Cherney D, Cheung AK, Ching CH, Chitalia N, Choksi R, Chukwu C, Chung K, Cianciolo G, Cipressa L, Clark S, Clarke H, Clarke R, Clarke S, Cleveland B, Cole E, Coles H, Condurache L, Connor A, Convery K, Cooper A, Cooper N, Cooper Z, Cooperman L, Cosgrove L, Coutts P, Cowley A, Craik R, Cui G, Cummins T, Dahl N, Dai H, Dajani L, D'Amelio A, Damian E, Damianik K, Danel L, Daniels C, Daniels T, Darbeau S, Darius H, Dasgupta T, Davies J, Davies L, Davis A, Davis J, Davis L, Dayanandan R, Dayi S, Dayrell R, De Nicola L, Debnath S, Deeb W, Degenhardt S, DeGoursey K, Delaney M, Deo R, DeRaad R, Derebail V, Dev D, Devaux M, Dhall P, Dhillon G, Dienes J, Dobre M, Doctolero E, Dodds V, Domingo D, Donaldson D, Donaldson P, Donhauser C, Donley V, Dorestin S, Dorey S, Doulton T, Draganova D, Draxlbauer K, Driver F, Du H, Dube F, Duck T, Dugal T, Dugas J, Dukka H, Dumann H, Durham W, Dursch M, Dykas R, Easow R, Eckrich E, Eden G, Edmerson E, Edwards H, Ee LW, Eguchi J, Ehrl Y, Eichstadt K, Eid W, Eilerman B, Ejima Y, Eldon H, Ellam T, Elliott L, Ellison R, Emberson J, Epp R, Er A, Espino-Obrero M, Estcourt S, Estienne L, Evans G, Evans J, Evans S, Fabbri G, Fajardo-Moser M, Falcone C, Fani F, Faria-Shayler P, Farnia F, Farrugia D, Fechter M, Fellowes D, Feng F, Fernandez J, Ferraro P, Field A, Fikry S, Finch J, Finn H, Fioretto P, Fish R, Fleischer A, Fleming-Brown D, Fletcher L, Flora R, Foellinger C, Foligno N, Forest S, Forghani Z, Forsyth K, Fottrell-Gould D, Fox P, Frankel A, Fraser D, Frazier R, Frederick K, Freking N, French H, Froment A, Fuchs B, Fuessl L, Fujii H, Fujimoto A, Fujita A, Fujita K, Fujita Y, Fukagawa M, Fukao Y, Fukasawa A, Fuller T, Funayama T, Fung E, Furukawa M, Furukawa Y, Furusho M, Gabel S, Gaidu J, Gaiser S, Gallo K, Galloway C, Gambaro G, Gan CC, Gangemi C, Gao M, Garcia K, Garcia M, Garofalo C, Garrity M, Garza A, Gasko S, Gavrila M, Gebeyehu B, Geddes A, Gentile G, George A, George J, Gesualdo L, Ghalli F, Ghanem A, Ghate T, Ghavampour S, Ghazi A, Gherman A, Giebeln-Hudnell U, Gill B, Gillham S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, Herfurth K, Hernandez G, Hernandez Pena A, Hernandez-Cassis C, Herrington WG, Herzog C, Hewins S, Hewitt D, Hichkad L, Higashi S, Higuchi C, Hill C, Hill L, Hill M, Himeno T, Hing A, Hirakawa Y, Hirata K, Hirota Y, Hisatake T, Hitchcock S, Hodakowski A, Hodge W, Hogan R, Hohenstatt U, Hohenstein B, Hooi L, Hope S, Hopley M, Horikawa S, Hosein D, Hosooka T, Hou L, Hou W, Howie L, Howson A, Hozak M, Htet Z, Hu X, Hu Y, Huang J, Huda N, Hudig L, Hudson A, Hugo C, Hull R, Hume L, Hundei W, Hunt N, Hunter A, Hurley S, Hurst A, Hutchinson C, Hyo T, Ibrahim FH, Ibrahim S, Ihana N, Ikeda T, Imai A, Imamine R, Inamori A, Inazawa H, Ingell J, Inomata K, Inukai Y, Ioka M, Irtiza-Ali A, Isakova T, Isari W, Iselt M, Ishiguro A, Ishihara K, Ishikawa T, Ishimoto T, Ishizuka K, Ismail R, Itano S, Ito H, Ito K, Ito M, Ito Y, Iwagaitsu S, Iwaita Y, Iwakura T, Iwamoto M, Iwasa M, Iwasaki H, Iwasaki S, Izumi K, Izumi K, Izumi T, Jaafar SM, Jackson C, Jackson Y, Jafari G, Jahangiriesmaili M, Jain N, Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura S, Kiyosue A, Kiyota M, Klauser F, Klausmann G, Kmietschak W, Knapp K, Knight C, Knoppe A, Knott C, Kobayashi M, Kobayashi R, Kobayashi T, Koch M, Kodama S, Kodani N, Kogure E, Koizumi M, Kojima H, Kojo T, Kolhe N, Komaba H, Komiya T, Komori H, Kon SP, Kondo M, Kondo M, Kong W, Konishi M, Kono K, Koshino M, Kosugi T, Kothapalli B, Kozlowski T, Kraemer B, Kraemer-Guth A, Krappe J, Kraus D, Kriatselis C, Krieger C, Krish P, Kruger B, Ku Md Razi KR, Kuan Y, Kubota S, Kuhn S, Kumar P, Kume S, Kummer I, Kumuji R, Küpper A, Kuramae T, Kurian L, Kuribayashi C, Kurien R, Kuroda E, Kurose T, Kutschat A, Kuwabara N, Kuwata H, La Manna G, Lacey M, Lafferty K, LaFleur P, Lai V, Laity E, Lambert A, Landray MJ, Langlois M, Latif F, Latore E, Laundy E, Laurienti D, Lawson A, Lay M, Leal I, Leal I, Lee AK, Lee J, Lee KQ, Lee R, Lee SA, Lee YY, Lee-Barkey Y, Leonard N, Leoncini G, Leong CM, Lerario S, Leslie A, Levin A, Lewington A, Li J, Li N, Li X, Li Y, Liberti L, Liberti ME, Liew A, Liew YF, Lilavivat U, Lim SK, Lim YS, Limon E, Lin H, Lioudaki E, Liu H, Liu J, Liu L, Liu Q, Liu WJ, Liu X, Liu Z, Loader D, Lochhead H, Loh CL, Lorimer A, Loudermilk L, Loutan J, Low CK, Low CL, Low YM, Lozon Z, Lu Y, Lucci D, Ludwig U, Luker N, Lund D, Lustig R, Lyle S, Macdonald C, MacDougall I, Machicado R, MacLean D, Macleod P, Madera A, Madore F, Maeda K, Maegawa H, Maeno S, Mafham M, Magee J, Maggioni AP, Mah DY, Mahabadi V, Maiguma M, Makita Y, Makos G, Manco L, Mangiacapra R, Manley J, Mann P, Mano S, Marcotte G, Maris J, Mark P, Markau S, Markovic M, Marshall C, Martin M, Martinez C, Martinez S, Martins G, Maruyama K, Maruyama S, Marx K, Maselli A, Masengu A, Maskill A, Masumoto S, Masutani K, Matsumoto M, Matsunaga T, Matsuoka N, Matsushita M, Matthews M, Matthias S, Matvienko E, Maurer M, Maxwell P, Mayne KJ, Mazlan N, Mazlan SA, Mbuyisa A, McCafferty K, McCarroll F, McCarthy T, McClary-Wright C, McCray K, McDermott P, McDonald C, McDougall R, McHaffie E, McIntosh K, McKinley T, McLaughlin S, McLean N, McNeil L, Measor A, Meek J, Mehta A, Mehta R, Melandri M, Mené P, Meng T, Menne J, Merritt K, Merscher S, Meshykhi C, Messa P, Messinger L, Miftari N, Miller R, Miller Y, Miller-Hodges E, Minatoguchi M, Miners M, Minutolo R, Mita T, Miura Y, Miyaji M, Miyamoto S, Miyatsuka T, Miyazaki M, Miyazawa I, Mizumachi R, Mizuno M, Moffat S, Mohamad Nor FS, Mohamad Zaini SN, Mohamed Affandi FA, Mohandas C, Mohd R, Mohd Fauzi NA, Mohd Sharif NH, Mohd Yusoff Y, Moist L, Moncada A, Montasser M, Moon A, Moran C, Morgan N, Moriarty J, Morig G, Morinaga H, Morino K, Morisaki T, Morishita Y, Morlok S, Morris A, Morris F, Mostafa S, Mostefai Y, Motegi M, Motherwell N, Motta D, Mottl A, Moys R, Mozaffari S, Muir J, Mulhern J, Mulligan S, Munakata Y, Murakami C, Murakoshi M, Murawska A, Murphy K, Murphy L, Murray S, Murtagh H, Musa MA, Mushahar L, Mustafa R, Mustafar R, Muto M, Nadar E, Nagano R, Nagasawa T, Nagashima E, Nagasu H, Nagelberg S, Nair H, Nakagawa Y, Nakahara M, 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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura S, Kiyosue A, Kiyota M, Klauser F, Klausmann G, Kmietschak W, Knapp K, Knight C, Knoppe A, Knott C, Kobayashi M, Kobayashi R, Kobayashi T, Koch M, Kodama S, Kodani N, Kogure E, Koizumi M, Kojima H, Kojo T, Kolhe N, Komaba H, Komiya T, Komori H, Kon SP, Kondo M, Kondo M, Kong W, Konishi M, Kono K, Koshino M, Kosugi T, Kothapalli B, Kozlowski T, Kraemer B, Kraemer-Guth A, Krappe J, Kraus D, Kriatselis C, Krieger C, Krish P, Kruger B, Ku Md Razi KR, Kuan Y, Kubota S, Kuhn S, Kumar P, Kume S, Kummer I, Kumuji R, Küpper A, Kuramae T, Kurian L, Kuribayashi C, Kurien R, Kuroda E, Kurose T, Kutschat A, Kuwabara N, Kuwata H, La Manna G, Lacey M, Lafferty K, LaFleur P, Lai V, Laity E, Lambert A, Landray MJ, Langlois M, Latif F, Latore E, Laundy E, Laurienti D, Lawson A, Lay M, Leal I, Leal I, Lee AK, Lee J, Lee KQ, Lee R, Lee SA, Lee YY, Lee-Barkey Y, Leonard N, Leoncini G, Leong CM, Lerario S, Leslie A, Levin A, Lewington A, Li J, Li N, Li X, Li Y, Liberti L, Liberti ME, Liew A, Liew YF, Lilavivat U, Lim SK, Lim YS, Limon E, Lin H, Lioudaki E, Liu H, Liu J, Liu L, Liu Q, Liu WJ, Liu X, Liu Z, Loader D, Lochhead H, Loh CL, Lorimer A, Loudermilk L, Loutan J, Low CK, Low CL, Low YM, Lozon Z, Lu Y, Lucci D, Ludwig U, Luker N, Lund D, Lustig R, Lyle S, Macdonald C, MacDougall I, Machicado R, MacLean D, Macleod P, Madera A, Madore F, Maeda K, Maegawa H, Maeno S, Mafham M, Magee J, Maggioni AP, Mah DY, Mahabadi V, Maiguma M, Makita Y, Makos G, Manco L, Mangiacapra R, Manley J, Mann P, Mano S, Marcotte G, Maris J, Mark P, Markau S, Markovic M, Marshall C, Martin M, Martinez C, Martinez S, Martins G, Maruyama K, Maruyama S, Marx K, Maselli A, Masengu A, Maskill A, Masumoto S, Masutani K, Matsumoto M, Matsunaga T, Matsuoka N, Matsushita M, Matthews M, Matthias S, Matvienko E, Maurer M, Maxwell P, Mayne KJ, Mazlan N, Mazlan SA, Mbuyisa A, McCafferty K, McCarroll F, McCarthy T, McClary-Wright C, McCray K, McDermott P, McDonald C, McDougall R, McHaffie E, McIntosh K, McKinley T, McLaughlin S, McLean N, McNeil L, Measor A, Meek J, Mehta A, Mehta R, Melandri M, Mené P, Meng T, Menne J, Merritt K, Merscher S, Meshykhi C, Messa P, Messinger L, Miftari N, Miller R, Miller Y, Miller-Hodges E, Minatoguchi M, Miners M, Minutolo R, Mita T, Miura Y, Miyaji M, Miyamoto S, Miyatsuka T, Miyazaki M, Miyazawa I, Mizumachi R, Mizuno M, Moffat S, Mohamad Nor FS, Mohamad Zaini SN, Mohamed Affandi FA, Mohandas C, Mohd R, Mohd Fauzi NA, Mohd Sharif NH, Mohd Yusoff Y, Moist L, Moncada A, Montasser M, Moon A, Moran C, Morgan N, Moriarty J, Morig G, Morinaga H, Morino K, Morisaki T, Morishita Y, Morlok S, Morris A, Morris F, Mostafa S, Mostefai Y, Motegi M, Motherwell N, Motta D, Mottl A, Moys R, Mozaffari S, Muir J, Mulhern J, Mulligan S, Munakata Y, Murakami C, Murakoshi M, Murawska A, Murphy K, Murphy L, Murray S, Murtagh H, Musa MA, Mushahar L, Mustafa R, Mustafar R, Muto M, Nadar E, Nagano R, Nagasawa T, Nagashima E, Nagasu H, Nagelberg S, Nair H, Nakagawa Y, Nakahara M, Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Bartsch A, Nikkhah D, Miller R, Mende K, Hovius SER, Kaempfen A. Correction of symbrachydactyly: a systematic review of surgical options. Syst Rev 2023; 12:218. [PMID: 37974291 PMCID: PMC10652478 DOI: 10.1186/s13643-023-02362-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/29/2023] [Indexed: 11/19/2023] Open
Abstract
Symbrachydactyly is a rare congenital malformation of the hand characterized by short or even absent fingers with or without syndactyly, mostly unilaterally present. The hand condition can vary from a small hand to only nubbins on the distal forearm. This study aims to systematically review the surgical management options for symbrachydactyly and compare functional and aesthetic outcomes.The review was performed according to the PRISMA guidelines. Literature was systematically assessed searching the Cochrane Library, PubMed, Embase, and PROSPERO databases up to January 1, 2023. Studies were identified using synonyms for 'symbrachydactyly' and 'treatment'. Inclusion criteria were the report of outcomes after surgical treatment of symbrachydactyly in humans. Studies were excluded if they were written in another language than English, German, or French. Case reports, letters to the editor, studies on animals, cadaveric, in vitro studies, biomechanical reports, surgical technique description, and papers discussing traumatic or oncologic cases were excluded.Twenty-four studies published were included with 539 patients (1037 digit corrections). Only one study included and compared two surgical techniques. The quality of the included studies was assessed using the Modified Coleman Methodology Score and ranged from 25 to 47. The range of motion was the main reported outcome and demonstrated modest results in all surgical techniques. The report on aesthetics of the hand was limited in non-vascularized transfers to 2/8 studies and in vascularized transfers to 5/8 studies, both reporting satisfactory results. On average, there was a foot donor site complication rate of 22% in non-vascularized transfers, compared to 2% in vascularized transfers. The hand-related complication rate of 54% was much higher in the vascularized group than in the non-vascularized transfer with 16%.No uniform strategy to surgically improve symbrachydactyly exists. All discussed techniques show limited functional improvement with considerable complication rates, with the vascularized transfer showing relative high hand-related complications and the non-vascularized transfer showing relative high foot-related complications.There were no high-quality studies, and due to a lack of comparing studies, the data could only be analysed qualitatively. Systematic assessment of studies showed insufficient evidence to determine superiority of any procedure to treat symbrachydactyly due to inadequate study designs and comparative studies. This systematic review was registered at the National Institute for Health Research PROSPERO International Prospective Register of Systematic Reviews number: CRD42020153590 and received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.Level of evidenceI.Systematic review registrationPROSPERO CRD42020153590.
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Affiliation(s)
- A Bartsch
- Paediatric Orthopaedic Surgery, University Children's Hospital Basel, Spitalstr. 33, CH-4056, Basel, Switzerland
- Orthopaedic Surgery and Traumatology, University Hospital Basel, Spitalstr. 21, CH-4031, Basel, Switzerland
| | - D Nikkhah
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust, London, UK
| | - R Miller
- Department of Plastic and Reconstructive Surgery, St George's Hospital, Blackshaw Road, London, SW17 0QT5, UK
| | - K Mende
- Paediatric Orthopaedic Surgery, University Children's Hospital Basel, Spitalstr. 33, CH-4056, Basel, Switzerland
- Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Spitalstr. 21, CH-4031, Basel, Switzerland
| | - S E R Hovius
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - A Kaempfen
- Paediatric Orthopaedic Surgery, University Children's Hospital Basel, Spitalstr. 33, CH-4056, Basel, Switzerland.
- Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Spitalstr. 21, CH-4031, Basel, Switzerland.
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Moayedi Y, Truby LK, Foroutan F, Han J, Guzman J, Angleitner P, Sabatino M, Felius J, van Zyl JS, Rodenas-Alesina E, Fan CP, DeVore AD, Miller R, Potena L, Zuckermann A, Farrero M, Chih S, Farr M, Hall S, Ross HJ, Khush KK. The International Consortium on Primary Graft Dysfunction: Redefining Clinical Risk Factors in the Contemporary Era of Heart Transplantation. J Card Fail 2023:S1071-9164(23)00382-2. [PMID: 37907150 DOI: 10.1016/j.cardfail.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Primary Graft Dysfunction (PGD) is the leading cause of morbidity and mortality early after heart transplant (HT). The International Consortium on PGD is a multicenter collaboration dedicated to identifying the clinical risk factors for PGD in the contemporary era of HT. The objectives of the current report were to 1) assess the incidence of severe PGD in an international cohort, 2) evaluate the performance of the most validated PGD risk tool, the RADIAL score, in a contemporary cohort, and 3) redefine clinical risk factors for severe PGD in the current era of HT. METHODS This is a retrospective, observational study of consecutive adult HT recipients between 2010 and 2020 in 10 centers in the United States, Canada, and Europe. Patients with severe PGD were compared to those without severe PGD (comprising those with no, mild and moderate PGD). The RADIAL score was calculated for each transplant recipient. The discriminatory power of the RADIAL score was evaluated using receiver operating characteristic (ROC) analysis and its calibration was assessed by plotting the percentage of PGD predicted versus observed. To identify clinical risk factors associated with severe PGD, we performed multivariable mixed-effects logistic regression modeling to account for among-center variability. RESULTS A total of 2,746 patients have been enrolled in the registry to date, including 2,015 (73.4%) from North America, and 731 (26.6%) from Europe. 215 participants (7.8%) met the criteria for severe PGD. There was an increase in the incidence of severe PGD over the study period (p-value for trend by difference sign test = 0.004). The Kaplan Meier estimate for 1-year survival was 75.7% [95%CI 69.4-80.9%] in patients with severe PGD as compared to 94.4% [95% CI 93.5-95.2%] in those without severe PGD (log-rank p-value <0.001). The RADIAL score performed poorly in our contemporary cohort and was not associated with severe PGD with an AUC of 0.53 (95%CI 0.48-0.58). In the multivariable regression model, acute preoperative dialysis (OR 2.41, 95% CI 1.31 - 4.43), durable LVAD support (OR 1.77, 95% CI 1.13 - 2.77), and total ischemic time (OR 1.20 for each additional hour, 95% CI 1.02 - 1.41) were associated with an increased risk of severe PGD. CONCLUSIONS Our consortium has identified an increasing incidence of PGD in the modern transplant era. We identified contemporary risk factors for this early post-transplant complication, which confers a high mortality risk. These results may enable the identification of patients at high risk for developing severe PGD in order to inform peri-transplant donor and recipient management practices.
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Affiliation(s)
- Y Moayedi
- Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Canada
| | - L K Truby
- UT Southwestern Medical Center, Dallas, USA
| | - F Foroutan
- Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Canada
| | - J Han
- University of Chicago, Chicago, USA
| | - J Guzman
- Hospital Clinic, Barcelona, Spain
| | | | | | - J Felius
- Baylor Medical Center, Dallas, USA
| | | | - E Rodenas-Alesina
- Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Canada
| | - C-P Fan
- Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Canada
| | - A D DeVore
- Duke University Medical Center, Durham, USA
| | - R Miller
- University of Calgary, Calgary, Canada
| | - L Potena
- University of Bologna, Bologna, Italy
| | | | | | - S Chih
- Ottawa Heart, Ottawa, Canada
| | - M Farr
- UT Southwestern Medical Center, Dallas, USA
| | - S Hall
- Baylor Medical Center, Dallas, USA
| | - H J Ross
- UT Southwestern Medical Center, Dallas, USA
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Stein KV, Goodwin N, Aldasoro E, Miller R. The Integrated Care Workforce: What does it Need? Who does it Take? Int J Integr Care 2023; 23:1. [PMID: 37426311 PMCID: PMC10327854 DOI: 10.5334/ijic.7686] [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] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023] Open
Affiliation(s)
- K. V. Stein
- Department of Public Health and Primary Care, Leiden University Medical Centre, The Netherlands
- International Journal of Integrated Care, The Netherlands
| | - N. Goodwin
- International Journal of Integrated Care, The Netherlands
- Central Coast Research Institute, Faculty of Health and Medicine, University of Newcastle and Central Coast Local Health District, AU
| | - E. Aldasoro
- International Journal of Integrated Care, The Netherlands
- International Foundation for Integrated Care, The Netherlands
| | - R. Miller
- International Journal of Integrated Care, The Netherlands
- Global Engagement for College of Social Sciences, University of Birmingham, UK
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11
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Han J, Moayedi Y, Truby L, Foroutan F, Bofarull JG, Saha S, Angleitner P, Sabatino M, Henricksen E, Luikart H, van Zyl J, Tremblay-Gravel M, Noly P, Segovia-Cubero J, Alesina ER, Potena L, Takeda K, Felius J, Clarke B, DeVore A, Kim G, Miller R, Zuckermann A, Farr M, Crespo-Leiro M, Hall S, Torres MF, Fan C, Ross H, Khush K, Chih S. Incidence and Predictors of Vasoplegia after Heart Transplantation: Results from the International PGD Consortium. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.185] [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: 04/05/2023] Open
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12
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Abstract
During recent years, great progress has been made in understanding the adsorption of surfactants at liquid interfaces. In addition to tensiometry, new efficient methodologies have been developed, in particular interfacial selective optical methods which allow direct access to the adsorbed amounts and interfacial layer compositions. In addition to these new experimental tools, the thermodynamic description by equations of state now allows one to provide a quantitative picture of surfactant interfacial layers. This is most notable for surfactant layers at water/oil interfaces. Additional knowledge about the structure of interfacial layers was gained through different types of molecular modeling. Improved interrelationships between these three aspects are the challenges for current and future work. Particular attention must be paid to dilational interfacial rheology studies, as these mechanical quantities are much more sensitive to small changes in the interfacial composition and structure.
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Affiliation(s)
- V I Kovalchuk
- Institute of Biocolloid Chemistry, National Academy of Sciences of Ukraine, Kyiv 03680, Ukraine
| | - E V Aksenenko
- Institute of Colloid Chemistry and Chemistry of Water, National Academy of Sciences of Ukraine, Kyiv 03680, Ukraine
| | - E Schneck
- Institute of Condensed Matter Physics, Technical University Darmstadt, 64289 Darmstadt, Germany
| | - R Miller
- Institute of Condensed Matter Physics, Technical University Darmstadt, 64289 Darmstadt, Germany
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13
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Elwasif W, Godoy W, Hagerty N, Harris JA, Hernandez O, Joo B, Kent P, Lebrun-Grandié D, Maccarthy E, Melesse Ver-Gara VG, Messer B, Miller R, Oral S, Bastrakov S, Bussmann M, Debus A, Steiniger K, Stephan J, Widera R, Bryngelson SH, LE Berre H, Radhakrishnan A, Young J, Chandrasekaran S, Ciorba F, Simsek O, Clark K, Spiga F, Hammond J, Stone JE, Hardy D, Keller S, Piccinali JG, Trott C. Application Experiences on a GPU-Accelerated Arm-based HPC Testbed. Proc Int Conf High Perform Comput Asia Pac Reg HPC Asia 2023 Workshops (2023) 2023; 2023:35-49. [PMID: 38197035 PMCID: PMC10773486 DOI: 10.1145/3581576.3581621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
This paper assesses and reports the experience of ten teams working to port, validate, and benchmark several High Performance Computing applications on a novel GPU-accelerated Arm testbed system. The testbed consists of eight NVIDIA Arm HPC Developer Kit systems, each one equipped with a server-class Arm CPU from Ampere Computing and two data center GPUs from NVIDIA Corp. The systems are connected together using InfiniBand interconnect. The selected applications and mini-apps are written using several programming languages and use multiple accelerator-based programming models for GPUs such as CUDA, OpenACC, and OpenMP offloading. Working on application porting requires a robust and easy-to-access programming environment, including a variety of compilers and optimized scientific libraries. The goal of this work is to evaluate platform readiness and assess the effort required from developers to deploy well-established scientific workloads on current and future generation Arm-based GPU-accelerated HPC systems. The reported case studies demonstrate that the current level of maturity and diversity of software and tools is already adequate for large-scale production deployments.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jan Stephan
- Helmholtz-Zentrum Dresden-Rossendorf, Germany
| | - René Widera
- Helmholtz-Zentrum Dresden-Rossendorf, Germany
| | | | | | | | | | | | | | | | | | | | | | | | - David Hardy
- University of Illinois at Urbana-Champaign, USA
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14
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Motlaghian SM, Vahidi V, Belger A, Bustillo JR, Faghiri A, Ford JM, Iraji A, Lim K, Mathalon DH, Miller R, Mueller BA, O'Leary D, Potkin SG, Preda A, van Erp TG, Calhoun VD. A method for estimating and characterizing explicitly nonlinear dynamic functional network connectivity in resting-state fMRI data. J Neurosci Methods 2023; 389:109794. [PMID: 36652974 DOI: 10.1016/j.jneumeth.2023.109794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 01/13/2023] [Indexed: 01/16/2023]
Abstract
The past 10 years have seen an explosion of approaches that focus on the study of time-resolved change in functional connectivity (FC). FC characterization among networks at a whole-brain level is frequently termed functional network connectivity (FNC). Time-resolved or dynamic functional network connectivity (dFNC) focuses on the estimation of transient, recurring, whole-brain patterns of FNC. While most approaches in this area have attempted to capture dynamic linear correlation, we are particularly interested in whether explicitly nonlinear relationships, above and beyond linear, are present and contain unique information. This study thus proposes an approach to assess explicitly nonlinear dynamic functional network connectivity (EN dFNC) derived from the relationship among independent component analysis time courses. Linear relationships were removed at each time point to evaluate, typically ignored, explicitly nonlinear dFNC using normalized mutual information (NMI). Simulations showed the proposed method estimated explicitly nonlinearity over time, even within relatively short windows of data. We then, applied our approach on 151 schizophrenia patients, and 163 healthy controls fMRI data and found three unique, highly structured, mostly long-range, functional states that also showed significant group differences. In particular, explicitly nonlinear relationships tend to be more widespread than linear ones. Results also highlighted a state with long range connections to the visual domain, which were significantly reduced in schizophrenia. Overall, this work suggests that quantifying EN dFNC may provide a complementary and potentially valuable tool for studying brain function by exposing relevant variation that is typically ignored.
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Affiliation(s)
- S M Motlaghian
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (Trends), Georgia State, Georgia Tech, and Emory, Atlanta, GA, USA.
| | - V Vahidi
- Department of Computer and Information Science, Spelman College, GA, USA
| | - A Belger
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - J R Bustillo
- Department of Psychiatry, University of New Mexico Albuquerque, NM, USA
| | - A Faghiri
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (Trends), Georgia State, Georgia Tech, and Emory, Atlanta, GA, USA
| | - J M Ford
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; San Francisco VA Medical Center, San Francisco, CA, USA
| | - A Iraji
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (Trends), Georgia State, Georgia Tech, and Emory, Atlanta, GA, USA
| | - K Lim
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - D H Mathalon
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; San Francisco VA Medical Center, San Francisco, CA, USA
| | - R Miller
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (Trends), Georgia State, Georgia Tech, and Emory, Atlanta, GA, USA
| | - B A Mueller
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - D O'Leary
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - S G Potkin
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - A Preda
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - T G van Erp
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - V D Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (Trends), Georgia State, Georgia Tech, and Emory, Atlanta, GA, USA
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15
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Timoshen K, Khrebina A, Lebedev V, Loglio G, Miller R, Sedov V, Noskov B. Dynamic surface properties of carboxyfullerene solutions. J Mol Liq 2022. [DOI: 10.1016/j.molliq.2022.121174] [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: 01/02/2023]
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16
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Noskov B, Akentiev A, Bykov A, Loglio G, Miller R, Milyaeva O. Spread and adsorbed layers of protein fibrils at water –air interface. Colloids Surf B Biointerfaces 2022; 220:112942. [DOI: 10.1016/j.colsurfb.2022.112942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/03/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
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17
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Guzman Bofarull J, Han J, Moayedi Y, Truby LK, Foroutan F, Miller R, Potena L, Zuckermann A, Chih S, Farr M, Hall S, Ross HJ, Khush K, Farrero M. Predictors of early renal dysfunction after heart transplantation: a report from the International Consortium on Primary Graft Dysfunction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Renal dysfunction is a common complication after heart transplantation (HT). Renal replacement therapy (RRT) after HT has been associated with increased risk of death. Long-term renal dysfunction is associated mainly to immunosuppressive therapy but is also strongly related to post-transplant renal failure. Predictors of early renal dysfunction after HT have not been clearly identified.
Purpose
We aimed to define predictors of early renal dysfunction after HT.
Methods
Our consortium includes 10 centers in the US, Canada and Europe. We collected data on all consecutive single-organ HT recipients from 2010 to 2020. The primary outcome was early renal dysfunction (ERD), defined as a composite of need for RRT or creatinine ≥2.5 mg/dL 24 hours after HT. We assessed the incidence of early renal dysfunction and performed univariate and multivariate analyses to identify the recipient and transplant characteristics associated with its development.
Results
We included 2,764 HT recipients: 282 (10.2%) presented early renal dysfunction and 2482 (89.8%) did not. Recipients who presented postoperative renal dysfunction were more frequently male, Caucasian, with previous sternotomy, higher baseline creatinine, longer ischemic time and worse donor LVEF. They were also more likely to be under RRT, intravenous inotropes or ECMO support and there was more incidence of severe primary graft dysfunction (PGD) (Table 1). Multi-variable logistic regression demonstrated that the strongest predictors for post-transplant renal dysfunction were development of severe PGD (OR 5.26, 2.88–9.62, p<0,001) and RRT prior to HT (OR 5.80, 2.93–11.5, p<0.001). Other predictors were male sex, previous sternotomy, long ischemic time and need for inotropes prior to HT.
Conclusions
Early renal dysfunction is a common complication after HT with an incidence around 10% in a large and contemporary cohort. The presence of PGD and need for RRT pre-transplant were the strongest predictors for its development. Interestingly, emergent transplantation or need for MCS were not independently associated with ERD. Further studies are needed to identify patients at high risk of early and late kidney dysfunction that may benefit from combined transplantation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - J Han
- Stanford University Medical Center , Stanford , United States of America
| | - Y Moayedi
- University of Toronto , Toronto , Canada
| | - L K Truby
- Duke University Medical Center , Durham , United States of America
| | - F Foroutan
- University of Toronto , Toronto , Canada
| | - R Miller
- University of Calgary , Calgary , Canada
| | - L Potena
- University of Bologna , Bologna , Italy
| | | | - S Chih
- Ottawa Heart Institute , Ottawa , Canada
| | - M Farr
- University of Texas Southwestern Medical Center , Dallas , United States of America
| | - S Hall
- Baylor University Medical Center , Dallas , United States of America
| | - H J Ross
- University of Toronto , Toronto , Canada
| | - K Khush
- Stanford University Medical Center , Stanford , United States of America
| | - M Farrero
- Hospital Clinic of Barcelona , Barcelona , Spain
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18
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Ballantyne B, Vandenberk B, Dykstra S, Labib D, Chew D, Heydari B, Lydell C, Howarth A, Fine N, Howlett J, White J, Miller R. PATIENTS WITH NON-ISCHEMIC CARDIOMYOPATHY AND MID-WALL STRIAE HAVE SIMILAR OUTCOMES AS PATIENTS WITH ISCHEMIC CARDIOMYOPATHY: A PROPENSITY-MATCHED ANALYSIS. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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19
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Daza JF, Cuthbertson BH, Myles PS, Shulman MA, Wijeysundera DN, Wijeysundera DN, Pearse RM, Myles PS, Abbott TEF, Shulman MA, Torres E, Ambosta A, Melo M, Mamdani M, Thorpe KE, Wallace S, Farrington C, Croal BL, Granton JT, Oh P, Thompson B, Hillis G, Beattie WS, Wijeysundera HC, Ellis M, Borg B, Kerridge RK, Douglas J, Brannan J, Pretto J, Godsall MG, Beauchamp N, Allen S, Kennedy A, Wright E, Malherbe J, Ismail H, Riedel B, Melville A, Sivakumar H, Murmane A, Kenchington K, Kirabiyik Y, Gurunathan U, Stonell C, Brunello K, Steele K, Tronstad O, Masel P, Dent A, Smith E, Bodger A, Abolfathi M, Sivalingam P, Hall A, Painter TW, Macklin S, Elliott A, Carrera AM, Terblanche NCS, Pitt S, Samuels J, Wilde C, Leslie K, MacCormick A, Bramley D, Southcott AM, Grant J, Taylor H, Bates S, Towns M, Tippett A, Marshall F, McCartney CJL, Choi S, Somascanthan P, Flores K, Karkouti K, Clarke HA, Jerath A, McCluskey SA, Wasowicz M, Day L, Pazmino-Canizares J, Belliard R, Lee L, Dobson K, Stanbrook M, Hagen K, Campbell D, Short T, Van Der Westhuizen J, Higgie K, Lindsay H, Jang R, Wong C, McAllister D, Ali M, Kumar J, Waymouth E, Kim C, Dimech J, Lorimer M, Tai J, Miller R, Sara R, Collingwood A, Olliff S, Gabriel S, Houston H, Dalley P, Hurford S, Hunt A, Andrews L, Navarra L, Jason-Smith A, Thompson H, McMillan N, Back G. Measurement properties of the WHO Disability Assessment Schedule 2.0 for evaluating functional status after inpatient surgery. Br J Surg 2022; 109:968-976. [PMID: 35929065 DOI: 10.1093/bjs/znac263] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/17/2022] [Accepted: 07/08/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Expert recommendations propose the WHO Disability Assessment Schedule (WHODAS) 2.0 as a core outcome measure in surgical studies, yet data on its long-term measurement properties remain limited. These were evaluated in a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) prospective cohort. METHODS Participants were adults (40 years of age or older) who underwent inpatient non-cardiac surgery. The 12-item WHODAS and EQ-5DTM-3L questionnaires were administered preoperatively (in person) and 1 year postoperatively (by telephone). Responsiveness was characterized using standardized response means (SRMs) and correlation coefficients between change scores. Construct validity was evaluated using correlation coefficients between 1-year scores and comparisons of WHODAS scores across clinically relevant subgroups. RESULTS The analysis included 546 patients. There was moderate correlation between changes in WHODAS and various EQ-5DTM subscales. The strongest correlation was between changes in WHODAS and changes in the functional domains of the EQ-5D-3L-for example, mobility (Spearman's rho 0.40, 95 per cent confidence interval [c.i.] 0.32 to 0.48) and usual activities (rho 0.45, 95 per cent c.i. 0.30 to 0.52). When compared across quartiles of EQ-5D index change, median WHODAS scores followed expected patterns of change. In subgroups with expected functional status changes, the WHODAS SRMs ranged from 'small' to 'large' in the expected directions of change. At 1 year, the WHODAS demonstrated convergence with the EQ-5D-3L functional domains, and good discrimination between patients with expected differences in functional status. CONCLUSION The WHODAS questionnaire has construct validity and responsiveness as a measure of functional status at 1 year after major surgery.
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Affiliation(s)
- Julian F Daza
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Brian H Cuthbertson
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Paul S Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Mark A Shulman
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Duminda N Wijeysundera
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada
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Oaknin A, Pothuri B, Gilbert L, Sabatier R, Brown J, Ghamande S, Mathews C, O'Malley D, Boni V, Gravina A, Banerjee S, Miller R, Pikiel J, Mirza M, Duan T, Han X, Zildjian S, Dewal N, J.Veneris, Tinker A. 547P Efficacy of dostarlimab in endometrial cancer (EC) by molecular subtype: A post hoc analysis of the GARNET study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.675] [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: 11/01/2022] Open
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Palmer K, El-Shakankery K, Kefas J, Gao K, Crusz S, Flynn M, Jonathan L, Lockley M, McCormack M, Macdonald N, Nicum S, Devlin MJ, Miller R. 600P Ethnic and socio-economic status in ovarian cancer patients recruited to clinical trials. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.728] [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: 11/01/2022] Open
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22
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Tinker A, Pothuri B, Gilbert L, Sabatier R, Brown J, Ghamande S, Mathews C, O'Malley D, Boni V, Gravina A, Banerjee S, Miller R, Pikiel J, Mirza M, Duan T, Antony G, Zildjian S, Zografos E, Veneris J, Oaknin A. 548P Progression-free survival (PFS) and overall survival (OS) in advanced/recurrent (AR) mismatch repair deficient/microsatellite instability–high or proficient/stable (dMMR/MSI-H or MMRp/MSS) endometrial cancer (EC) treated with dostarlimab in the GARNET study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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23
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Han D, Rozanski A, Miller R, Gransar H, Hayes S, Friedman J, Thomson L, Berman D. 604 Temporal Changes In Prognostic Outcomes Among Patients Undergoing Coronary Artery Calcium Scanning: 1998 To 2013. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hariharan R, He P, Karpavičiūtė N, Derrick R, Jacques C, Chambost J, Ebner T, Rosselot M, Loubersac S, Wouters K, Zaninovic N, Miller R, Malmsten J, Badalotti M, Hickman C. P-281 A multi-centre evaluation of a novel 4-cell embryo classification system based on intercellular contact points. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Is there any prognostic value to classifying 4-cell embryos according to intercellular contact points (ICPs)?
Summary answer
A significant association was found between the new blastomere arrangement classifications and blastulation, as well as blastocyst quality. No significant association was found for pregnancy.
What is known already
Current literature states that the geometric arrangement of blastomeres in 4-cell embryos is usually classified as either “tetrahedral” or “non-tetrahedral/planar”. Though tetrahedral embryos have been associated with greater developmental capacity, their prevalence has varied between studies. At ESHRE 2021, Hickman et al. proposed a more fine-grained classification system; each class was associated with a 4-digit code, where the Nth digit in said code gave the number of cells with N-1 ICPs. This gave rise to 6 classes: tetrahedral (0004), pseudotetrahedral (0022), planar (0040), closed-Y (0121), open-Y (0301) and linear (0220). In our study, we evaluate this new system.
Study design, size, duration
This study was a retrospective analysis of 844 4-cell embryos across 3 clinics in 3 countries. Focal stacks of the embryos were captured on Embryoscope/MIRI time-lapse incubators between 2018 and 2020. Embryos were annotated by their respective clinics using the original “tetrahedral/planar” system. Additionally, data on blastulation, blastocyst grade (Gardner scale) and biochemical pregnancy rates were obtained for each embryo.
Participants/materials, setting, methods
The embryos were annotated according to the new system by a panel of three researchers without knowledge of the clinics’ or each other’s classifications. Afterwards, the panelists assembled for discussion and a unanimous consensus was reached for each embryo. The cell arrangement classes were analysed with respect to blastulation rates, blastocyst grade and pregnancy rates using chi-squared tests. The distribution of classes across the clinics was also analysed, as well as agreement among the panelists.
Main results and the role of chance
Under the new system, tetrahedral and pseudotetrahedral embryos saw significantly higher rates of blastulation (P = 0.017) and good-quality blastocysts (p = 0.043; here, “good-quality” means that the grade contains no ‘C’s or numbers less than 3) compared to other arrangements. No association was found with respect to biochemical pregnancy (p = 0.77).
There was significant variation between the clinic-provided classifications (p < 0.001) with tetrahedral-to-planar ratios ranging from 1 to 9. Under the new system, there was no significant difference between the proportions of each arrangement (p = 0.66). The arrangements in order of decreasing prevalence across all the data were tetrahedral (63.7%), pseudotetrahedral (25.8%), planar (8.0%), closed-Y (2.2%) and linear (0.3%). No open-Y embryos were observed. Upon comparison with the clinic-provided tetrahedral/planar classifications, there were clear differences in the treatment of pseudotetrahedral embryos - some clinics predominantly classified them as “tetrahedral” while others as “planar”.
Prior to any discussions, the panelists’ annotations unanimously agreed on the classifications of 63% of the embryos; with 33% of the embryos having 2 different classifications and 4% of embryos causing total disagreement. The majority of disagreements regarded pseudotetrahedral embryos being confused for either tetrahedral or planar embryos.
Limitations, reasons for caution
It can be at times difficult to visualise the 3D structure of embryos from focal stacks. As a result, some annotations may be erroneous, though the use of a panel-based approach helped to mitigate this. Moreover, further studies will need to take place to validate the findings in this work.
Wider implications of the findings
The findings demonstrate the prognostic utility of Hickman et al.’s ICP-based classification system. Moreover, the findings suggest that much of the variability seen in the prevalence of tetrahedral embryos under the tetrahedral/planar system came from the mislabelling of pseudotetrahedral embryos which comprised 25.8% of the study population.
Trial registration number
N/A
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Affiliation(s)
- R Hariharan
- Apricity, AI Team , London, United Kingdom
- University Hospitals of Morecambe Bay NHS Foundation Trust, Furness General Hospital , Barrow-in-Furness, United Kingdom
| | - P He
- Apricity, AI Team , London, United Kingdom
- University College London, Department of Computer Science , London, United Kingdom
- University College London, Wellcome / EPSRC Centre for Interventional and Surgical Sciences , London, United Kingdom
| | | | - R Derrick
- Apricity, AI Team , London, United Kingdom
- Royal Surrey NHS Foundation Trust, Royal Surrey County Hospital , Guildford, United Kingdom
| | | | | | - T Ebner
- Kepler University Hospital, Department of Gynecology- Obstetrics and Gynecological Endocrinology , Linz, Austria
| | - M Rosselot
- Nantes University Hospital, ART Centre , Nantes, France
| | - S Loubersac
- Nantes University Hospital, ART Centre , Nantes, France
| | - K Wouters
- University Hospital Brussels, Centre for Reproductive Medicine , Brussels, Belgium
| | - N Zaninovic
- Weill Cornell Medical College, Department of Obstetrics and Gynecology , New York City, U.S.A
- Weill Cornell Medical College, Department of Reproductive Medicine , New York City, U.S.A
| | - R Miller
- Weill Cornell Medical College, Department of Reproductive Medicine , New York City, U.S.A
| | - J Malmsten
- Weill Cornell Medical College, Department of Reproductive Medicine , New York City, U.S.A
| | - M Badalotti
- Fertilitat, Reproductive Medicine Centre , Porto Alegre, Brazil
| | - C Hickman
- Apricity, AI Team , London, United Kingdom
- Imperial College London, Faculty of Medicine , London, United Kingdom
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Moayedi Y, Foroutan F, Truby L, Han J, Angleitner P, Guzman J, Sabatino M, Felius J, Zafar H, Law D, Van Zyl J, Tremblay-Gravel M, Segovia J, Devore A, Kim G, Lasarte MR, Knezevic I, Noly P, Farr M, Zuckermann A, Potena L, Ferrero M, Miller R, Fan S, Chih S, Hall S, Khush K, Ross H. Using Machine Learning to Develop a Contemporary Primary Graft Dysfunction Prediction Model: The International Consortium on PGD. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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26
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Truby L, Moayedi Y, Foroutan F, Han J, Guzman J, Farrero M, Zafar H, Felius J, van Zyl J, Hall S, Law D, Chih S, Angleitner P, Sabatino M, DeVore A, Miller R, Potena L, Zuckermann A, Ross H, Khush K, Farr M. Bridge to Transplant with Durable Left Ventricular Assist Device is Associated with Primary Graft Dysfunction Following Heart Transplantation: A Report from the International Consortium on Primary Graft Dysfunction. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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27
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Saeed D, Miller R, Darcy C, Miller K, Madden K, McKee H, Agnew J, Crawford P, Carter G, Parsons C. Medication-Related Fall (MRF) screening and scoring tool: consensus Delphi validation. International Journal of Pharmacy Practice 2022. [DOI: 10.1093/ijpp/riac019.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Falls are associated with negative health outcomes such as injury and mortality, as well as increased healthcare usage and costs. Risk factors for falls are multifactorial and include polypharmacy and the use of certain medications (1).
Aim
To develop and validate a medication-related fall (MRF) screening and scoring tool.
Methods
The MRF tool was developed from medication classes associated with falling in the Polypharmacy Guidance Realistic Prescribing 2018 (2), and additional medications identified and categorised by specialist and consultant pharmacists and physicians across a region of the United Kingdom. Medication classes were categorised as high-risk (three points), moderate-risk (two points) or low-risk (one point) in their ‘potential to cause falls’. The overall medication-related fall risk for the patient was determined by summing the scores for all medications. The MRF was validated using Delphi consensus methodology, whereby three iterative rounds of online surveys were conducted using SurveyMonkey®. Delphi panel experts were defined as individuals with recognised expertise in geriatric medicine and pharmacotherapy in older people. Twenty-two experts determined their agreement with the falls risk associated with each medication on a 5-point Likert scale with accompanying written feedback. Only medications with at least 75% of respondents agreeing or strongly agreeing were retained in the next round. Following the first validation round, any proposed criteria that did not meet retention requirements were removed. The second and third rounds of the survey were created based on the panel comments from the previous round.
Results
Consensus was reached for 19 medications/medication classes to be included in the final version of the MRF tool (table) and to reject eight medications/medication classes. Consensus was not reached regarding eight medications and they were not included in the final version of the tool.
Conclusion
The MRF tool is simple and feasible to use in healthcare settings to evaluate and optimise medications as a standalone screening instrument or as part of a multidisciplinary intervention to reduce fall risk and negative fall-related outcomes. The score from the MRF tool has potential for use as a clinical parameter to evaluate prescribing appropriateness.
References
(1) Public Health England (2020) Falls: applying All Our Health. Available at https://www.gov.uk/government/publications/falls-applying-all-our-health/falls-applying-all-our-health Guidance Falls: applying All Our Health. (Accessed: 4th April 2020)
(2) Scottish Government Polypharmacy Model of Care Group (2018). Polypharmacy Guidance, Realistic Prescribing. 3rd Edition.
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Affiliation(s)
- D Saeed
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - R Miller
- Western Health and Social Care Trust, Londonderry, UK
| | - C Darcy
- Western Health and Social Care Trust, Londonderry, UK
| | - K Miller
- South Eastern Health and Social Care Trust, Belfast, UK
| | - K Madden
- South Eastern Health and Social Care Trust, Belfast, UK
| | - H McKee
- Northern Health and Social Care Trust, Antrim, UK
| | - J Agnew
- South Eastern Health and Social Care Trust, Belfast, UK
| | - P Crawford
- Belfast Health and Social Care Trust, Belfast, UK
| | - G Carter
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - C Parsons
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
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Dabestani M, Yeganehzad S, Miller R. A natural source of saponin: Comprehensive study on interfacial properties of Chubak (Acanthophyllum Glandulosum) root extract and related saponins. Colloids Surf A Physicochem Eng Asp 2021. [DOI: 10.1016/j.colsurfa.2021.127594] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sabovcik F, Miller R, Cauwenberghs N, Hoffmann R, Haddad F, Kuznetsova T. Temporal shift and accuracy of machine learning in heart transplant outcomes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Accurate prediction of outcomes following a heart transplant is critical to explaining risks and benefits to patients and decision-making when considering potential organ offers. Given the large number of potential variables to be considered, this task may be most efficiently performed using machine learning (ML).
Purpose
We trained and tested different ML algorithms to accurately predict outcomes following a cardiac transplant using the United Network of Organ Sharing (UNOS) database.
Methods
We included 67 939 adult and pediatric patients enrolled in the UNOS database between January 1994 and December 2016 who underwent cardiac transplantation (median age 53 [IQR 38 – 60], 72.7% males). In our models, as an input, we included 114 features that have been collected from recipients and donors prior to transplant. The primary outcome was all-cause mortality at one-year post-transplant. We evaluated three different ML methods: XGBoost, Random Forest (RF) and L2 regularized logistic regression. Algorithms were trained and tested using shuffled 10-fold cross-validation (CV) as well as rolling CV. In the rolling CV, to mimic prospective procedure, ML models were trained by incrementally adding patients according to transplant year and testing models on the data in the following year. The hyperparameters, controlling the learning process, were tuned using Bayesian optimization. Prognostic accuracy for one-year all-cause mortality was characterized using the area under the receiver-operating characteristic curve (AUC).
Results
In total, 8,394 patients died within 1 year of transplant. We observed a substantial difference in prognostic accuracy between the shuffled 10-fold CV and the rolling CV. In the 10-fold CV, XGBoost and RF achieved high predictive performance with AUC of 0.848 (95% CI: 0.842–0.854) and 0.891 (95% CI: 0.886–0.896), respectively. In the rolling CV, which is a more realistic setting, AUC dropped to 0.673 (95% CI: 0.661–0.684) for XGBoost and 0.670 (0.657–0.683) for RF. Predictive performance of L2 regularized logistic regression remained stable across the two CV procedures, achieving AUC 0.669 (95% CI: 0.662–0.676) in the 10-fold shuffled CV and 0.665 (95% CI: 0.649–0.680) in the rolling CV procedure (Figure).
Conclusions
Our study suggests that ML models could be used to predict mortality in the first year post-transplant. We also show that the choice of CV procedure is crucial for evaluating ML models, particularly in data collected over a long period of time. The difference between the shuffled and rolling CV in the predictive performance of the tree-based ML models might indicate temporal dataset shift. In the rolling CV, all three methods achieved similar predictive performance.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Research Foundation Flanders (FWO)
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Affiliation(s)
- F Sabovcik
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - R Miller
- Libin Cardiovascular Institute of Alberta, Calgary, Canada
| | - N Cauwenberghs
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - R Hoffmann
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - F Haddad
- Stanford University, Department of Medicine, Palo Alto, United States of America
| | - T Kuznetsova
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
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McGrath K, Gibson J, Mardell A, Sumner G, Clarke B, Miller R. AMBULATORY PULMONARY ARTERY PRESSURE MONITORING REDUCES COSTS AND IMPROVES OUTCOMES IN SYMPTOMATIC HEART FAILURE: A SINGLE-CENTER CANADIAN EXPERIENCE. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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31
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Vasanthan V, Rieger J, Holloway D, Miller R, Clarke B, Kent W. STERNUM-SPARING LEFT VENTRICULAR ASSIST DEVICE INSERTION REDUCES BLOOD LOSS AND PERIOPERATIVE TRANSFUSIONS: INITIAL CANADIAN EXPERIENCE. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.210] [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: 11/30/2022] Open
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32
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Boeckle M, Schiestl M, Frohnwieser A, Gruber R, Miller R, Suddendorf T, Gray RD, Taylor AH, Clayton NS. New Caledonian crows' planning behaviour: a reply to de Mahy et al. Proc Biol Sci 2021; 288:20211271. [PMID: 34465241 DOI: 10.1098/rspb.2021.1271] [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: 11/12/2022] Open
Affiliation(s)
- M Boeckle
- Department of Psychology, University of Cambridge, Cambridge, UK.,Scientific Working Group, Die offene Tür (The open door), Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Psychiatry for Adults, University Hospital Tulln, Tulln, Austria
| | - M Schiestl
- School of Psychology, University of Auckland, Auckland, New Zealand.,Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany.,Faculty of Veterinary Sciences, University of Veterinary Sciences, Brno, Czech Republic
| | - A Frohnwieser
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - R Gruber
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - R Miller
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - T Suddendorf
- School of Psychology, University of Queensland, Saint Lucia, Queensland, Australia
| | - R D Gray
- School of Psychology, University of Auckland, Auckland, New Zealand.,Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - A H Taylor
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - N S Clayton
- Department of Psychology, University of Cambridge, Cambridge, UK
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Lythgoe M, Cleary S, Kalofonou F, Grunewald T, Miller R, Cartwright D, Glasspool R, Jones R, Rossides S, Ratnakumaran R, Michael A, McNeish I, Tookman L, Krell J. 747P Real-world experience of rucaparib in patients with ovarian cancer: A multicentre United Kingdom study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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34
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Griggs C, Schmaedick M, Gerall C, Fan W, Orlas C, Price J, Simpson L, Miller R, DeFazio J, Stylianos S, Rothenberg S, Duron V. Vanishing congenital lung malformations: What is the incidence of true regression? J Neonatal Perinatal Med 2021; 15:105-111. [PMID: 34459416 DOI: 10.3233/npm-210740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A congenital lung malformation (CLM) that is diagnosed on prenatal ultrasound exam may subsequently become undetectable on later scans, a "vanishing" CLM. OBJECTIVE The purpose of our study is to characterize the prenatal natural history and postnatal outcomes of "vanishing" lesions treated at our institution. METHODS We performed a retrospective chart review of 107 patients diagnosed prenatally with CLM at our institution. Comparisons were made using Kruskal-Wallis or t-test for continuous variables and Fisher's exact test or Chi-Square test for categorical variables. Multivariable analysis using logistic regression was performed. RESULTS Of the 104 patients, 59 (56.7%) had lesions that became sonographically undetectable on serial ultrasound scans. Patients with lesions that vanished prenatally tended to need less Neonatal Intensive Care Unit (NICU) admission at birth (persistent CLM: 54.8%vs vanished CLM: 28.8%), decreased need for supplemental O2 at birth (persistent CLM: 31.0%vs vanished CLM: 11.9%), and decreased delay in feeds (persistent CLM: 26.2%vs vanished CLM: 8.5%) compared to those with persistent CLM. After multivariate analysis controlling for maternal steroid administration and sex, admission to NICU maintained a slight statistical significance, with patients in the vanishing CLM group 2.5 times less likely to be admitted to the NICU. None of our patients whose lesions vanished prenatally required mechanical ventilation. Eighty-six patients underwent postnatal computed tomography (CT) chest. Only 2 patients had lesions that regressed on postnatal CT. CONCLUSION Lesions that vanish on prenatal imaging may be associated with improved clinical outcomes. The rate of true regression at our institution was as low as 2.3%.
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Affiliation(s)
- C Griggs
- Department of Pediatric Surgery, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - M Schmaedick
- Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - C Gerall
- Department of Pediatric Surgery, Columbia University Medical Center, New York, New York. USA
| | - W Fan
- Department of Biostatistics, Irving Institute for Clinical and Translational Research, New York, New York, USA
| | - C Orlas
- Department of Pediatric Surgery, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - J Price
- Department of Pediatric Surgery, Columbia University Medical Center, New York, New York. USA
| | - L Simpson
- Department of Obstetrics and Gynecology, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - R Miller
- Department of Obstetrics and Gynecology, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - J DeFazio
- Department of Pediatric Surgery, Columbia University Medical Center, New York, New York. USA
| | - S Stylianos
- Department of Pediatric Surgery, Columbia University Medical Center, New York, New York. USA
| | - S Rothenberg
- Department of Pediatric Surgery, Columbia University Medical Center, New York, New York. USA.,Department of Pediatric Surgery, Rocky Mountain Hospital for Children, Denver, Colorado, USA
| | - V Duron
- Department of Pediatric Surgery, Columbia University Medical Center, New York, New York. USA
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35
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Culmer P, Davis Birch W, Waters I, Keeling A, Osnes C, Jones D, de Boer G, Hetherington R, Ashton S, Latham M, Beacon T, Royston T, Miller R, Littlejohns A, Parmar J, Lawton T, Murdoch S, Brettle D, Musasizi R, Nampiina G, Namulema E, Kapur N. The LeVe CPAP System for Oxygen-Efficient CPAP Respiratory Support: Development and Pilot Evaluation. Front Med Technol 2021; 3:715969. [PMID: 35047948 PMCID: PMC8757765 DOI: 10.3389/fmedt.2021.715969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/29/2021] [Indexed: 12/04/2022] Open
Abstract
Background: The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has placed a significant demand on healthcare providers (HCPs) to provide respiratory support for patients with moderate to severe symptoms. Continuous Positive Airway Pressure (CPAP) non-invasive ventilation can help patients with moderate symptoms to avoid the need for invasive ventilation in intensive care. However, existing CPAP systems can be complex (and thus expensive) or require high levels of oxygen, limiting their use in resource-stretched environments. Technical Development + Testing: The LeVe ("Light") CPAP system was developed using principles of frugal innovation to produce a solution of low complexity and high resource efficiency. The LeVe system exploits the air flow dynamics of electric fan blowers which are inherently suited to delivery of positive pressure at appropriate flow rates for CPAP. Laboratory evaluation demonstrated that performance of the LeVe system was equivalent to other commercially available systems used to deliver CPAP, achieving a 10 cm H2O target pressure within 2.4% RMS error and 50-70% FiO2 dependent with 10 L/min oxygen from a commercial concentrator. Pilot Evaluation: The LeVe CPAP system was tested to evaluate safety and acceptability in a group of ten healthy volunteers at Mengo Hospital in Kampala, Uganda. The study demonstrated that the system can be used safely without inducing hypoxia or hypercapnia and that its use was well-tolerated by users, with no adverse events reported. Conclusions: To provide respiratory support for the high patient numbers associated with the COVID-19 pandemic, healthcare providers require resource efficient solutions. We have shown that this can be achieved through frugal engineering of a CPAP ventilation system, in a system which is safe for use and well-tolerated in healthy volunteers. This approach may also benefit other respiratory conditions which often go unaddressed in Low and Middle Income Countries (LMICs) for want of context-appropriate technology designed for the limited oxygen resources available.
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Affiliation(s)
- Pete Culmer
- School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
| | - W. Davis Birch
- School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
| | - I. Waters
- School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
| | - A. Keeling
- School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
- School of Dentistry, University of Leeds, Leeds, United Kingdom
| | - C. Osnes
- School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
- School of Dentistry, University of Leeds, Leeds, United Kingdom
| | - D. Jones
- School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
| | - G. de Boer
- School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
| | - R. Hetherington
- School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
| | - S. Ashton
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - M. Latham
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - T. Beacon
- Medical Aid International Ltd., Bedford, United Kingdom
| | - T. Royston
- Medical Aid International Ltd., Bedford, United Kingdom
| | - R. Miller
- Medical Aid International Ltd., Bedford, United Kingdom
| | | | - J. Parmar
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Tom Lawton
- Bradford Teaching Hospitals National Health Service (NHS) Foundation Trust, Bradford, United Kingdom
| | - S. Murdoch
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - D. Brettle
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | | | | | | | - N. Kapur
- School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
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Hariharan R, He P, Hickman C, Chambost J, Jacques C, Hentschke M, Cunegatto B, Dutra C, Drakeley A, Zhan Q, Miller R, Verheyen G, Rosselot M, Loubersac S, Kelley K. P–165 Using Artificial Intelligence to Classify Embryo Shape: An International Perspective. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Is a pre-trained machine learning algorithm able to accurately detect cellular arrangement in 4-cell embryos from a different continent?
Summary answer
Artificial Intelligence (AI) analysis of 4-cell embryo classification is transferable across clinics globally with 79% accuracy.
What is known already
Previous studies observing four-cell human embryo configurations have demonstrated that non-tetrahedral embryos (embryos in which cells make contact with fewer than 3 other cells) are associated with compromised blastulation and implantation potential. Previous research by this study group has indicated the efficacy of AI models in classification of tetrahedral and non-tetrahedral embryos with 87% accuracy, with a database comprising 2 clinics both from the same country (Brazil). This study aims to evaluate the transferability and robustness of this model on blind test data from a different country (France).
Study design, size, duration
The study was a retrospective cohort analysis in which 909 4-cell embryo images (“tetrahedral”, n = 749; “non-tetrahedral”, n = 160) were collected from 3 clinics (2 Brazilian, 1 French). All embryos were captured at the central focal plane using Embryoscope™ time-lapse incubators. The training data consisted solely of embryo images captured in Brazil (586 tetrahedral; 87 non-tetrahedral) and the test data consisted exclusively of embryo images captured in France (163 tetrahedral; 72 non-tetrahedral).
Participants/materials, setting, methods
The embryo images were labelled as either “tetrahedral” or “non-tetrahedral” at their respective clinics. Annotations were then validated by three operators. A ResNet–50 neural network model pretrained on ImageNet was fine-tuned on the training dataset to predict the correct annotation for each image. We used the cross entropy loss function and the RMSprop optimiser (lr = 1e–5). Simple data augmentations (flips and rotations) were used during the training process to help counteract class imbalances.
Main results and the role of chance
Our model was capable of classifying embryos in the blind French test set with 79% accuracy when trained with the Brazilian data. The model had sensitivity of 91% and 51% for tetrahedral and non-tetrahedral embryos respectively; precision was 81% and 73%; F1 score was 86% and 60%; and AUC was 0.61 and 0.64. This represents a 10% decrease in accuracy compared to when the model both trained and tested on different data from the same clinics.
Limitations, reasons for caution
Although strict inclusion and exclusion criteria were used, inter-operator variability may affect the pre-processing stage of the algorithm. Moreover, as only one focal plane was used, ambiguous cases were interpoloated and further annotated. Analysing embryos at multiple focal planes may prove crucial in improving the accuracy of the model.
Wider implications of the findings: Though the use of machine learning models in the analysis of embryo imagery has grown in recent years, there has been concern over their robustness and transferability. While previous results have demonstrated the utility of locally-trained models, our results highlight the potential for models to be implemented across different clinics.
Trial registration number
Not applicable
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Affiliation(s)
| | - P He
- Apricity, AI Team, London, United Kingdom
| | - C Hickman
- Apricity, AI Team, London, United Kingdom
| | | | | | - M Hentschke
- Fertilitat, Gynaecology, Porto Alegre, Brazil
| | - B Cunegatto
- Fertilitat, Embryology, Porto Alegre, Brazil
| | - C Dutra
- Reproferty, Embryology, São José dos Campos, Brazil
| | - A Drakeley
- Hewitt Fertility Centre of Liverpool Women’s Hospital, Obstetrics and Gynaecology, Liverpool, United Kingdom
| | - Q Zhan
- Weill Cornell Medicine, Obstetrics and Gynaecology, New York, USA
| | - R Miller
- Weill Cornell Medicine, Reproductive Medicine, New York, USA
| | - G Verheyen
- UZ Brussels, Reproductive Medicine, Jette, Belgium
| | - M Rosselot
- CHU de Nantes, Reproductive Medicine, Nantes, France
| | - S Loubersac
- CHU de Nantes, Reproductive Medicine, Nantes, France
| | - K Kelley
- POMA Fertility, Data Analytics, Kirkland, USA
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37
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Eiras-Diaz A, FrykforsvonHekkel A, Hanot E, Stanzani G, Florey J, Miller R, Llabres-Diaz F. CT findings, management and short-term outcome of dogs with pyothorax: 101 cases (2010 to 2019). J Small Anim Pract 2021; 62:959-966. [PMID: 34254321 DOI: 10.1111/jsap.13374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/09/2021] [Accepted: 04/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe diagnosis, CT findings, management and short-term outcome of a large population of canine pyothorax cases. METHODS Retrospective analysis of 101 canine pyothorax cases at two UK referral centres. Medical records and CT images were reviewed. Dogs were included if pre- and post-contrast CT was performed within 48 hours of presentation. RESULTS CT abnormalities included pleural thickening (84.1%), pannus (67.3%), pneumothorax (61.4%), mediastinal effusion (28.7%), pulmonary (13.8%) and mediastinal (7.9%) abscessation, foreign body presence (7.9%), foreign body tracts (6.9%) and pneumonia (6.9%). Seventy-one percent of dogs were managed surgically, of which 90.2% survived, and 29% were managed medically, of which 72.4% survived. Overall mortality was 14.8% and 86.6% of these dogs died within 48 hours of admission. All dogs with evidence of a foreign body on CT underwent surgery. CLINICAL SIGNIFICANCE Mortality in our population was low and most dogs that died did so within 48 hours of hospitalisation, regardless of management type.
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Affiliation(s)
- A Eiras-Diaz
- Dick White Referrals, Newmarket, Station Farm, London Road, Cambridgeshire, CB8 0UH, UK.,Southfields Veterinary Specialists, 1 Bramston Way, Basildon, SS15 6TP, UK
| | - A FrykforsvonHekkel
- Queen Mother Hospital for Animals, Royal Veterinary College, University of London, North Mymms, AL9 7TA, UK
| | - E Hanot
- Dick White Referrals, Newmarket, Station Farm, London Road, Cambridgeshire, CB8 0UH, UK
| | - G Stanzani
- Dick White Referrals, Newmarket, Station Farm, London Road, Cambridgeshire, CB8 0UH, UK.,Bloomsbury Institute for Intensive Care Medicine, University College London, Gower Street, London, WC1E 6BT, UK
| | - J Florey
- Dick White Referrals, Newmarket, Station Farm, London Road, Cambridgeshire, CB8 0UH, UK
| | - R Miller
- Dick White Referrals, Newmarket, Station Farm, London Road, Cambridgeshire, CB8 0UH, UK
| | - F Llabres-Diaz
- Queen Mother Hospital for Animals, Royal Veterinary College, University of London, North Mymms, AL9 7TA, UK
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Wüstneck R, Miller R, Czichocki G. Characterization of the Adsorption Behaviour of Sodium-n-Alkylsulphates at the Interface Air/Aqueous Solution by Different Adsorption Isotherms. TENSIDE SURFACT DET 2021. [DOI: 10.1515/tsd-1992-290416] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Miller R, Fainerman VB, Schano KH, Hofmann A, Heyer W. Bestimmung der dynamischen Oberflächenspannung mit Hilfe eines automatischen Blasendrucktensiometers / Dynamic surface tension determination using an automated bubble pressure tensiometer. TENSIDE SURFACT DET 2021. [DOI: 10.1515/tsd-1997-340514] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bentzon AK, Panteleev A, Mitsura V, Borodulina E, Skrahina A, Denisova E, Tetradov S, Podlasin R, Riekstina V, Kancauskiene Z, Paduto D, Mocroft A, Trofimova T, Miller R, Post F, Grezesczuk A, Lundgren JD, Inglot M, Podlekareva D, Bolokadze N, Kirk O. Healthcare delivery for HIV-positive people with tuberculosis in Europe. HIV Med 2021; 22:283-293. [PMID: 33215809 PMCID: PMC9801686 DOI: 10.1111/hiv.13016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND In a 2013 survey, we reported distinct discrepancies in delivery of tuberculosis (TB) and HIV services in eastern Europe (EE) vs. western Europe (WE). OBJECTIVES To verify the differences in TB and HIV services in EE vs. WE. METHODS Twenty-three sites completed a survey in 2018 (EE, 14; WE, nine; 88% response rate). Results were compared across as well as within the two regions. When possible, results were compared with the 2013 survey. RESULTS Delivery of healthcare was significantly less integrated in EE: provision of TB and HIV services at one site (36% in EE vs. 89% in WE; P = 0.034), and continued TB follow-up in one location (42% vs. 100%; P = 0.007). Although access to TB diagnostics, standard TB and HIV drugs was generally good, fewer sites in EE reported unlimited access to rifabutin/multi-drug-resistant TB (MDR-TB) drugs, HIV integrase inhibitors and opioid substitution therapy (OST). Compared with 2013, routine usage of GeneXpert was more common in EE in 2018 (54% vs. 92%; P = 0.073), as was access to moxifloxacin (46% vs. 91%; P = 0.033), linezolid (31% vs. 64%; P = 0.217), and bedaquiline (0% vs. 25%; P = 0.217). Integration of TB and HIV services (46% vs. 39%; P = 1.000) and provision of OST to patients with opioid dependency (54% vs. 46%; P = 0.695) remained unchanged. CONCLUSION Delivery of TB and HIV healthcare, including integration of TB and HIV care and access to MDR-TB drugs, still differs between WE and EE, as well as between individual EE sites.
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Affiliation(s)
- A K Bentzon
- CHIP (Centre of Excellence for Health, Immunity and Infections), Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Panteleev
- Department of HIV/TB, TB Hospital 2, St Petersburg, Russia
| | - V Mitsura
- Gomel State Medical University, Gomel, Belarus
| | - E Borodulina
- Department of Phthisiology and Pulmonology, Samara State Medical University of Minzdrav of Russia, Samara, Russia
| | - A Skrahina
- Republican Research and Practical Clinic for Pulmonology, Minsk, Belarus
| | - E Denisova
- Botkin Hospital of Infectious Disease, St Petersburg, Russia
| | - S Tetradov
- Dr. Victor Babes Hospital, Bucharest, Romania
| | - R Podlasin
- Wojewodski Szpital Zakanzy/Medical University of Warsaw, Warsaw, Poland
| | - V Riekstina
- Clinic of TB and Lung Diseases, Riga, Latvia
| | - Z Kancauskiene
- Clinic for Communicable Diseases and AIDS, Vilnius, Lithuania
| | - D Paduto
- Gomel Region Clinic for Hygiene, Svetlogorsk, Belarus
| | - A Mocroft
- Department of Infection and Population Health, University College London, London, UK
| | - T Trofimova
- Clinic for Prevention and Control of AIDS, Novgorod, Russia
| | - R Miller
- Mortimer Market Clinic, London, UK
| | - F Post
- King's College Hospital, London, UK
| | - A Grezesczuk
- Medical University Teaching Hospital, Bialystok, Poland
| | - J D Lundgren
- CHIP (Centre of Excellence for Health, Immunity and Infections), Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - M Inglot
- Wroclaw University School of Medicine, Wroclaw, Poland
| | - D Podlekareva
- CHIP (Centre of Excellence for Health, Immunity and Infections), Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - N Bolokadze
- Infectious Diseases, AIDS and Clinical Immunology Research Clinic, Tbilisi, Georgia
| | - O Kirk
- CHIP (Centre of Excellence for Health, Immunity and Infections), Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Miller R, Ambler G, Ramirez J, Rees J, Hinchliffe R, Twine C, Rudd S, Blazeby J, Avery K. Patient Reported Outcome Measures for Major Lower Limb Amputation Caused by Peripheral Artery Disease or Diabetes: A Systematic Review. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Miller R, Wagner S, Hammond J, Roberts N, Marshall K, Barth B. Posterior reversible encephalopathy syndrome in the emergency department: A single center retrospective study. Am J Emerg Med 2021; 45:61-64. [PMID: 33667750 DOI: 10.1016/j.ajem.2021.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Posterior Reversible Encephalopathy Syndrome (PRES) and the related term Reversible Posterior Leukoencephalopathy Syndrome (RPLS) denote a constellation of clinical symptoms paired with key radiological findings. These symptoms may include headache, altered mental status, visual changes, and seizures. PRES is a rare condition and remains a challenging diagnosis to make in the emergency department. Data on risk factors and clinical presentation are limited, and there is no recent literature-supported diagnostic criteria. Our primary objective was to identify initial symptoms, clinical presentation, and risk factors that should guide the emergency clinician to consider a diagnosis of PRES. A secondary objective was to identify associations between risk factors and the outcomes of mortality and ICU admissions. METHODS This was a retrospective, observational study that evaluated patients seen in the Emergency Department (ED) in an urban tertiary care center with the diagnosis of PRES or RPLS from 1/1/2008 to 1/1/2018. The Health System's Electronic Medical Record was used to collect data. Search criteria included any patient diagnosed with Posterior Reversible Encephalopathy Syndrome (PRES) or Reversible Posterior Leukoencephalopathy Syndrome (RPLS), and excluded patients under 18 years of age, transfer patients, or patients that were not evaluated in our emergency department. RESULTS We identified 98 patients based on our initial search criteria. After a chart review, 27 patients met our predefined eligibility criteria. In patients with confirmed diagnosis of PRES, the majority were female (70%) and 37% were either on an immunomodulator or undergoing chemotherapy at the time of presentation. 67% of patients presented with altered mental status, 41% had a focal neurologic deficit, and 37% had a witnessed seizure prior to diagnosis. Headache (48%), nausea (33%), and vision changes (30%) were the next most common reported symptoms. The majority of patients were hypertensive at time of presentation (82%) and many had a past medical history of hypertension (78%); twelve were given anti-hypertensive medications. 33% of the patients were admitted to the ICU and 26% died. There were no statistical associations found between documented ED interventions and the outcome of mortality. CONCLUSION PRES is difficult to identify and diagnose in the emergency department. Significant risk factors such as female gender, hypertension, and those currently undergoing active immunotherapy/chemotherapy are associated with PRES. Common presenting complaints and exam findings include headache, altered mental status, and neurologic deficits. Emergency providers should consider PRES in patients presenting with altered mental status with significant risk factors, especially with neurologic deficits for which stroke has been ruled out.
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Affiliation(s)
- Ross Miller
- University of Kansas Medical Center, Kansas City, KS, USA.
| | - Samuel Wagner
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Jordan Hammond
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Nathan Roberts
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Ken Marshall
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Bradley Barth
- University of Kansas Medical Center, Kansas City, KS, USA
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Bykov A, Milyaeva O, Isakov N, Michailov A, Loglio G, Miller R, Noskov B. Dynamic properties of adsorption layers of pulmonary surfactants. Influence of matter exchange with bulk phase. Colloids Surf A Physicochem Eng Asp 2021. [DOI: 10.1016/j.colsurfa.2020.125851] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Boeckle M, Schiestl M, Frohnwieser A, Gruber R, Miller R, Suddendorf T, Gray RD, Taylor AH, Clayton NS. New Caledonian crows plan for specific future tool use. Proc Biol Sci 2020; 287:20201490. [PMID: 33143583 PMCID: PMC7735258 DOI: 10.1098/rspb.2020.1490] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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] [Indexed: 12/28/2022] Open
Abstract
The ability to plan for future events is one of the defining features of human intelligence. Whether non-human animals can plan for specific future situations remains contentious: despite a sustained research effort over the last two decades, there is still no consensus on this question. Here, we show that New Caledonian crows can use tools to plan for specific future events. Crows learned a temporal sequence where they were (a) shown a baited apparatus, (b) 5 min later given a choice of five objects and (c) 10 min later given access to the apparatus. At test, these crows were presented with one of two tool-apparatus combinations. For each combination, the crows chose the right tool for the right future task, while ignoring previously useful tools and a low-value food item. This study establishes that planning for specific future tool use can evolve via convergent evolution, given that corvids and humans shared a common ancestor over 300 million years ago, and offers a route to mapping the planning capacities of animals.
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Affiliation(s)
- M Boeckle
- Department of Psychology, University of Cambridge, Cambridge, UK.,Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria.,Department of Psychiatry and Psychotherapy, University Hospital Tulln, Tulln, Austria
| | - M Schiestl
- School of Psychology, University of Auckland, Auckland, New Zealand.,Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany.,University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | - A Frohnwieser
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - R Gruber
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - R Miller
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - T Suddendorf
- School of Psychology, University of Queensland, Brisbane, Australia
| | - R D Gray
- School of Psychology, University of Auckland, Auckland, New Zealand.,Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - A H Taylor
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - N S Clayton
- Department of Psychology, University of Cambridge, Cambridge, UK
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Miller R, Wentzel AR, Richards GA. COVID-19: NAD + deficiency may predispose the aged, obese and type2 diabetics to mortality through its effect on SIRT1 activity. Med Hypotheses 2020; 144:110044. [PMID: 32758884 PMCID: PMC7322475 DOI: 10.1016/j.mehy.2020.110044] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 12/13/2022]
Abstract
The SARS-CoV-2 hyperinflammatory response is associated with high mortality. This hypothesis suggests that a deficiency of nicotinamide adenine dinucleotide (NAD+) may be the primary factor related to the SARS-Cov-2 disease spectrum and the risk for mortality, as subclinical nutritional deficiencies may be unmasked by any significant increase in oxidative stress. NAD+ levels decline with age and are also reduced in conditions associated with oxidative stress as occurs with hypertension, diabetes and obesity. These groups have also been observed to have high mortality following infection with COVID-19. Further consumption of NAD+ in a pre-existent depleted state is more likely to cause progression to the hyperinflammatory stage of the disease through its limiting effects on the production of SIRT1. This provides a unifying hypothesis as to why these groups are at high risk of mortality and suggests that nutritional support with NAD+ and SIRT1 activators, could minimise disease severity if administered prophylactically and or therapeutically. The significance of this, if proven, has far-reaching consequences in the management of COVID-19 especially in third world countries, where resources and finances are limited.
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Affiliation(s)
- R Miller
- Telluraves Aerospace, Cape Town, South Africa
| | - A R Wentzel
- Consultant Anaesthesiologist, Port Elizabeth, South Africa.
| | - G A Richards
- Emeritus Professor Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Gibson J, Trpkov C, Miller R, Grant A, Schnell G, Har B, Clarke B. A FIVE-YEAR SINGLE CANADIAN CENTRE EXPERIENCE WITH PERCUTANEOUS LEFT VENTRICULAR ASSIST DEVICE IN CARDIOGENIC SHOCK. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Miller R, Crawford B. PMU28 Utilization Patterns of a Japanese Biomedical Database, Ichushi, in Real-World Evidence Review: A Scoping Review. Value Health Reg Issues 2020. [DOI: 10.1016/j.vhri.2020.07.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brown J, Breslau J, Siegwarth A, Miller R, Kase C, Dunbar M, Briscombe B, Dey J. Implementation and Costs of the Certified Community Behavioral Health Clinic Demonstration. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13473] [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: 11/29/2022] Open
Affiliation(s)
- J. Brown
- Mathematica Atlanta GA United States
| | - J. Breslau
- RAND Corporation Pittsburgh PA United States
| | | | - R. Miller
- Mathematica Oakland CA United States
| | - C. Kase
- RAND Corporation Pittsburgh PA United States
| | - M. Dunbar
- RAND Corporation Santa Monica CA United States
| | | | - J. Dey
- U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation Washington DC United States
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