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Lee J, Nandalur S, Hazy A, Al-Katib S, Kim K, Ye H, Kolderman N, Dhaliwal A, Krauss D, Quinn T, Marvin K, Nandalur KR. Prostatic Urethral Length on MRI Potentially Predicts Late Genitourinary Toxicity After Prostate Cancer Radiation. Acad Radiol 2023:S1076-6332(23)00471-3. [PMID: 37858506 DOI: 10.1016/j.acra.2023.09.004] [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: 08/01/2023] [Revised: 08/28/2023] [Accepted: 09/03/2023] [Indexed: 10/21/2023]
Abstract
RATIONALE AND OBJECTIVES The purpose of our study was to evaluate pretreatment prostate quantitative magnetic resonance imaging (MRI) measurements and clinical characteristics in predicting genitourinary (GU) toxicity after radiotherapy (RT) for prostate cancer. MATERIALS AND METHODS In this single-institution retrospective cohort study, we evaluated patients with prostate adenocarcinoma who underwent MRI within 6 months before completing definitive RT and follow-up information in our GU toxicity database from June 2016 to February 2023. MRI measurements included quantitative urethra, prostate, and bladder measurements. GU toxicity was physician-scored using the Common Terminology Criteria for Adverse Events (CTCAE v4.0) with acute toxicity defined as ≤180 days and late defined as >180 days. Multivariable logistic regression model was constructed for grade ≥2 acute toxicity and Cox proportional hazards regression for late toxicity, adjusted for clinical factors and RT method. RESULTS A total of 361 men (median age 68 years, interquartile range [IQR] 62-73) were included; 14.4% (50/347) men experienced grade ≥2 acute toxicity. Brachytherapy (odds ratio [OR]: 2.9, 95% confidence interval [CI]: 1.5-5.8), P < 0.01) was associated with increased odds of acute GU toxicity, and longer MUL (OR: 0.41 [95%CI: 0.18-0.92], P = 0.03) with decreased odds. Median follow-up for late toxicity was 15.0 months (IQR: 9.0-28.0) with approximately 88.7% and 72.0% patients free of toxicity at 1 and 3 years, respectively. Only longer prostatic urethral length (hazard ratio [HR]: 1.6, 95%CI: 1.2-2.1, P < 0.01) was associated with increased risk of late GU toxicity, notably urinary frequency/urgency symptoms (HR: 1.7 [95%CI: 1.3-2.3], P < 0.01). CONCLUSION Longer prostatic urethral length measured on prostate MRI is independently associated with higher risk of developing late grade ≥2 GU toxicity after radiation therapy for prostate cancer. This pretreatment metric may be potentially valuable in risk-stratification models for quality of life following prostate RT.
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Affiliation(s)
- Joseph Lee
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan (J.L., S.N., A.H., H.Y., D.K., T.Q., K.M.); Medical School, Oakland University William Beaumont School of Medicine, Rochester, Michigan (J.L., S.N., A.H., S.A.K., K.K., H.Y., N.K., A.D., D.K., T.Q., K.R.N.)
| | - Sirisha Nandalur
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan (J.L., S.N., A.H., H.Y., D.K., T.Q., K.M.); Medical School, Oakland University William Beaumont School of Medicine, Rochester, Michigan (J.L., S.N., A.H., S.A.K., K.K., H.Y., N.K., A.D., D.K., T.Q., K.R.N.)
| | - Allison Hazy
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan (J.L., S.N., A.H., H.Y., D.K., T.Q., K.M.); Medical School, Oakland University William Beaumont School of Medicine, Rochester, Michigan (J.L., S.N., A.H., S.A.K., K.K., H.Y., N.K., A.D., D.K., T.Q., K.R.N.)
| | - Sayf Al-Katib
- Medical School, Oakland University William Beaumont School of Medicine, Rochester, Michigan (J.L., S.N., A.H., S.A.K., K.K., H.Y., N.K., A.D., D.K., T.Q., K.R.N.); Department of Radiology and Molecular Imaging, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan (S.A.K., N.K., A.D., K.R.N.)
| | - Kyu Kim
- Medical School, Oakland University William Beaumont School of Medicine, Rochester, Michigan (J.L., S.N., A.H., S.A.K., K.K., H.Y., N.K., A.D., D.K., T.Q., K.R.N.)
| | - Hong Ye
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan (J.L., S.N., A.H., H.Y., D.K., T.Q., K.M.); Medical School, Oakland University William Beaumont School of Medicine, Rochester, Michigan (J.L., S.N., A.H., S.A.K., K.K., H.Y., N.K., A.D., D.K., T.Q., K.R.N.)
| | - Nathan Kolderman
- Medical School, Oakland University William Beaumont School of Medicine, Rochester, Michigan (J.L., S.N., A.H., S.A.K., K.K., H.Y., N.K., A.D., D.K., T.Q., K.R.N.); Department of Radiology and Molecular Imaging, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan (S.A.K., N.K., A.D., K.R.N.)
| | - Abhay Dhaliwal
- Medical School, Oakland University William Beaumont School of Medicine, Rochester, Michigan (J.L., S.N., A.H., S.A.K., K.K., H.Y., N.K., A.D., D.K., T.Q., K.R.N.); Department of Radiology and Molecular Imaging, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan (S.A.K., N.K., A.D., K.R.N.)
| | - Daniel Krauss
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan (J.L., S.N., A.H., H.Y., D.K., T.Q., K.M.); Medical School, Oakland University William Beaumont School of Medicine, Rochester, Michigan (J.L., S.N., A.H., S.A.K., K.K., H.Y., N.K., A.D., D.K., T.Q., K.R.N.)
| | - Thomas Quinn
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan (J.L., S.N., A.H., H.Y., D.K., T.Q., K.M.); Medical School, Oakland University William Beaumont School of Medicine, Rochester, Michigan (J.L., S.N., A.H., S.A.K., K.K., H.Y., N.K., A.D., D.K., T.Q., K.R.N.)
| | - Kimberly Marvin
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan (J.L., S.N., A.H., H.Y., D.K., T.Q., K.M.)
| | - Kiran R Nandalur
- Medical School, Oakland University William Beaumont School of Medicine, Rochester, Michigan (J.L., S.N., A.H., S.A.K., K.K., H.Y., N.K., A.D., D.K., T.Q., K.R.N.); Department of Radiology and Molecular Imaging, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan (S.A.K., N.K., A.D., K.R.N.).
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Huckvale K, Hoon L, Stech E, Newby JM, Zheng WY, Han J, Vasa R, Gupta S, Barnett S, Senadeera M, Cameron S, Kurniawan S, Agarwal A, Kupper JF, Asbury J, Willie D, Grant A, Cutler H, Parkinson B, Ahumada-Canale A, Beames JR, Logothetis R, Bautista M, Rosenberg J, Shvetcov A, Quinn T, Mackinnon A, Rana S, Tran T, Rosenbaum S, Mouzakis K, Werner-Seidler A, Whitton A, Venkatesh S, Christensen H. Protocol for a bandit-based response adaptive trial to evaluate the effectiveness of brief self-guided digital interventions for reducing psychological distress in university students: the Vibe Up study. BMJ Open 2023; 13:e066249. [PMID: 37116996 PMCID: PMC10151864 DOI: 10.1136/bmjopen-2022-066249] [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] [Indexed: 04/30/2023] Open
Abstract
INTRODUCTION Meta-analytical evidence confirms a range of interventions, including mindfulness, physical activity and sleep hygiene, can reduce psychological distress in university students. However, it is unclear which intervention is most effective. Artificial intelligence (AI)-driven adaptive trials may be an efficient method to determine what works best and for whom. The primary purpose of the study is to rank the effectiveness of mindfulness, physical activity, sleep hygiene and an active control on reducing distress, using a multiarm contextual bandit-based AI-adaptive trial method. Furthermore, the study will explore which interventions have the largest effect for students with different levels of baseline distress severity. METHODS AND ANALYSIS The Vibe Up study is a pragmatically oriented, decentralised AI-adaptive group sequential randomised controlled trial comparing the effectiveness of one of three brief, 2-week digital self-guided interventions (mindfulness, physical activity or sleep hygiene) or active control (ecological momentary assessment) in reducing self-reported psychological distress in Australian university students. The adaptive trial methodology involves up to 12 sequential mini-trials that allow for the optimisation of allocation ratios. The primary outcome is change in psychological distress (Depression, Anxiety and Stress Scale, 21-item version, DASS-21 total score) from preintervention to postintervention. Secondary outcomes include change in physical activity, sleep quality and mindfulness from preintervention to postintervention. Planned contrasts will compare the four groups (ie, the three intervention and control) using self-reported psychological distress at prespecified time points for interim analyses. The study aims to determine the best performing intervention, as well as ranking of other interventions. ETHICS AND DISSEMINATION Ethical approval was sought and obtained from the UNSW Sydney Human Research Ethics Committee (HREC A, HC200466). A trial protocol adhering to the requirements of the Guideline for Good Clinical Practice was prepared for and approved by the Sponsor, UNSW Sydney (Protocol number: HC200466_CTP). TRIAL REGISTRATION NUMBER ACTRN12621001223820.
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Affiliation(s)
- Kit Huckvale
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Leonard Hoon
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, Victoria, Australia
| | - Eileen Stech
- Black Dog Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jill M Newby
- Black Dog Institute, UNSW Sydney, Sydney, New South Wales, Australia
- School of Psychology, UNSW Sydney, Sydney, New South Wales, Australia
| | - Wu Yi Zheng
- Black Dog Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jin Han
- Black Dog Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Rajesh Vasa
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, Victoria, Australia
| | - Sunil Gupta
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, Victoria, Australia
| | - Scott Barnett
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, Victoria, Australia
| | - Manisha Senadeera
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, Victoria, Australia
| | - Stuart Cameron
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, Victoria, Australia
| | - Stefanus Kurniawan
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, Victoria, Australia
| | - Akash Agarwal
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, Victoria, Australia
| | - Joost Funke Kupper
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, Victoria, Australia
| | - Joshua Asbury
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, Victoria, Australia
| | - David Willie
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, Victoria, Australia
| | - Alasdair Grant
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, Victoria, Australia
| | - Henry Cutler
- Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
| | - Bonny Parkinson
- Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
| | | | - Joanne R Beames
- Black Dog Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Rena Logothetis
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, Victoria, Australia
| | - Marya Bautista
- Black Dog Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jodie Rosenberg
- Black Dog Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Artur Shvetcov
- Black Dog Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Thomas Quinn
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, Victoria, Australia
| | - Andrew Mackinnon
- Black Dog Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Santu Rana
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, Victoria, Australia
| | - Truyen Tran
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, Victoria, Australia
| | - Simon Rosenbaum
- School of Psychiatry, UNSW Sydney, Sydney, New South Wales, Australia
| | - Kon Mouzakis
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, Victoria, Australia
| | | | - Alexis Whitton
- Black Dog Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Svetha Venkatesh
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, Victoria, Australia
| | - Helen Christensen
- Black Dog Institute, UNSW Sydney, Sydney, New South Wales, Australia
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Wightman H, Quinn T, Mair FS, Lewsey J, McAllister DA, Hanlon P. 1311 FRAILTY IN RANDOMISED CONTROLLED TRIALS FOR DEMENTIA OR MILD COGNITIVE IMPAIRMENT. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.016] [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: 01/18/2023] Open
Abstract
Abstract
Background
Frailty and dementia have a bidirectional relationship. However, frailty is rarely reported in clinical trials for dementia and mild cognitive impairment (MCI) which limits assessment of trial applicability. This study aims to use a frailty index (FI) to measure frailty using individual participant data (IPD) from clinical trials for MCI and dementia and to quality the prevalence of frailty and its association with serious adverse events (SAEs) and trial attrition.
Methods
We analysed IPD from three dementia (n=1) and MCI (n=2) trials. An FI comprising physical deficits was created for each trial using baseline IPD. Poisson and logistic regression were used to examine associations with SAEs and attrition, respectively. Estimates were pooled in random effects meta-analysis. Analyses were repeated using an FI incorporating cognitive as well as physical deficits, and results compared.
Results
The mean physical FI was 0.13 and 0.14 in the MCI trials and 0.25 in the dementia trial. Frailty prevalence (FI>0.24) was 5.1%, 5.4% in MCI trials and 55.6% in dementia. After including cognitive deficits, prevalence was similar in MCI (4.6% and 4.9%) but higher in dementia (80.7%). 99th percentile of FI (0.29 in MCI, 0.44 in dementia) was lower than in most general population studies. Frailty was associated with SAEs (physical FI IRR = 1.63 [1.43, 1.87]; physical/cognitive FI IRR = 1.67 [1.45, 1.93]). Frailty was not associated with trial attrition (physical FI OR = 1.18 [0.92, 1.53]; physical/cognitive FI OR = 1.17 [0.92, 1.49]).
Conclusion
Measuring frailty from IPD in dementia and MCI trials is feasible. Severe frailty may be under-represented. Frailty is associated with clinically significant outcomes. Including only physical deficits may underestimate frailty in dementia. Frailty can and should be measured in trials for dementia and MCI, and efforts should be made to facilitate inclusion of people living with frailty.
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So J, Mabe NW, Englinger B, Chow KH, Moyer SM, Yerrum S, Trissal MC, Marques JG, Kwon JJ, Shim B, Pal S, Panditharatna E, Quinn T, Schaefer DA, Jeong D, Mayhew DL, Hwang J, Beroukhim R, Ligon KL, Stegmaier K, Filbin MG, Hahn WC. VRK1 as a synthetic lethal target in VRK2 promoter-methylated cancers of the nervous system. JCI Insight 2022; 7:e158755. [PMID: 36040810 PMCID: PMC9675470 DOI: 10.1172/jci.insight.158755] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
Collateral lethality occurs when loss of a gene/protein renders cancer cells dependent on its remaining paralog. Combining genome-scale CRISPR/Cas9 loss-of-function screens with RNA sequencing in over 900 cancer cell lines, we found that cancers of nervous system lineage, including adult and pediatric gliomas and neuroblastomas, required the nuclear kinase vaccinia-related kinase 1 (VRK1) for their survival in vivo. VRK1 dependency was inversely correlated with expression of its paralog VRK2. VRK2 knockout sensitized cells to VRK1 loss, and conversely, VRK2 overexpression increased cell fitness in the setting of VRK1 loss. DNA methylation of the VRK2 promoter was associated with low VRK2 expression in human neuroblastomas and adult and pediatric gliomas. Mechanistically, depletion of VRK1 reduced barrier-to-autointegration factor phosphorylation during mitosis, resulting in DNA damage and apoptosis. Together, these studies identify VRK1 as a synthetic lethal target in VRK2 promoter-methylated adult and pediatric gliomas and neuroblastomas.
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Affiliation(s)
- Jonathan So
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Nathaniel W Mabe
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorder Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Bernhard Englinger
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorder Center and Harvard Medical School, Boston, Massachusetts, USA
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Kin-Hoe Chow
- Department of Oncologic Pathology and
- Center for Patient Derived Models, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Sydney M Moyer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Smitha Yerrum
- Department of Oncologic Pathology and
- Center for Patient Derived Models, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Maria C Trissal
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorder Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Joana G Marques
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorder Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Jason J Kwon
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Brian Shim
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Sangita Pal
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Eshini Panditharatna
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorder Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas Quinn
- Department of Oncologic Pathology and
- Center for Patient Derived Models, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel A Schaefer
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorder Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Daeun Jeong
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorder Center and Harvard Medical School, Boston, Massachusetts, USA
| | - David L Mayhew
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Radiation Oncology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Justin Hwang
- Department of Medicine and
- Masonic Cancer Center, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Rameen Beroukhim
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Keith L Ligon
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Oncologic Pathology and
| | - Kimberly Stegmaier
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorder Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Mariella G Filbin
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorder Center and Harvard Medical School, Boston, Massachusetts, USA
| | - William C Hahn
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
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Murphy C, Hartop K, Aggrey K, Bilan J, Lumsden J, Colquhoun K, Quinn T. 802 CONCURRENT PATHOLOGIES OBSERVED IN OLDER ADULTS WITH COVID-19 INFECTION. Age Ageing 2022. [PMCID: PMC9383589 DOI: 10.1093/ageing/afac037.802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction This study aimed to look at the effect of frailty and multi morbidity on short-term outcomes in patients diagnosed with COVID-19 in a hospital setting, looking specifically at the variety of concurrent pathologies diagnosed during their admission and how these affected the course of their illness and mortality. Methods The study took place at Glasgow Royal Infirmary. We retrospectively collected data from 280 patients who were admitted to the medicine for the elderly department between the 1st October and 1st December 2020 and diagnosed with COVID-19. Results In this cohort, 65% of older adults in hospital with COVID-19 had their admissions complicated by concurrent pathologies; most commonly delirium, acute kidney injury and pulmonary embolism, also increasing mortality in this group. It was also found that 39% of patients in this group had co-pathologies that were not necessarily associated with COVID-19 disease, for example AKI, AF and stroke/TIA. 35% of older adults in this group had no concurrent medical diagnoses during their admission, however this did not correlate with reduced mortality in this group. Conclusion The data highlights the vulnerability of older adults with COVID-19 infection making them more susceptible to concurrent disease and contributing to further morbidity and mortality. We also found a large number of patients had co-pathologies not associated with COVID-19 disease, highlighting the importance of considering other diagnoses in frail elderly patients.
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Affiliation(s)
- C Murphy
- Department of Medicine for the elderly; Department of Medicine for the elderly; University of Glasgow; University of Glasgow; Department of Medicine for the elderly; Department of Medicine for the elderly; Department of Medicine for the elderly
| | - K Hartop
- Department of Medicine for the elderly; Department of Medicine for the elderly; University of Glasgow; University of Glasgow; Department of Medicine for the elderly; Department of Medicine for the elderly; Department of Medicine for the elderly
| | - K Aggrey
- Department of Medicine for the elderly; Department of Medicine for the elderly; University of Glasgow; University of Glasgow; Department of Medicine for the elderly; Department of Medicine for the elderly; Department of Medicine for the elderly
| | - J Bilan
- Department of Medicine for the elderly; Department of Medicine for the elderly; University of Glasgow; University of Glasgow; Department of Medicine for the elderly; Department of Medicine for the elderly; Department of Medicine for the elderly
| | - J Lumsden
- Department of Medicine for the elderly; Department of Medicine for the elderly; University of Glasgow; University of Glasgow; Department of Medicine for the elderly; Department of Medicine for the elderly; Department of Medicine for the elderly
| | - K Colquhoun
- Department of Medicine for the elderly; Department of Medicine for the elderly; University of Glasgow; University of Glasgow; Department of Medicine for the elderly; Department of Medicine for the elderly; Department of Medicine for the elderly
| | - T Quinn
- Department of Medicine for the elderly; Department of Medicine for the elderly; University of Glasgow; University of Glasgow; Department of Medicine for the elderly; Department of Medicine for the elderly; Department of Medicine for the elderly
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Lake I, Wang RC, Rothman RE, Laeyendecker O, Fernandez R, Dashler G, Quinn T, Hsieh YH. 294. Surveillance for Potential Post-Acute COVID-19 Syndrome Medical Complications in the Emergency Department (ED) – A Retrospective Longitudinal Study of ED Patients Who Had Evidence of SARS-CoV-2 Infection Versus Those Who Did Not. Open Forum Infect Dis 2021. [PMCID: PMC8644491 DOI: 10.1093/ofid/ofab466.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background As the COVID-19 pandemic continues, growing attention has been placed on whether patients previously infected with SARS-CoV-2 have an increased risk of developing and/or exacerbating medical complications. Our study aimed to determine whether individuals with previous evidence of SARS-CoV-2 infection prior to their current emergency department (ED) visit were more likely to present with specific clinical sign/symptoms, laboratory markers, and/or clinical complications. Methods A COVID-19 seroprevalence study was conducted at Johns Hopkins Hospital ED (JHH ED) from March 16 to May 31, 2020. Evidence of ever having SARS-CoV-2 infection (PCR positive or IgG Ab positive) was found in 268 ED patients at this time (i.e. infected and/or previously infected). These patients were matched 1:2 to controls, by date, to other patients who attended the JHHED. Clinical signs/symptoms, laboratory markers, and/or clinical complications associated with ED visits and/or hospitalizations at JHH within 6 months after their initial ED visit was abstracted through chart review for these 804 patients. Cox proportional hazards regression analyses were performed. Results Among 804 ED patients analyzed, 50% were female, 56% Black race, and 15% Hispanic with a mean age of 47 years. 323 (40%) patients had at least 1 subsequent ED visit and additional 70 (9%) had been admitted to JHH. After controlling for race and ethnicity, patients with evidence of current or prior COVID-19 infection were more likely to require supplemental oxygen [hazards ratio (HR) =2.53; p=0.005] and have a cardiovascular complication [HR =2.13; p=0.008] during the subsequent ED visit than the non-infected patients. Conclusion Our findings demonstrate that those previously infected with SARS-CoV-2 have an increased frequency of cardiovascular complications and need for supplemental oxygen in ED visits in the months after their initial SARS-CoV-2 infection was detected. EDs could serve as a critical surveillance site for monitoring post-acute COVID-19 syndrome complications. Disclosures Richard E. Rothman, PhD, MD, Chem bio (Grant/Research Support)
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Affiliation(s)
- Isabel Lake
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | | | | | | | - Gaby Dashler
- Johns Hopkins School of Medicine, Baltimore, Maryland
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7
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Steiner T, Dichgans M, Norrving B, Aamodt AH, Berge E, Christensen H, Fuentes B, Khatri P, Korompoki E, Martí-Fabregas J, Quinn T, Toni D, Zedde M, Sacco S, Turc G. European Stroke Organisation (ESO) standard operating procedure for the preparation and publishing of guidelines. Eur Stroke J 2021; 6:CXXII-CXXXIV. [PMID: 34746429 DOI: 10.1177/23969873211024143] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 01/06/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022] Open
Abstract
The first European Stroke Organization (ESO) standard operating procedure (SOP) published in 2015 aimed at the implementation the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to provide evidence-based guidelines for stroke management. This second ESO-SOP is aiming at further increase of the practicability of ESO guidelines and its technical implications. Authors comprised of the members of the ESO guideline Board and ESO Executive Committee. The final document was agreed on by several internal reviews. The second SOP comprises of the following aspects: rational for the SOP, the introduction of expert consensus statements, types of guideline documents, structures involved and detailed description of the guideline preparation process, handling of financial and intellectual conflicts of interest (CoI), involvement of ESO members in the guideline process, review process, authorship and publication policy, updating of guidelines, cooperation with other societies, and dealing with falsified data. This second SOP supersedes the first SOP published in 2015.
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Affiliation(s)
- T Steiner
- Department of Neurology, Klinikum Frankfurt Höchst GmbH, Frankfurt am Main, Germany.,Department of Neurology Hospital, Heidelberg University, Heidelberg, Germany
| | - M Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - B Norrving
- Department of Clinical Sciences Lund University Hospital and Lund University Departmnet of Neurology, Skane University Hospital, Lund, Sweden
| | - A H Aamodt
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - E Berge
- Department of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - H Christensen
- Department of Neurology, Bispebjerg Hospital, University of Copenhagen, Kobenhavn, Denmark
| | - B Fuentes
- Department of Neurology, Hospital Universitario La Paz, Madrid, Spain
| | - P Khatri
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - E Korompoki
- Division of Brain Science, Imperial College London, London, UK.,Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | | | - T Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - D Toni
- Departments of Neurological Sciences and Emergency, Unità di Trattamento Neurovascolare, University of Rome La Sapienza, Rome, Italy
| | - M Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale - IRCCS, di Reggio Emilia, Reggio Emilia, Italy
| | - S Sacco
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - G Turc
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Université de Paris, Paris, France
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8
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Nair GB, Al-Katib S, Podolsky R, Quinn T, Stevens C, Castillo E. Dynamic lung compliance imaging from 4DCT-derived volume change estimation. Phys Med Biol 2021; 66. [PMID: 34560677 DOI: 10.1088/1361-6560/ac29ce] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/24/2021] [Indexed: 11/12/2022]
Abstract
Background. Lung compliance (LC) is the ability of the lung to expand with changes in pressure and is one of the earliest physiological measurements to be altered in patients with parenchymal lung disease. Therefore, compliance monitoring could potentially identify patients at risk for disease progression. However, in clinical practice, compliance measurements are prohibitively invasive for use as a routine monitoring tool.Purpose. We propose a novel method for computing dynamic lung compliance imaging (LCI) from non-contrast computed tomography (CT) scans. LCI applies image processing methods to free-breathing 4DCT images, acquired under two different continuous positive airway pressures (CPAP) applied using a full-face mask, in order to compute the lung volume change induced by the pressure change. LCI provides a quantitative volumetric map of lung stiffness.Methods. We compared mean LCI values computed for 10 patients with idiopathic pulmonary fibrosis (IPF) and 7 non-IPF patients who were screened for lung nodules. 4DCTs were acquired for each patient at 5 cm and 10 cm H20 CPAP, as the patients were free breathing at functional residual capacity. LCI was computed from the two 4DCTs. Mean LCI intensities, which represent relative voxel volume change induced by the change in CPAP pressure, were computed.Results.The mean LCI values for patients with IPF ranged between [0.0309, 0.1165], whereas the values ranged between [0.0704, 0.2185] for the lung nodule cohort. Two-sided Wilcoxon rank sum test indicated that the difference in medians is statistically significant (pvalue = 0.009) and that LCI -measured compliance is overall lower in the IPF patient cohort.Conclusion. There is considerable difference in LC scores between patients with IPF compared to controls. Future longitudinal studies should look for LC alterations in areas of lung prior to radiographic detection of fibrosis to further characterize LCI's potential utility as an image marker for disease progression.
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Affiliation(s)
- Girish B Nair
- Division of Pulmonary and Critical Care, Beaumont Health, OUWB School of Medicine, United States of America
| | - Sayf Al-Katib
- Department of Radiology and Molecular Imaging, Beaumont Health, OUWB School of Medicine, United States of America
| | - Robert Podolsky
- Division of Informatics & Biostatistics, Beaumont Research Institute, Beaumont Health, United States of America
| | - Thomas Quinn
- Department of Radiation Oncology, Beaumont Health, OUWB School of Medicine, United States of America
| | - Craig Stevens
- Department of Radiation Oncology, Beaumont Health, OUWB School of Medicine, United States of America
| | - Edward Castillo
- Department of Radiation Oncology, Beaumont Health, OUWB School of Medicine, United States of America.,Department of Biomedical Engineering, The University of Texas at Austin, United States of America
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9
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Jones K, Quinn T, Mazor KM, Muehlschlegel S. Prognostic Uncertainty in Critically Ill Patients with Traumatic Brain Injury: A Multicenter Qualitative Study. Neurocrit Care 2021; 35:311-321. [PMID: 34080083 DOI: 10.1007/s12028-021-01230-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/10/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Prognostic uncertainty is frequently cited as a barrier to communication between physicians and patients and is particularly burdensome for surrogate decision-makers, who must make choices on behalf of their incapacitated family members. The Conceptual Taxonomy of Uncertainty is one model through which physician and surrogate communication can be analyzed to identify strategies for reducing uncertainty in surrogate decision-making. Our objective was to examine themes of uncertainty in physician communication of prognosis and surrogate goals-of-care decision-making for critically ill patients with traumatic brain injury (TBI). METHODS We performed a secondary analysis of a previous qualitative study that involved semistructured interviews of 16 surrogates of critically ill patients with TBI from two level 1 trauma centers and 20 TBI expert physicians from seven trauma centers. Open-ended questions about prognostic uncertainty were asked. We identified major themes with an inductive approach. The Conceptual Taxonomy of Uncertainty was applied to further characterize these themes as data-centered, system-centered, and patient-centered issues of uncertainty. RESULTS Nearly all surrogates (15 of 16) and physicians (19 of 20) recognized the emotional burden of uncertainty in the decision-making process for surrogates. More than three quarters of surrogates (13 of 16) described instances in which a lack of information regarding their loved one's disease or prognosis created uncertainty in their decision-making process, identifying both positive and negative instances of prognostic communication by physicians. We found that physicians used one of three strategies to communicate prognostic uncertainty to surrogates: leaving no room for uncertainty, honesty about uncertainty, and range of possibilities. These strategies did not meet the communication preferences of the majority of surrogates, with more than a third of decision-makers (6 of 15) being frustrated by too much ambiguity about prognosis as well as the failure to acknowledge the existence of uncertainty. CONCLUSIONS We found that physician communication strategies rarely addressed surrogate needs regarding uncertainty adequately, suggesting an urgent need for future research into improved communication of prognostic uncertainty.
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Affiliation(s)
- Kelsey Jones
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Thomas Quinn
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Kathleen M Mazor
- Department of Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA
| | - Susanne Muehlschlegel
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA.
- Department of Anesthesiology/Critical Care, University of Massachusetts Medical School, Worcester, MA, USA.
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
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10
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Rehman R, Aoun M, Levitin R, Quinn T, Kabolizadeh P. Perivascular Epithelioid Cell Tumor of the Buttock Region. Cureus 2021; 13:e15252. [PMID: 34188991 PMCID: PMC8231071 DOI: 10.7759/cureus.15252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Perivascular epithelioid cell neoplasms, also known as PEComas, are a group of rare mesenchymal tumors that have a perivascular distribution and have no known counterpart to normal cells. The PEComa grouping includes angiomyolipomas, lymphangioleiomyomatoses, clear cell (sugar) tumors at extrapulmonary and intrapulmonary sites, clear cell myomelanocytic tumor of the falciform ligament/ligamentum teres among others. These rare tumors most commonly arise in the uterus. Here, we present an unusual case of malignant PEComa arising in the buttock region.
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Affiliation(s)
- Rafey Rehman
- Department of Radiation Oncology, Beaumont Hospital, Royal Oak, USA
| | - Mariam Aoun
- Department of Radiation Oncology, Beaumont Hospital, Royal Oak, USA
| | - Ronald Levitin
- Department of Radiation Oncology, Beaumont Hospital, Royal Oak, USA
| | - Thomas Quinn
- Department of Radiation Oncology, Beaumont Hospital, Royal Oak, USA
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11
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Rehman R, Squires B, Osto M, Quinn T, Kabolizadeh P. Hidradenocarcinoma of the Abdominal Wall Treated With Wide Surgical Excision and Adjuvant Radiotherapy. Cureus 2021; 13:e14724. [PMID: 34094723 PMCID: PMC8169006 DOI: 10.7759/cureus.14724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Hidradenocarcinomas are rare malignant sweat gland tumors that typically arise in the head and neck area. To the best of our knowledge, this is the only reported instance of hidradenocarcinoma of the abdominal wall as well as the first case arising from a region of prior trauma. A 72-year-old female presented with a left abdominal wall lesion, which she had first noticed after an injury to the area. Initially, the lesion remained stable in size, after which it became mildly pruritic, progressive in size, and expressive of a clear, non-odorous discharge. Imaging demonstrated a heterogeneous cystic density. Surgical pathology revealed a malignant dermal adnexal neoplasm composed of pleomorphic polygonal cells and focal intracytoplasmic lumina lined by eosinophilic cuticles, as well as areas of ductal differentiation, apocrine differentiation, and mucinous metaplasia. Surgical excision of the mass was performed, followed by adjuvant external beam radiotherapy (EBRT). The patient had no long-term toxicities or clinical evidence of local disease recurrence as of one year post-surgery and six months post-EBRT. Early diagnosis and treatment are essential to improving outcomes in patients with hidradenocarcinomas. Frequent follow-up is equally important, as these tumors have high recurrence rates.
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Affiliation(s)
- Rafey Rehman
- Department of Radiation Oncology, Beaumont Health, Royal Oak, USA
| | - Bryan Squires
- Department of Radiation Oncology, Beaumont Health, Royal Oak, USA
| | - Muhammad Osto
- Department of Dermatology, Wayne State University School of Medicine, Detroit, USA
| | - Thomas Quinn
- Department of Radiation Oncology, Beaumont Health, Royal Oak, USA
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12
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Tieges Z, MacLullich AMJ, Anand A, Cassaroni M, O'Connor M, Ryan D, Saller T, Arora R, Chang Y, Agarwal K, Taffet G, Quinn T, Shenkin S, Galvin R. 33 Diagnostic Test Accuracy of the 4AT for Delirium Detection: Systematic Review and Meta-Analysis. Age Ageing 2021. [DOI: 10.1093/ageing/afab029.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Detection of delirium in hospitalised older adults is recommended in national and international guidelines. The 4 ‘A’s Test (4AT; www.the4AT.com) is a short (<2 min) instrument for delirium detection that is used internationally as a standard tool in clinical practice. We performed a systematic review and meta-analysis of diagnostic test accuracy of the 4AT for delirium detection.
Methods
We searched the following electronic databases through Ovid: MEDLINE, Embase, and PsycINFO. Additional databases were searched: CINAHL (EBSCOhost), clinicaltrials.gov and Cochrane Central Register of Controlled Trials from 2011 (4AT publication) until 21 December 2019. Inclusion criteria: older adults (≥65) across any setting of care except critical care; validation study of the 4AT against a delirium reference standard (standard diagnostic criteria or validated tool). Two reviewers independently screened abstracts and papers and performed the data extraction. Pooled estimates of sensitivity and specificity were generated from a bivariate random effects model.
Results
17 studies (n = 3,701 observations) were included. Various settings including acute medicine, surgery, stroke wards and the emergency department were represented. The overall prevalence of delirium was 24.2% (95% CI 17.8–32.1%; range 10.5–61.9%). The pooled sensitivity was 0.88 (95% CI 0.80–0.93) and the pooled specificity was 0.88 (95% CI 0.82–0.92). The methodological quality of studies was mostly good.
Conclusions
The 4AT is now supported by a substantial evidence base comparable to other well-studied tools such as the Confusion Assessment Method (CAM). The strong pooled sensitivity and specificity findings for the 4AT in this meta-analysis along with its brevity and lack of need for specific training provide support for its use as an effective assessment tool for delirium.
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Affiliation(s)
- Z Tieges
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - A M J MacLullich
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - A Anand
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - M Cassaroni
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - M O'Connor
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - D Ryan
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - T Saller
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - R Arora
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - Y Chang
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - K Agarwal
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - G Taffet
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - T Quinn
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - S Shenkin
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - R Galvin
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
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13
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Castillo E, Nair G, Turner-Lawrence D, Myziuk N, Emerson S, Al-Katib S, Westergaard S, Castillo R, Vinogradskiy Y, Quinn T, Guerrero T, Stevens C. Quantifying pulmonary perfusion from noncontrast computed tomography. Med Phys 2021; 48:1804-1814. [PMID: 33608933 PMCID: PMC8252085 DOI: 10.1002/mp.14792] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/14/2021] [Accepted: 02/08/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Computed tomography (CT)‐derived ventilation methods compute respiratory induced volume changes as a surrogate for pulmonary ventilation. Currently, there are no known methods to derive perfusion information from noncontrast CT. We introduce a novel CT‐Perfusion (CT‐P) method for computing the magnitude mass changes apparent on dynamic noncontrast CT as a surrogate for pulmonary perfusion. Methods CT‐Perfusion is based on a mass conservation model which describes the unknown mass change as a linear combination of spatially corresponding inhale and exhale HU estimated voxel densities. CT‐P requires a deformable image registration (DIR) between the inhale/exhale lung CT pair, a preprocessing lung volume segmentation, and an estimate for the Jacobian of the DIR transformation. Given this information, the CT‐P image, which provides the magnitude mass change for each voxel within the lung volume, is formulated as the solution to a constrained linear least squares problem defined by a series of subregional mean magnitude mass change measurements. Similar to previous robust CT‐ventilation methods, the amount of uncertainty in a subregional sample mean measurement is related to measurement resolution and can be characterized with respect to a tolerance parameter τ. Spatial Spearman correlation between single photon emission CT perfusion (SPECT‐P) and the proposed CT‐P method was assessed in two patient cohorts via a parameter sweep of τ. The first cohort was comprised of 15 patients diagnosed with pulmonary embolism (PE) who had SPECT‐P and 4DCT imaging acquired within 24 h of PE diagnosis. The second cohort was comprised of 15 nonsmall cell lung cancer patients who had SPECT‐P and 4DCT images acquired prior to radiotherapy. For each test case, CT‐P images were computed for 30 different uncertainty parameter values, uniformly sampled from the range [0.01, 0.125], and the Spearman correlation between the SPECT‐P and the resulting CT‐P images were computed. Results The median correlations between CT‐P and SPECT‐P taken over all 30 test cases ranged between 0.49 and 0.57 across the parameter sweep. For the optimal tolerance τ = 0.0385, the CT‐P and SPECT‐P correlations across all 30 test cases ranged between 0.02 and 0.82. A one‐sample sign test was applied separately to the PE and lung cancer cohorts. A low Spearmen correlation of 15% was set as the null median value and two‐sided alternative was tested. The PE patients showed a median correlation of 0.57 (IQR = 0.305). One‐sample sign test was statistically significant with 96.5 % confidence interval: 0.20–0.63, P < 0.00001. Lung cancer patients had a median correlation of 0.57(IQR = 0.230). Again, a one‐sample sign test for median was statistically significant with 96.5 percent confidence interval: 0.45–0.71, P < 0.00001. Conclusion CT‐Perfusion is the first mechanistic model designed to quantify magnitude blood mass changes on noncontrast dynamic CT as a surrogate for pulmonary perfusion. While the reported correlations with SPECT‐P are promising, further investigation is required to determine the optimal CT acquisition protocol and numerical method implementation for CT‐P imaging.
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Affiliation(s)
- Edward Castillo
- Department of Radiation Oncology, Beaumont Health, Royal Oak, MI, USA.,Department of Computational and Applied Mathematics, Rice University, Houston, TX, USA
| | - Girish Nair
- Department of Internal Medicine, Beaumont Health, Royal Oak, MI, USA
| | | | - Nicholas Myziuk
- Department of Radiation Oncology, Beaumont Health, Royal Oak, MI, USA
| | - Scott Emerson
- Department of Diagnostic Radiology, Beaumont Health, Royal Oak, MI, USA
| | - Sayf Al-Katib
- Department of Diagnostic Radiology, Beaumont Health, Royal Oak, MI, USA
| | - Sarah Westergaard
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | - Richard Castillo
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | | | - Thomas Quinn
- Department of Radiation Oncology, Beaumont Health, Royal Oak, MI, USA
| | - Thomas Guerrero
- Department of Radiation Oncology, Beaumont Health, Royal Oak, MI, USA
| | - Craig Stevens
- Department of Radiation Oncology, Beaumont Health, Royal Oak, MI, USA
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14
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Quinn T, Patil D, Mulloy E, Akanksha M. 057 Cost of Intralesional Collagenase Clostridium Histiolyticum Therapy Versus Surgery for the Management of Peyronie's Disease: A Claims-Based Analysis (2009-2018). J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Fernanda García M, Souza Junqueira M, Silva Mororó J, Camacho X, Paula Faria D, Godoi Carneiro C, Gallazzi F, Chammas R, Quinn T, Cabral P, Cerecetto H. Radio‐ and Fluorescent‐Labeling of Rituximab Based on the Inverse Electron Demand Diels‐Alder Reaction. ChemistrySelect 2021. [DOI: 10.1002/slct.202100042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- María Fernanda García
- Centro de Investigaciones Nucleares, Facultad de Ciencias Universidad de la República Mataojo 2055 11400 Montevideo Uruguay
| | - Mara Souza Junqueira
- Centro de Investigação Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo Faculdade de Medicina Universidade de São Paulo São Paulo Brazil
| | - Janio Silva Mororó
- Centro de Investigação Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo Faculdade de Medicina Universidade de São Paulo São Paulo Brazil
| | - Ximena Camacho
- Centro de Investigaciones Nucleares, Facultad de Ciencias Universidad de la República Mataojo 2055 11400 Montevideo Uruguay
| | - Daniele Paula Faria
- Laboratório de Medicina Nuclear (LIM43), Faculdade de Medicina Universidade de São Paulo São Paulo Brazil
| | - Camila Godoi Carneiro
- Laboratório de Medicina Nuclear (LIM43), Faculdade de Medicina Universidade de São Paulo São Paulo Brazil
| | - Fabio Gallazzi
- Molecular Interactions Core and Department of Biochemistry University of Missouri Columbia MO 65211 USA
| | - Roger Chammas
- Laboratório de Medicina Nuclear (LIM43), Faculdade de Medicina Universidade de São Paulo São Paulo Brazil
| | - Thomas Quinn
- Molecular Interactions Core and Department of Biochemistry University of Missouri Columbia MO 65211 USA
| | - Pablo Cabral
- Centro de Investigaciones Nucleares, Facultad de Ciencias Universidad de la República Mataojo 2055 11400 Montevideo Uruguay
| | - Hugo Cerecetto
- Centro de Investigaciones Nucleares, Facultad de Ciencias Universidad de la República Mataojo 2055 11400 Montevideo Uruguay
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Kared H, Bloch E, Redd A, Nardin A, Sumatoh H, Kairi F, Carbajo D, Abel B, Newell E, Laeyendecker O, Bonny T, Benner S, Pekosz A, Tobian A, Quinn T. LB-18. Broad and Prevalent SARS-CoV-2 CD8+ T Cell Response in Recovered COVID-19 Individuals Demonstrates Kinetics of Early Differentiation. Open Forum Infect Dis 2020. [PMCID: PMC7776945 DOI: 10.1093/ofid/ofaa515.1915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Understanding the diversity, breadth, magnitude, and functional profile of the T cell response against SARS-CoV-2 in recovered COVID-19 individuals is critical to evaluate the contribution of T cells to produce a potentially protective immune response. Methods We used a multiplexed peptide-MHC tetramer approach to screen a total of 408 SARS-CoV-2 candidate peptide epitopes for CD8+ T cell recognition in a cohort of 30 individuals recovered from COVID-19. The peptides spanned the whole viral genome and were restricted to six prevalent HLA alleles; T cells were simultaneously characterized by a 28-marker phenotypic panel. The evolution of the SARS-CoV-2 T cell responses was then statistically modeled against time from diagnosis, and in relation to humoral and inflammatory response. Workflow for Study. A multiplexed peptide-MHC tetramer approach was used to screen SARS-CoV-2 candidate peptide epitopes in a cohort of 30 COVID-19 recovered patients across 6 prevalent HLA alleles, and T cells profiled with a 28-marker phenotypic panel. ![]()
Multiplex tetramer screen. One representative COVID-19 recovered patient and one healthy donor were screened for HLA- relevant SARS-CoV-2 epitopes, as well as epitopes for CMV, EBV, Influenza, Adenovirus and MART-1. Shown are the frequencies of tetramer-positive CD8 T cells from 2 technical replicates per subject. ![]()
Results Almost all individuals screened showed a T cell response against SARS-CoV-2 (29/30): 132 SARS-CoV-2-specific CD8+ T cells hits were detected, corresponding to 52 unique reactive epitopes. Twelve of the 52 unique SARS-CoV-2-specific epitopes were recognized by more than 40% of the individuals screened, indicating high prevalence in the subjects. Importantly, these CD8+ T cell responses were directed against both structural and non-structural viral proteins, with the highest magnitude against nucleocapsid derived peptides, but without any antigen-driven bias in the phenotype of specific T cells. Overall, SARS-CoV-2 T cells showed specific states of differentiation (stem-cell memory and transitional memory), which differed from those of MART-1, influenza, CMV and EBV-specific T cells. UMAP visualization revealed a phenotypic profile of SARS-CoV-2-specific CD8 T cells in COVID-19 convalescent donors that is distinct from other viral specificities, such as influenza, CMV, EBV and Adenovirus. ![]()
SARS-CoV-2 epitope screening revealed CD8+ T cell responses directed against both structural and non-structural viral proteins, with the highest magnitude response against nucleocapsid derived peptides ![]()
Conclusion The kinetics modeling demonstrates a dynamic, evolving immune response characterized by a time-dependent decrease in overall inflammation, increase in neutralizing antibody titer, and progressive differentiation of a broad SARS-CoV-2 CD8 T cell response. It could be desirable to aim at recapitulating the hallmarks of this robust CD8 T cell response in the design of protective COVID-19 vaccines. Disclosures Hassen Kared, PhD, ImmunoScape (Shareholder) Alessandra Nardin, DvM, ImmunoScape (Shareholder) Hermi Sumatoh, BSc, Dip MTech, ImmunoScape (Shareholder) Faris Kairi, BSc, ImmunoScape (Shareholder) Daniel Carbajo, PhD, ImmunoScape (Shareholder) Brian Abel, PhD, MBA, ImmunoScape (Shareholder) Evan Newell, PhD, ImmunoScape (Shareholder)
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Affiliation(s)
- Hassen Kared
- ImmunoScape, Singapore, Not Applicable, Singapore
| | - Evan Bloch
- Johns Hopkins University, Baltimore, Maryland
| | | | | | | | - Faris Kairi
- ImmunoScape, Singapore, Not Applicable, Singapore
| | | | | | | | | | - Tania Bonny
- Johns Hopkins University, Baltimore, Maryland
| | | | - Andy Pekosz
- Johns Hopkins University, Baltimore, Maryland
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Ciminata G, Venson R, Geue C, Quinn T, Trotter R, Pollock K, Lister S. Atrial fibrillation and stroke outcomes in Scotland: real-world evidence from a contemporary, national dataset. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Atrial Fibrillation (AF) is an important cause of mortality and morbidity. The major risk of AF is stroke, which can be reduced through anticoagulation. The burden of stroke, and AF-related stroke, is particularly high in Scotland. It is often reported that AF-related stroke is associated with poorer outcomes than other stroke types, it is also thought to lead to an increased institutionalisation. Data supporting these observations are historic, but major advances in AF assessment and treatment could have changed outcome patterns. Real world evidence on outcomes, collected at scale, can give a useful measure of contemporary AF stroke outcomes.
Purpose
To assess whether stroke patients, with and without AF on admission, differ in terms of al-cause mortality, recurrence of stroke, and care home admission using contemporary large-scale observational data.
Methods
A retrospective cohort study linking national hospital, prescribing, care home and stroke audit data was conducted. The cohort, comprising patients ≥18 years of age with incident ischemic stroke between 2009 and 2017, was divided into three groups: AF-related stroke prescribed oral anticoagulant (OAC) pre-stroke event (AF-OAC Group); AF-related stroke not prescribed anticoagulant pre-stroke event (AF-noOAC Group); stroke with no prevalent or incident AF and no anticoagulation (comparator) (noAF-noOAC Group). Time-to-event analyses (adjusted for demographic and clinical characteristics) were conducted to estimate hazard ratios for recurrent stroke, all-cause mortality, and care-home admission with a follow-up time of two years.
Results
From a cohort of 64,159 incident ischemic strokes, 4,418 and 15,124 patients with AF were identified for groups AF-OAC and AF-noOAC, respectively. The remaining 44,617 patients belonged to group noAF-noOAC. An increasing number of incident strokes was observed with increasing age in each group up to 80–84 years. The risk of recurrent stroke was significantly greater in groups AF-OAC (HR 1.12 [95% CI 1.08,1.17]) and AF-noOAC (HR 1.05 [95% CI 1.03,1.08]) compared to noAF-noOAC group. An increased risk of all-cause mortality was observed in groups AF-OAC (HR 1.52 [95% CI 1.39,1.66]) and AF-noOAC (HR 1.59 [95% CI 1.51,1.68]) compared to the noAF-noOAC group. Patients in group AF-noOAC were more likely to be discharged to a care home following stroke (HR 1.37 [95% CI 1.23,1.52]) compared to patients in the other groups.
Conclusion
AF-related stroke is associated with poor outcomes, with significantly higher risks of recurrent stroke and all-cause mortality for patients with AF compared to non-AF stroke. Despite advances in AF care, our data suggest there is still potential to prevent a substantial proportion of disabling strokes through better identification and treatment of AF. These results must be interpreted with caution, as data take no account of treatment adherence, dosing or rationale for individual patient level prescribing decisions.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Bristol-Myers Squibb Research and Development
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Affiliation(s)
- G Ciminata
- University of Glasgow, Glasgow, United Kingdom
| | - R Venson
- University of Glasgow, Glasgow, United Kingdom
| | - C Geue
- University of Glasgow, Glasgow, United Kingdom
| | - T Quinn
- University of Glasgow, Glasgow, United Kingdom
| | | | - K Pollock
- Bristol-Myers Squibb UK, Uxbridge, United Kingdom
| | - S Lister
- Bristol-Myers Squibb UK, Uxbridge, United Kingdom
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18
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Quinn T, Watkins A, Hampton C, Halter M, Weston C, Gale C, Gavalova L, Driscoll T, Davies G, Snooks H. Has the proportion of patients diagnosed with myocardial infarction that receives a 12 ECG in the prehospital setting in the UK changed over time? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Two thirds of patients with Acute Myocardial Infarction (AMI) arrive at hospital in the UK by ambulance, usually staffed by paramedics who routinely carry out 12 lead ECGs for patients with suspected heart attack. However, recent research found that prehospital ECGs were missing for 40% of these patients, with better survival prospects in those who had received one.
Purpose
We are investigating reasons for non-administration of 12 lead ECG for patients diagnosed with AMI, in order to develop an intervention to improve practice. Firstly we explored whether the proportion of patients with AMI that receive a prehospital ECG has changed over time.
Methods
Interrogation of national UK national heart attack register (MINAP) database, extraction of data related to patients brought by ambulance by year.
Results
The cohort of patients diagnosed with AMI and taken to hospital by ambulance ranged from 32410 in 2005 to 60265 in 2017; the proportion with a prehospital ECG increased steadily across this period, from 51% to 78%, an average increase of 1.9% per annum.
Conclusions
Evidence based guidelines supporting the use of 12 lead ECG by ambulance paramedics may have contributed to improvements in care. However, 1 in 5 patients brought to hospital by ambulance still does not receive an ECG prior to arrival, which we know compromises their survival prospects. In order to optimise care we need to establish whether non-administration is a question of misdiagnosis, patient refusal or lack of availability of trained crews/equipment.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): British Heart Foundation
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Affiliation(s)
- T Quinn
- St George's University Hospital NHS Foundation Trust, London, United Kingdom
| | - A Watkins
- Swansea University, Swansea, United Kingdom
| | - C Hampton
- Swansea University, Swansea, United Kingdom
| | - M Halter
- St George's University Hospital NHS Foundation Trust, London, United Kingdom
| | - C Weston
- Swansea University, Swansea, United Kingdom
| | - C.P Gale
- University of Leeds, Leeds, United Kingdom
| | - L Gavalova
- St George's University Hospital NHS Foundation Trust, London, United Kingdom
| | - T Driscoll
- Swansea University, Swansea, United Kingdom
| | - G Davies
- St George's University Hospital NHS Foundation Trust, London, United Kingdom
| | - H.A Snooks
- Swansea University, Swansea, United Kingdom
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19
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Sanyaolu L, Scholz AFM, Mayo I, Coode-Bate J, Oldroyd C, Carter B, Quinn T, Hewitt J. Risk factors for incident delirium among urological patients: a systematic review and meta-analysis with GRADE summary of findings. BMC Urol 2020; 20:169. [PMID: 33109133 PMCID: PMC7590461 DOI: 10.1186/s12894-020-00743-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/14/2020] [Indexed: 12/02/2022] Open
Abstract
Background Post-operative delirium is an important, yet under-researched complication of surgery. Patients undergoing urological surgery may be at especially high risk of POD, as they are often older, and interventions can be associated with conditions that trigger delirium. The main aim of this systematic review was to evaluate the available evidence for risk factors in this patient group. Methods Five databases were searched (MEDLINE, Web of Science, EMBASE, CINAHL and PsychInfo) between January 1987 and June 2019. The Newcastle–Ottawa Scale was used to assess for risk of bias. Pooled odds ratio or mean difference (MD) for individual risk factors were estimated using the Mantel–Haenzel and inverse variance methods. Results Seven articles met the inclusion criteria, giving a total population of 1937. The incidence of POD ranged from 5 to 29%. Three studies were deemed low risk of bias and four at a high risk of bias. Nine risk factors were suitable for meta-analysis, with age (MD 4.314 95% CI 1.597, 7.032 p = 0.002) and the clock drawing test (MD − 2.443 95% CI − 3.029, − 1.857 p < 0.001) having a statistically significant association with POD in pooled analyses. Conclusion Delirium is common in urological patients. This review has identified a lack of studies in this surgical population, with wide heterogeneity and high risk of bias. It also highlights a number of potential risk factors for post-operative delirium, of which some are modifiable. However, the strength of evidence is weak at present and so future research should focus on assessing comparable risk factors in this patient group in order to inform future clinical practice. Review registration The review protocol was prospectively registered with the PROSPERO database (reference CRD42017054613)
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Affiliation(s)
- L Sanyaolu
- Division of Population Medicine, Cardiff University, Cardiff, UK.
| | - A F M Scholz
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - I Mayo
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | | | - C Oldroyd
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - B Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Cochrane Skin Group, School of Medicine, The University of Nottingham, Nottingham, UK
| | - T Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - J Hewitt
- Division of Population Medicine, Cardiff University, Cardiff, UK
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20
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Quinn T, Jain M, Lee MT. An unusual headache: CSF negative APML relapse in the brain. Oxf Med Case Reports 2020; 2020:omaa075. [PMID: 32995030 PMCID: PMC7507884 DOI: 10.1093/omcr/omaa075] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/22/2020] [Accepted: 07/17/2020] [Indexed: 12/25/2022] Open
Abstract
Acute Promyelocytic Leukaemia (APML) is a subtype of Acute Myeloid Leukaemia (AML), responsible for around 10% of cases of the disease in adults. Extra medullary disease (EMD) occurs infrequently in APML, but where EMD does occur, the central nervous system is one of the most commonly infiltrated sites. Our case describes a man in his 40s undergoing post-therapy surveillance for APML who presented to follow-up clinic with a headache, which was ultimately found to be caused by a tumour comprised of APML cells. His case presented a diagnostic challenge due to the benign appearances of the lesion on initial computed tomography brain imaging and the non-diagnostic cerebrospinal fluid analysis. The diagnostic difficulties described in our case emphasizes that clinicians working with APML patients must approach new neurological symptoms with a high degree of suspicion to prevent diagnostic delay.
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Affiliation(s)
- Thomas Quinn
- Department of Neurology, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Manish Jain
- Department of Haematology, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Ming-Te Lee
- Department of Haematology, Leeds Teaching Hospitals Trust, Leeds, UK
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21
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Mills B, Megia-Fernandez A, Norberg D, Duncan S, Marshall A, Akram AR, Quinn T, Young I, Bruce AM, Scholefield E, Williams GOS, Krstajić N, Choudhary TR, Parker HE, Tanner MG, Harrington K, Wood HAC, Birks TA, Knight JC, Haslett C, Dhaliwal K, Bradley M, Ucuncu M, Stone JM. Molecular detection of Gram-positive bacteria in the human lung through an optical fiber-based endoscope. Eur J Nucl Med Mol Imaging 2020; 48:800-807. [PMID: 32915268 PMCID: PMC7485201 DOI: 10.1007/s00259-020-05021-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/31/2020] [Indexed: 12/13/2022]
Abstract
Purpose The relentless rise in antimicrobial resistance is a major societal challenge and requires, as part of its solution, a better understanding of bacterial colonization and infection. To facilitate this, we developed a highly efficient no-wash red optical molecular imaging agent that enables the rapid, selective, and specific visualization of Gram-positive bacteria through a bespoke optical fiber–based delivery/imaging endoscopic device. Methods We rationally designed a no-wash, red, Gram-positive-specific molecular imaging agent (Merocy-Van) based on vancomycin and an environmental merocyanine dye. We demonstrated the specificity and utility of the imaging agent in escalating in vitro and ex vivo whole human lung models (n = 3), utilizing a bespoke fiber–based delivery and imaging device, coupled to a wide-field, two-color endomicroscopy system. Results The imaging agent (Merocy-Van) was specific to Gram-positive bacteria and enabled no-wash imaging of S. aureus within the alveolar space of whole ex vivo human lungs within 60 s of delivery into the field-of-view, using the novel imaging/delivery endomicroscopy device. Conclusion This platform enables the rapid and specific detection of Gram-positive bacteria in the human lung. Electronic supplementary material The online version of this article (10.1007/s00259-020-05021-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bethany Mills
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
| | - Alicia Megia-Fernandez
- School of Chemistry, University of Edinburgh, Joseph Black Building, David Brewster Road, Edinburgh, EH9 3FJ, UK
| | - Dominic Norberg
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Sheelagh Duncan
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Adam Marshall
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Ahsan R Akram
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Thomas Quinn
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Irene Young
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Annya M Bruce
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Emma Scholefield
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Gareth O S Williams
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Nikola Krstajić
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Tushar R Choudhary
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.,The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | - Helen E Parker
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.,Department of Applied Physics, Royal Institute of Technology, KTH, SE-106 91, Stockholm, Sweden
| | - Michael G Tanner
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.,Scottish Universities Physics Alliance (SUPA), Institute of Photonics and Quantum Sciences, Heriot-Watt University, Edinburgh, EH14 4AS, UK
| | - Kerrianne Harrington
- Centre for Photonics and Photonic Materials, Department of Physics, University of Bath, Bath, BA2 7AY, UK
| | - Harry A C Wood
- Centre for Photonics and Photonic Materials, Department of Physics, University of Bath, Bath, BA2 7AY, UK
| | - Timothy A Birks
- Centre for Photonics and Photonic Materials, Department of Physics, University of Bath, Bath, BA2 7AY, UK
| | - Jonathan C Knight
- Centre for Photonics and Photonic Materials, Department of Physics, University of Bath, Bath, BA2 7AY, UK
| | - Christopher Haslett
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Kevin Dhaliwal
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Mark Bradley
- School of Chemistry, University of Edinburgh, Joseph Black Building, David Brewster Road, Edinburgh, EH9 3FJ, UK.
| | - Muhammed Ucuncu
- School of Chemistry, University of Edinburgh, Joseph Black Building, David Brewster Road, Edinburgh, EH9 3FJ, UK. .,Department of Analytical Chemistry, Faculty of Pharmacy, Izmir Katip Celebi University, Izmir, Turkey.
| | - James M Stone
- Centre for Photonics and Photonic Materials, Department of Physics, University of Bath, Bath, BA2 7AY, UK.
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22
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Klein S, Pekosz A, Park HS, Ursin R, Shapiro J, Benner S, Littlefield K, Kumar S, Naik HM, Betenbaugh M, Shrestha R, Wu A, Hughes R, Burgess I, Caturegli P, Laeyendecker O, Quinn T, Sullivan D, Shoham S, Redd A, Bloch E, Casadevall A, Tobian A. Sex, age, and hospitalization drive antibody responses in a COVID-19 convalescent plasma donor population. medRxiv 2020:2020.06.26.20139063. [PMID: 32607519 PMCID: PMC7325184 DOI: 10.1101/2020.06.26.20139063] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Convalescent plasma is currently one of the leading treatments for COVID-19, but there is a paucity of data identifying therapeutic efficacy. A comprehensive analysis of the antibody responses in potential plasma donors and an understanding of the clinical and demographic factors that drive variant antibody responses is needed. Among 126 potential convalescent plasma donors, the humoral immune response was evaluated by a SARS-CoV-2 virus neutralization assay using Vero-E6-TMPRSS2 cells, commercial IgG and IgA ELISA to Spike (S) protein S1 domain (Euroimmun), IgA, IgG and IgM indirect ELISAs to the full-length S or S-receptor binding domain (S-RBD), and an IgG avidity assay. Multiple linear regression and predictive models were utilized to assess the correlations between antibody responses with demographic and clinical characteristics. IgG titers were greater than either IgM or IgA for S1, full length S, and S-RBD in the overall population. Of the 126 plasma samples, 101 (80%) had detectable neutralizing titers. Using neutralization titer as the reference, the sensitivity of the IgG ELISAs ranged between 95-98%, but specificity was only 20-32%. Male sex, older age, and hospitalization with COVID-19 were all consistently associated with increased antibody responses across the serological assays. Neutralizing antibody titers were reduced over time in contrast to overall antibody responses. There was substantial heterogeneity in the antibody response among potential convalescent plasma donors, but sex, age and hospitalization emerged as factors that can be used to identify individuals with a high likelihood of having strong antiviral antibody levels.
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23
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Muehlschlegel S, Hwang DY, Flahive J, Quinn T, Lee C, Moskowitz J, Goostrey K, Jones K, Pach JJ, Knies AK, Shutter L, Goldberg R, Mazor KM. Goals-of-care decision aid for critically ill patients with TBI: Development and feasibility testing. Neurology 2020; 95:e179-e193. [PMID: 32554766 DOI: 10.1212/wnl.0000000000009770] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 12/17/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To develop and demonstrate early feasibility of a goals-of-care decision aid for surrogates of patients who are critically ill with traumatic brain injury (ciTBI) that meets accepted international decision aid guidelines. METHODS We developed the decision aid in 4 stages: (1) qualitative study of goals-of-care communication and decision needs of 36 stakeholders of ciTBI (surrogates and physicians), which informed (2) development of paper-based decision aid with iterative revisions after feedback from 52 stakeholders; (3) acceptability and usability testing in 18 neurologic intensive care unit (neuroICU) family members recruited from 2 neuroICU waiting rooms using validated scales; and (4) open-label, randomized controlled feasibility trial in surrogates of ciTBI. We performed an interim analysis of 16 surrogates of 12 consecutive patients who are ciTBI to confirm early feasibility of the study protocol and report recruitment, participation, and retention rates to date. RESULTS The resultant goals-of-care decision aid achieved excellent usability (median System Usability Scale 87.5 [possible range 0-100]) and acceptability (97% graded the tool's content as "good" or "excellent"). Early feasibility of the decision aid and the feasibility trial protocol was demonstrated by high rates of recruitment (73% consented), participation (100%), and retention (100% both after the goals-of-care clinician-family meeting and at 3 months) and complete data for the measurements of all secondary decision-related and behavioral outcomes to date. CONCLUSIONS Our systematic development process resulted in a novel goals-of-care decision aid for surrogates of patients who are ciTBI with excellent usability, acceptability, and early feasibility in the neuroICU environment, and meets international decision aid standards. This methodology may be a development model for other decision aids in neurology to promote shared decision-making.
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Affiliation(s)
- Susanne Muehlschlegel
- From the Departments of Neurology (S.M., C.L., K.G., K.J.), Anesthesiology/Critical Care (S.M.), Surgery (S.M.), Population and Quantitative Health Sciences (J.F., R.G.), Meyers Primary Care Institute (K.M.M.), and Internal Medicine (K.M.M.), University of Massachusetts Medical School, Worcester; Center for Neuroepidemiology and Clinical Neurological Research (D.Y.H.) and Department of Neurology (D.Y.H., J.J.P., A.K.K.), Yale School of Medicine, New Haven, CT; Department of Medicine (T.Q.), Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry (J.M.), Brown Medical School, Providence, RI; and Departments of Critical Care Medicine and Neurology (L.S.), University of Pittsburgh School of Medicine, PA.
| | - David Y Hwang
- From the Departments of Neurology (S.M., C.L., K.G., K.J.), Anesthesiology/Critical Care (S.M.), Surgery (S.M.), Population and Quantitative Health Sciences (J.F., R.G.), Meyers Primary Care Institute (K.M.M.), and Internal Medicine (K.M.M.), University of Massachusetts Medical School, Worcester; Center for Neuroepidemiology and Clinical Neurological Research (D.Y.H.) and Department of Neurology (D.Y.H., J.J.P., A.K.K.), Yale School of Medicine, New Haven, CT; Department of Medicine (T.Q.), Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry (J.M.), Brown Medical School, Providence, RI; and Departments of Critical Care Medicine and Neurology (L.S.), University of Pittsburgh School of Medicine, PA
| | - Julie Flahive
- From the Departments of Neurology (S.M., C.L., K.G., K.J.), Anesthesiology/Critical Care (S.M.), Surgery (S.M.), Population and Quantitative Health Sciences (J.F., R.G.), Meyers Primary Care Institute (K.M.M.), and Internal Medicine (K.M.M.), University of Massachusetts Medical School, Worcester; Center for Neuroepidemiology and Clinical Neurological Research (D.Y.H.) and Department of Neurology (D.Y.H., J.J.P., A.K.K.), Yale School of Medicine, New Haven, CT; Department of Medicine (T.Q.), Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry (J.M.), Brown Medical School, Providence, RI; and Departments of Critical Care Medicine and Neurology (L.S.), University of Pittsburgh School of Medicine, PA
| | - Thomas Quinn
- From the Departments of Neurology (S.M., C.L., K.G., K.J.), Anesthesiology/Critical Care (S.M.), Surgery (S.M.), Population and Quantitative Health Sciences (J.F., R.G.), Meyers Primary Care Institute (K.M.M.), and Internal Medicine (K.M.M.), University of Massachusetts Medical School, Worcester; Center for Neuroepidemiology and Clinical Neurological Research (D.Y.H.) and Department of Neurology (D.Y.H., J.J.P., A.K.K.), Yale School of Medicine, New Haven, CT; Department of Medicine (T.Q.), Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry (J.M.), Brown Medical School, Providence, RI; and Departments of Critical Care Medicine and Neurology (L.S.), University of Pittsburgh School of Medicine, PA
| | - Christopher Lee
- From the Departments of Neurology (S.M., C.L., K.G., K.J.), Anesthesiology/Critical Care (S.M.), Surgery (S.M.), Population and Quantitative Health Sciences (J.F., R.G.), Meyers Primary Care Institute (K.M.M.), and Internal Medicine (K.M.M.), University of Massachusetts Medical School, Worcester; Center for Neuroepidemiology and Clinical Neurological Research (D.Y.H.) and Department of Neurology (D.Y.H., J.J.P., A.K.K.), Yale School of Medicine, New Haven, CT; Department of Medicine (T.Q.), Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry (J.M.), Brown Medical School, Providence, RI; and Departments of Critical Care Medicine and Neurology (L.S.), University of Pittsburgh School of Medicine, PA
| | - Jesse Moskowitz
- From the Departments of Neurology (S.M., C.L., K.G., K.J.), Anesthesiology/Critical Care (S.M.), Surgery (S.M.), Population and Quantitative Health Sciences (J.F., R.G.), Meyers Primary Care Institute (K.M.M.), and Internal Medicine (K.M.M.), University of Massachusetts Medical School, Worcester; Center for Neuroepidemiology and Clinical Neurological Research (D.Y.H.) and Department of Neurology (D.Y.H., J.J.P., A.K.K.), Yale School of Medicine, New Haven, CT; Department of Medicine (T.Q.), Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry (J.M.), Brown Medical School, Providence, RI; and Departments of Critical Care Medicine and Neurology (L.S.), University of Pittsburgh School of Medicine, PA
| | - Kelsey Goostrey
- From the Departments of Neurology (S.M., C.L., K.G., K.J.), Anesthesiology/Critical Care (S.M.), Surgery (S.M.), Population and Quantitative Health Sciences (J.F., R.G.), Meyers Primary Care Institute (K.M.M.), and Internal Medicine (K.M.M.), University of Massachusetts Medical School, Worcester; Center for Neuroepidemiology and Clinical Neurological Research (D.Y.H.) and Department of Neurology (D.Y.H., J.J.P., A.K.K.), Yale School of Medicine, New Haven, CT; Department of Medicine (T.Q.), Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry (J.M.), Brown Medical School, Providence, RI; and Departments of Critical Care Medicine and Neurology (L.S.), University of Pittsburgh School of Medicine, PA
| | - Kelsey Jones
- From the Departments of Neurology (S.M., C.L., K.G., K.J.), Anesthesiology/Critical Care (S.M.), Surgery (S.M.), Population and Quantitative Health Sciences (J.F., R.G.), Meyers Primary Care Institute (K.M.M.), and Internal Medicine (K.M.M.), University of Massachusetts Medical School, Worcester; Center for Neuroepidemiology and Clinical Neurological Research (D.Y.H.) and Department of Neurology (D.Y.H., J.J.P., A.K.K.), Yale School of Medicine, New Haven, CT; Department of Medicine (T.Q.), Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry (J.M.), Brown Medical School, Providence, RI; and Departments of Critical Care Medicine and Neurology (L.S.), University of Pittsburgh School of Medicine, PA
| | - Jolanta J Pach
- From the Departments of Neurology (S.M., C.L., K.G., K.J.), Anesthesiology/Critical Care (S.M.), Surgery (S.M.), Population and Quantitative Health Sciences (J.F., R.G.), Meyers Primary Care Institute (K.M.M.), and Internal Medicine (K.M.M.), University of Massachusetts Medical School, Worcester; Center for Neuroepidemiology and Clinical Neurological Research (D.Y.H.) and Department of Neurology (D.Y.H., J.J.P., A.K.K.), Yale School of Medicine, New Haven, CT; Department of Medicine (T.Q.), Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry (J.M.), Brown Medical School, Providence, RI; and Departments of Critical Care Medicine and Neurology (L.S.), University of Pittsburgh School of Medicine, PA
| | - Andrea K Knies
- From the Departments of Neurology (S.M., C.L., K.G., K.J.), Anesthesiology/Critical Care (S.M.), Surgery (S.M.), Population and Quantitative Health Sciences (J.F., R.G.), Meyers Primary Care Institute (K.M.M.), and Internal Medicine (K.M.M.), University of Massachusetts Medical School, Worcester; Center for Neuroepidemiology and Clinical Neurological Research (D.Y.H.) and Department of Neurology (D.Y.H., J.J.P., A.K.K.), Yale School of Medicine, New Haven, CT; Department of Medicine (T.Q.), Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry (J.M.), Brown Medical School, Providence, RI; and Departments of Critical Care Medicine and Neurology (L.S.), University of Pittsburgh School of Medicine, PA
| | - Lori Shutter
- From the Departments of Neurology (S.M., C.L., K.G., K.J.), Anesthesiology/Critical Care (S.M.), Surgery (S.M.), Population and Quantitative Health Sciences (J.F., R.G.), Meyers Primary Care Institute (K.M.M.), and Internal Medicine (K.M.M.), University of Massachusetts Medical School, Worcester; Center for Neuroepidemiology and Clinical Neurological Research (D.Y.H.) and Department of Neurology (D.Y.H., J.J.P., A.K.K.), Yale School of Medicine, New Haven, CT; Department of Medicine (T.Q.), Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry (J.M.), Brown Medical School, Providence, RI; and Departments of Critical Care Medicine and Neurology (L.S.), University of Pittsburgh School of Medicine, PA
| | - Robert Goldberg
- From the Departments of Neurology (S.M., C.L., K.G., K.J.), Anesthesiology/Critical Care (S.M.), Surgery (S.M.), Population and Quantitative Health Sciences (J.F., R.G.), Meyers Primary Care Institute (K.M.M.), and Internal Medicine (K.M.M.), University of Massachusetts Medical School, Worcester; Center for Neuroepidemiology and Clinical Neurological Research (D.Y.H.) and Department of Neurology (D.Y.H., J.J.P., A.K.K.), Yale School of Medicine, New Haven, CT; Department of Medicine (T.Q.), Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry (J.M.), Brown Medical School, Providence, RI; and Departments of Critical Care Medicine and Neurology (L.S.), University of Pittsburgh School of Medicine, PA
| | - Kathleen M Mazor
- From the Departments of Neurology (S.M., C.L., K.G., K.J.), Anesthesiology/Critical Care (S.M.), Surgery (S.M.), Population and Quantitative Health Sciences (J.F., R.G.), Meyers Primary Care Institute (K.M.M.), and Internal Medicine (K.M.M.), University of Massachusetts Medical School, Worcester; Center for Neuroepidemiology and Clinical Neurological Research (D.Y.H.) and Department of Neurology (D.Y.H., J.J.P., A.K.K.), Yale School of Medicine, New Haven, CT; Department of Medicine (T.Q.), Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry (J.M.), Brown Medical School, Providence, RI; and Departments of Critical Care Medicine and Neurology (L.S.), University of Pittsburgh School of Medicine, PA
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Salman R, Robson J, Quinn T. The role of Radiological follow-up protocol in patients with surgically resected Non-Small Cell Lung Cancer. Lung Cancer 2019. [DOI: 10.1183/13993003.congress-2019.pa3023] [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: 11/05/2022]
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Affiliation(s)
| | - Thomas Quinn
- College of MedicineLake Erie College of Osteopathic MedicineBradentonFL
| | - Roger Biringer
- College of MedicineLake Erie College of Osteopathic MedicineBradentonFL
| | - Mohamed Hussein
- College of MedicineLake Erie College of Osteopathic MedicineBradentonFL
| | | | - Luisa Barrueto
- College of MedicineLake Erie College of Osteopathic MedicineBradentonFL
| | - Jordan Finizio
- College of MedicineLake Erie College of Osteopathic MedicineBradentonFL
| | - Michelle Huang
- College of MedicineLake Erie College of Osteopathic MedicineBradentonFL
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Backhouse EV, Brown R, Williams S, Parry-Jones A, Werring D, Sprigg N, Touyz R, Tyrrell P, Robinson T, Rudd A, McManus R, O’Brien J, Markus H, Bath P, Quinn T, Doubal F, Wardlaw JM. 136Rates, risks and routes to reduce vascular dementia (R4VAD). Age Ageing 2019. [DOI: 10.1093/ageing/afz001.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Quinn T, Skwarski K. A review of urgent suspected lung cancer referrals in Edinburgh Royal Infirmary. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30110-2] [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: 11/27/2022]
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Feodorova V, Sultanakhmedov E, Saltykov Y, Zaitsev S, Utz S, Corbel M, Gaydos C, Quinn T, Motin V. First Detection of Chlamydia trachomatis 'Swedish' Variant (nvCT) in a Russian Couple with Infertility. Open Microbiol J 2018; 12:343-352. [PMID: 30450141 PMCID: PMC6198409 DOI: 10.2174/1874285801812010343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 09/23/2018] [Accepted: 09/27/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Chronic asymptomatic chlamydial genital infection caused by the wild-type of Chlamydia trachomatis (wtCT) is the most common bacterial infection causing human infertility. The novel 'Swedish' variant of С.trachomatis (nvCT) which contains a 377 bp deletion in a region that is specifically targeted in some nucleic acid amplification tests may impede diagnosis. OBJECTIVE The study aimed to investigate whether nvCT may be a possible cause of infertility in a couple undergoing in vitro fertilization (IVF). METHOD Clinical specimens from both genital (urethra and cervix) and extra-genital sites (pharynx, conjunctive, blood) of a couple who experienced multiple unsuccessful attempts at pregnancy by natural fertilization and IVF procedures were analyzed before and after antibiotic therapy. Both partners had neither somatic nor endocrinal abnormality nor any clinically apparent genital manifestations of Chlamydia or other STIs. RESULTS Before antibiotic therapy all the samples of the Female Partner (FP) contained DNA of only the nvCT. After antibiotic therapy, additionally, DNA of wtCT of genovars E and D was detected in specimens from her conjunctiva and oropharynx. All samples of the Male Partner (MP) revealed co-infection of nvCT and wtCT. Identical SNP within the variable region 4 (VD4) of the ompA gene confirmed the identity of the wtCT strains found in both partners. The FP had a positive anti-chlamydial IgG titer. The sperm characteristics of the MP, motility (immotile spermatozoa was 51.1% versus 21.6%) and vitality (46% versus 68%) declined progressively, and the MP anti-chlamydial IgG titer was negative. CONCLUSION Infertility in this couple may have been caused by chronic asymptomatic and persistent nvCT-associated infection that was complicated by re-infection later with wtCT. This study illustrates the importance of including detection methods for nvCT strains in the investigation of infertility cases.
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Affiliation(s)
- Valentina Feodorova
- Laboratory for Molecular Biology and NanoBiotechnology, Federal Research Center for Virology and Microbiology, Branch in Saratov, Ap. 6, the 53 Strelkovoi Divisii Street, Saratov, 410028, Russia
| | - Edgar Sultanakhmedov
- Department for Skin Diseases, Saratov State Medical University, 22, Proviantskaya Street, Saratov, 410028, Russia
| | - Yury Saltykov
- Laboratory for Molecular Biology and NanoBiotechnology, Federal Research Center for Virology and Microbiology, Branch in Saratov, Ap. 6, the 53 Strelkovoi Divisii Street, Saratov, 410028, Russia
| | - Sergey Zaitsev
- Laboratory for Molecular Biology and NanoBiotechnology, Federal Research Center for Virology and Microbiology, Branch in Saratov, Ap. 6, the 53 Strelkovoi Divisii Street, Saratov, 410028, Russia
| | - Sergey Utz
- Department for Skin Diseases, Saratov State Medical University, 22, Proviantskaya Street, Saratov, 410028, Russia
| | - Michael Corbel
- Department of Bacteriology, The National Institute for Biological Standards and Control (NIBSC), Potters Bar, EN6 3QG, UK
| | - Charlotte Gaydos
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, 855 N. Wolfe Street, Rangos Bldg, Suite 530, Baltimore, MD 21205, USA
| | - Thomas Quinn
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, 855 N. Wolfe Street, Rangos Bldg, Suite 530, Baltimore, MD 21205, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore, MD, 21205, USA
| | - Vladimir Motin
- Department of Pathology & Immunology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0609, USA
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Taylor-Rowan M, Quinn T, Smith P, Ellis G, Keir R, McAlpine C, Marsh G, Murtagh J, McElroy M, Mitchell L, Waddell G, Williams A, Duffy L, Oswald S, Myles A, Bann A, Rodger K, Reid J, Kellichan L, Docharty D, Marshall T, McGurn B, Ritchie C, Wells A, Talbot A, McInnes C, Reynish E, Coleman D, Flynn B, Scott A, Coull A, Dingwall L. 53ASSESSING THE PSYCHOMETRIC PROPERTIES OF THE HIS “THINK FRAILTY” TOOL. Age Ageing 2018. [DOI: 10.1093/ageing/afy127.02] [Citation(s) in RCA: 2] [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: 11/13/2022] Open
Affiliation(s)
| | - T Quinn
- New Lister Building, Glasgow Royal Infirmary
| | - P Smith
- New Lister Building, Glasgow Royal Infirmary
| | - G Ellis
- New Lister Building, Glasgow Royal Infirmary
| | - R Keir
- New Lister Building, Glasgow Royal Infirmary
| | - C McAlpine
- New Lister Building, Glasgow Royal Infirmary
| | - G Marsh
- New Lister Building, Glasgow Royal Infirmary
| | - J Murtagh
- New Lister Building, Glasgow Royal Infirmary
| | - M McElroy
- New Lister Building, Glasgow Royal Infirmary
| | - L Mitchell
- New Lister Building, Glasgow Royal Infirmary
| | - G Waddell
- New Lister Building, Glasgow Royal Infirmary
| | - A Williams
- New Lister Building, Glasgow Royal Infirmary
| | - L Duffy
- New Lister Building, Glasgow Royal Infirmary
| | - S Oswald
- New Lister Building, Glasgow Royal Infirmary
| | - A Myles
- New Lister Building, Glasgow Royal Infirmary
| | - A Bann
- New Lister Building, Glasgow Royal Infirmary
| | - K Rodger
- New Lister Building, Glasgow Royal Infirmary
| | - J Reid
- New Lister Building, Glasgow Royal Infirmary
| | - L Kellichan
- New Lister Building, Glasgow Royal Infirmary
| | - D Docharty
- New Lister Building, Glasgow Royal Infirmary
| | - T Marshall
- New Lister Building, Glasgow Royal Infirmary
| | - B McGurn
- New Lister Building, Glasgow Royal Infirmary
| | - C Ritchie
- New Lister Building, Glasgow Royal Infirmary
| | - A Wells
- New Lister Building, Glasgow Royal Infirmary
| | - A Talbot
- New Lister Building, Glasgow Royal Infirmary
| | - C McInnes
- New Lister Building, Glasgow Royal Infirmary
| | - E Reynish
- New Lister Building, Glasgow Royal Infirmary
| | - D Coleman
- New Lister Building, Glasgow Royal Infirmary
| | - B Flynn
- New Lister Building, Glasgow Royal Infirmary
| | - A Scott
- New Lister Building, Glasgow Royal Infirmary
| | - A Coull
- New Lister Building, Glasgow Royal Infirmary
| | - L Dingwall
- New Lister Building, Glasgow Royal Infirmary
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Drozdowska BA, MacKinnon S, Hamilton M, Noel-Storr AH, McShane R, Quinn T. 57ARE METHODOLOGICAL QUALITY AND COMPLETENESS OF REPORTING ASSOCIATED WITH CITATION-BASED MEASURES OF PUBLICATION IMPACT? A SECONDARY ANALYSIS OF A SYSTEMATIC REVIEW OF DEMENTIA BIOMARKER STUDIES. Age Ageing 2018. [DOI: 10.1093/ageing/afy127.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Quinn T, Moskowitz J, Khan MW, Shutter L, Goldberg R, Col N, Mazor KM, Muehlschlegel S. What Families Need and Physicians Deliver: Contrasting Communication Preferences Between Surrogate Decision-Makers and Physicians During Outcome Prognostication in Critically Ill TBI Patients. Neurocrit Care 2018; 27:154-162. [PMID: 28685395 DOI: 10.1007/s12028-017-0427-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Surrogate decision-makers ("surrogates") and physicians of incapacitated patients have different views of prognosis and how it should be communicated, but this has not been investigated in neurocritically ill patients. We examined surrogates' communication preferences and physicians' practices during the outcome prognostication for critically ill traumatic brain injury (ciTBI) patients in two level-1 trauma centers and seven academic medical centers in the USA. METHODS We used qualitative content analysis and descriptive statistics of transcribed interviews to identify themes in surrogates (n = 16) and physicians (n = 20). RESULTS The majority of surrogates (82%) preferred numeric estimates describing the patient's prognosis, as they felt it would increase prognostic certainty, and limit the uncertainty perceived as frustrating. Conversely, 75% of the physicians reported intentionally omitting numeric estimates during prognostication meetings due to low confidence in family members' abilities to appropriately interpret probabilities, worry about creating false hope, and distrust in the accuracy and data quality of existing TBI outcome models. Physicians felt that these models are for research only and should not be applied to individual patients. Surrogates valued compassion during prognostication discussions, and acceptance of their goals-of-care decision by clinicians. Physicians and surrogates agreed on avoiding false hope. CONCLUSION We identified fundamental differences in the communication preferences of prognostic information between ciTBI patient surrogates and physicians. These findings inform the content of a future decision aid for goals-of-care discussions in ciTBI patients. If validated, these findings may have important implications for improving communication practices in the neurointensive care unit independent of whether a formal decision aid is used.
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Affiliation(s)
- Thomas Quinn
- Department of Neurology (Neurocritical Care), University of Massachusetts Medical School, 55 Lake Ave North, S-5, Worcester, MA, USA
| | - Jesse Moskowitz
- Department of Neurology (Neurocritical Care), University of Massachusetts Medical School, 55 Lake Ave North, S-5, Worcester, MA, USA
| | - Muhammad W Khan
- Department of Neurology (Neurocritical Care), University of Massachusetts Medical School, 55 Lake Ave North, S-5, Worcester, MA, USA
| | - Lori Shutter
- Departments of Critical Care Medicine & Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Robert Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Nananda Col
- Shared Decision Making Resources, Georgetown, ME, USA
| | - Kathleen M Mazor
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Susanne Muehlschlegel
- Department of Neurology (Neurocritical Care), University of Massachusetts Medical School, 55 Lake Ave North, S-5, Worcester, MA, USA. .,Department of Anesthesiology/Critical Care, University of Massachusetts Medical School, Worcester, MA, USA. .,Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
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Moskowitz J, Quinn T, Khan MW, Shutter L, Goldberg R, Col N, Mazor KM, Muehlschlegel S. Should We Use the IMPACT-Model for the Outcome Prognostication of TBI Patients? A Qualitative Study Assessing Physicians' Perceptions. MDM Policy Pract 2018; 3:2381468318757987. [PMID: 30288437 PMCID: PMC6124938 DOI: 10.1177/2381468318757987] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 12/26/2017] [Indexed: 11/15/2022] Open
Abstract
Introduction. Shared Decision-Making may facilitate information exchange, deliberation, and effective decision-making, but no decision aids currently exist for difficult decisions in neurocritical care patients. The International Patient Decision Aid Standards, a framework for the creation of high-quality decision aids (DA), recommends the presentation of numeric outcome and risk estimates. Efforts are underway to create a goals-of-care DA in critically-ill traumatic brain injury (ciTBI) patients. To inform its content, we examined physicians’ perceptions, and use of the IMPACT-model, the most widely validated ciTBI outcome model, and explored physicians’ preferences for communicating prognostic information towards families. Methods. We conducted a qualitative study using semi-structured interviews in 20 attending physicians (neurosurgery,neurocritical care,trauma,palliative care) at 7 U.S. academic medical centers. We used performed qualitative content analysis of transcribed interviews to identify major themes. Results. Only 12 physicians (60%) expressed awareness of the IMPACT-model; two stated that they “barely” knew the model. Seven physicians indicated using the model at least some of the time in clinical practice, although none used it exclusively to derive a patient’s prognosis. Four major themes emerged: the IMPACT-model is intended for research but should not be applied to individual patients; mistrust in the IMPACT-model derivation data; the IMPACT-model is helpful in reducing prognostic variability among physicians; concern that statistical models may mislead families about a patient’s prognosis. Discussion: Our study identified significant variability of the awareness, perception, and use of the IMPACT-model among physicians. While many physicians prefer to avoid conveying numeric prognostic estimates with families using the IMPACT-model, several physicians thought that they “ground” them and reduce prognostic variability among physicians. These findings may factor into the creation and implementation of future ciTBI-related DAs.
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Affiliation(s)
- Jesse Moskowitz
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA (JM, TQ, MWK, SM).,Depts. of Critical Care Medicine & Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA (LS).,Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA (RG).,Shared Decision Making Resources, Georgetown, ME, USA (NC).,Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Anesthesiology/Critical Care, University of Massachusetts Medical School, Worcester, MA, USA (SM).,Surgery, University of Massachusetts Medical School, Worcester, MA, USA(SM)
| | - Thomas Quinn
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA (JM, TQ, MWK, SM).,Depts. of Critical Care Medicine & Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA (LS).,Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA (RG).,Shared Decision Making Resources, Georgetown, ME, USA (NC).,Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Anesthesiology/Critical Care, University of Massachusetts Medical School, Worcester, MA, USA (SM).,Surgery, University of Massachusetts Medical School, Worcester, MA, USA(SM)
| | - Muhammad W Khan
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA (JM, TQ, MWK, SM).,Depts. of Critical Care Medicine & Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA (LS).,Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA (RG).,Shared Decision Making Resources, Georgetown, ME, USA (NC).,Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Anesthesiology/Critical Care, University of Massachusetts Medical School, Worcester, MA, USA (SM).,Surgery, University of Massachusetts Medical School, Worcester, MA, USA(SM)
| | - Lori Shutter
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA (JM, TQ, MWK, SM).,Depts. of Critical Care Medicine & Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA (LS).,Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA (RG).,Shared Decision Making Resources, Georgetown, ME, USA (NC).,Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Anesthesiology/Critical Care, University of Massachusetts Medical School, Worcester, MA, USA (SM).,Surgery, University of Massachusetts Medical School, Worcester, MA, USA(SM)
| | - Robert Goldberg
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA (JM, TQ, MWK, SM).,Depts. of Critical Care Medicine & Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA (LS).,Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA (RG).,Shared Decision Making Resources, Georgetown, ME, USA (NC).,Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Anesthesiology/Critical Care, University of Massachusetts Medical School, Worcester, MA, USA (SM).,Surgery, University of Massachusetts Medical School, Worcester, MA, USA(SM)
| | - Nananda Col
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA (JM, TQ, MWK, SM).,Depts. of Critical Care Medicine & Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA (LS).,Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA (RG).,Shared Decision Making Resources, Georgetown, ME, USA (NC).,Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Anesthesiology/Critical Care, University of Massachusetts Medical School, Worcester, MA, USA (SM).,Surgery, University of Massachusetts Medical School, Worcester, MA, USA(SM)
| | - Kathleen M Mazor
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA (JM, TQ, MWK, SM).,Depts. of Critical Care Medicine & Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA (LS).,Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA (RG).,Shared Decision Making Resources, Georgetown, ME, USA (NC).,Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Anesthesiology/Critical Care, University of Massachusetts Medical School, Worcester, MA, USA (SM).,Surgery, University of Massachusetts Medical School, Worcester, MA, USA(SM)
| | - Susanne Muehlschlegel
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA (JM, TQ, MWK, SM).,Depts. of Critical Care Medicine & Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA (LS).,Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA (RG).,Shared Decision Making Resources, Georgetown, ME, USA (NC).,Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA (KMM).,Anesthesiology/Critical Care, University of Massachusetts Medical School, Worcester, MA, USA (SM).,Surgery, University of Massachusetts Medical School, Worcester, MA, USA(SM)
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García MF, Gallazzi F, Junqueira MDS, Fernández M, Camacho X, Mororó JDS, Faria D, Carneiro CDG, Couto M, Carrión F, Pritsch O, Chammas R, Quinn T, Cabral P, Cerecetto H. Synthesis of hydrophilic HYNIC-[1,2,4,5]tetrazine conjugates and their use in antibody pretargeting with99mTc. Org Biomol Chem 2018; 16:5275-5285. [DOI: 10.1039/c8ob01255e] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Pretargeted imaging is shown to be an attractive strategy to overcome disadvantages associated with traditional radioimmunoconjugates.
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Neubeck L, Barclay K, Dunn M, Oliver C, Armitage W, Hodson P, Bruce J, Grubb N, Quinn T. Scottish National Inquiry on Atrial Fibrillation. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Martin A, Durand C, Quinn T, Siliciano R, Redd A. Measurement and characterization of the latent reservoir for HIV-1 in patients receiving solid organ transplant. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30606-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Chen F, Ma K, Benezra M, Zhang L, Cheal SM, Phillips E, Yoo B, Pauliah M, Overholtzer M, Zanzonico P, Sequeira S, Gonen M, Quinn T, Wiesner U, Bradbury MS. Cancer-Targeting Ultrasmall Silica Nanoparticles for Clinical Translation: Physicochemical Structure and Biological Property Correlations. Chem Mater 2017; 29:8766-8779. [PMID: 29129959 PMCID: PMC5679295 DOI: 10.1021/acs.chemmater.7b03033] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Although a large body of literature exists on the potential use of nanoparticles for medical applications, the number of probes translated into human clinical trials is remarkably small. A major challenge of particle probe development and their translation is the elucidation of safety profiles associated with their structural complexity, not only in terms of size distribution and heterogeneities in particle composition but also their effects on biological activities and the relationship between particle structure and pharmacokinetics. Here, we report on the synthesis, characterization, and long-term stability of ultrasmall (<10 nm diameter) dual-modality (optical and positron emission tomography) and integrintargeting silica nanoparticles (cRGDY-PEG-Cy5-C' dots and 124I-(or 131I-) cRGDY-PEG-Cy5-C'dots) and the extent to which their surface ligand density differentially modulates key in vitro and in vivo biological activities in melanoma models over a range of ligand numbers (i.e., ~6-18). Gel permeation chromatography, established as an important particle characterization tool, revealed a two-year shelf life for cRGDY-PEG-Cy5-C' dots. Radiochromatography further demonstrated the necessary radiochemical stability for clinical applications. The results of subsequent ligand density-dependent studies elucidate strong modulations in biological response, including statistically significant increases in integrin-specific targeting and particle uptake, cellular migration and adhesion, renal clearance, and tumor-to-blood ratios with increasing ligand number. We anticipate that nanoprobe characteristics and a better understanding of the structure-function relationships determined in this study will help guide identification of other lead nanoparticle candidates for in vitro and in vivo biological assessments and product translation.
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Affiliation(s)
- Feng Chen
- Department of Radiology, Sloan Kettering Institute for Cancer Research, New York, New York 10065, United States
| | - Kai Ma
- Department of Materials Science & Engineering, Cornell University, Ithaca, New York 14853, United States
| | - Miriam Benezra
- Department of Radiology, Sloan Kettering Institute for Cancer Research, New York, New York 10065, United States
| | - Li Zhang
- Department of Radiology, Sloan Kettering Institute for Cancer Research, New York, New York 10065, United States
| | - Sarah M. Cheal
- Department of Radiology, Sloan Kettering Institute for Cancer Research, New York, New York 10065, United States
| | - Evan Phillips
- Department of Radiology, Sloan Kettering Institute for Cancer Research, New York, New York 10065, United States
| | - Barney Yoo
- Department of Radiology, Sloan Kettering Institute for Cancer Research, New York, New York 10065, United States
| | - Mohan Pauliah
- Department of Radiology, Sloan Kettering Institute for Cancer Research, New York, New York 10065, United States
| | - Michael Overholtzer
- Cell Biology Program, Sloan Kettering Institute for Cancer Research, New York, New York 10065, United States
- BCMB Allied Program, Weill Cornell Medical College, New York, New York 10065, United States
| | - Pat Zanzonico
- Department of Medical Physics, Sloan Kettering Institute for Cancer Research, New York, New York 10065, United States
| | - Sonia Sequeira
- Investigational Products Core, Sloan Kettering Institute for Cancer Research, New York, New York 10065, United States
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Sloan Kettering Institute for Cancer Research, New York, New York 10065, United States
| | - Thomas Quinn
- Department of Biochemistry, University of Missouri, Columbia, Missouri 65211, United States
| | - Ulrich Wiesner
- Department of Materials Science & Engineering, Cornell University, Ithaca, New York 14853, United States
- Corresponding Authors. .
| | - Michelle S. Bradbury
- Department of Radiology, Sloan Kettering Institute for Cancer Research, New York, New York 10065, United States
- Molecular Pharmacology Program, Sloan Kettering Institute for Cancer Research, New York, New York 10065, United States
- Corresponding Authors. .
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Zambrano AI, Muñoz BE, Mkocha H, Dize L, Gaydos CA, Quinn T, West SK. Measuring Trachomatous Inflammation-Intense (TI) When Prevalence Is Low Provides Data on Infection With Chlamydia trachomatis. Invest Ophthalmol Vis Sci 2017; 58:997-1000. [PMID: 28535271 PMCID: PMC5308676 DOI: 10.1167/iovs.16-20421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Clinical trachoma is the current measure of effectiveness of antibiotic and environmental improvements in trachoma endemic communities. Impact assessments measure only trachomatous inflammation-follicular (TF). Trachomatous inflammation-intense (TI) is not used for decisions on stopping mass drug administration (MDA) or achieving intervention goals. We tested the supposition that TI was not associated with Chlamydia trachomatis when disease prevalence is low. Methods In 35 communities undergoing MDA as part of a larger project, 110 children ages 1 to 9 years were randomly selected in each community for surveys at baseline, 6, and 12 months. Both eyelids were graded for TF and TI, and a swab for detection of C. trachomatis infection was taken. Results Overall TF prevalence was 5% at baseline. Cases of TI alone constituted 15% of trachoma; 37% of TI cases had infection. At 6 and 12 months, the proportion of trachoma cases that had TI only was 13% and 20%; infection rates were similar to the rates in cases with TF alone. Conclusions Despite low prevalence of trachoma, infection rates for TF alone and TI alone were similar at each time point. The exclusion of cases of TI alone when reporting trachoma prevalence discards additional information on infection. Trachomatous inflammation-intense could be considered as part of impact surveys.
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Affiliation(s)
- Andrea I Zambrano
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Beatriz E Muñoz
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | | | - Laura Dize
- International Chlamydia Laboratory, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Charlotte A Gaydos
- International Chlamydia Laboratory, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Thomas Quinn
- International Chlamydia Laboratory, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, United States 4National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States
| | - Sheila K West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, United States
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Ji C, Lall R, Quinn T, Kaye C, Haywood K, Horton J, Gordon V, Deakin CD, Pocock H, Carson A, Smyth M, Rees N, Han K, Byers S, Brace-McDonnell S, Gates S, Perkins GD. Post-admission outcomes of participants in the PARAMEDIC trial: A cluster randomised trial of mechanical or manual chest compressions. Resuscitation 2017; 118:82-88. [PMID: 28689046 DOI: 10.1016/j.resuscitation.2017.06.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/26/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND The PARAMEDIC cluster randomised trial evaluated the LUCAS mechanical chest compression device, and did not find evidence that use of mechanical chest compression led to an improvement in survival at 30 days. This paper reports patient outcomes from admission to hospital to 12 months after randomisation. METHODS Information about hospital length of stay and intensive care management was obtained through linkage with Hospital Episode Statistics and the Intensive Care National Audit and Research Centre. Patients surviving to hospital discharge were approached to complete questionnaires (SF-12v2, EQ-5D, MMSE, HADS and PTSD-CL) at 90days and 12 months. The study is registered with Current Controlled Trials, number ISRCTN08233942. RESULTS 377 patients in the LUCAS arm and 658 patients in the manual chest compression were admitted to hospital. Hospital and intensive care length of stay were similar. Long term follow-up assessments were limited by poor response rates (53.7% at 3 months and 55.6% at 12 months). Follow-up rates were lower in those with worse neurological function. Among respondents, long term health related quality of life outcomes and emotional well-being was similar between groups. Cognitive function, measured by MMSE, was marginally lower in the LUCAS arm mean 26.9 (SD 3.7) compared to control mean 28.0 (SD 2.3), adjusted mean difference -1.5 (95% CI -2.6 to -0.4). CONCLUSION There were no clinically important differences identified in outcomes at long term follow-up between those allocated to the mechanical chest compression compared to those receiving manual chest compression.
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Affiliation(s)
- C Ji
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - R Lall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - T Quinn
- Kingston University and St George's University of London Joint Faculty Health, Social Care and Education, London, UK
| | - C Kaye
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - K Haywood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - J Horton
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - V Gordon
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - C D Deakin
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK; NIHR Southampton Respiratory Biomedical Research Unit, Southampton, UK
| | - H Pocock
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK
| | - A Carson
- West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | - M Smyth
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK; West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | - N Rees
- Welsh Ambulance Services NHS Trust, Denbighshire, Wales, UK
| | - K Han
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK
| | - S Byers
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - S Gates
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - G D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK.
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Arba F, Quinn T, Hankey GJ, Inzitari D, Ali M, Lees KR. Determinants of post-stroke cognitive impairment: analysis from VISTA. Acta Neurol Scand 2017; 135:603-607. [PMID: 27412470 DOI: 10.1111/ane.12637] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Post-stroke cognitive impairment (PSCI) occurs commonly and is linked with development of dementia. We investigated the relationship between demographic, clinical and stroke symptoms at stroke onset and the presence of PSCI at 1 and 3 years after stroke. METHODS We accessed anonymized data from the Virtual International Stroke Trial Archive (VISTA), including demographic and clinical variables. Post-stroke cognitive impairment was defined as a Mini-Mental State Examination (MMSE) score of ≤26. We assessed univariate relationships between baseline stroke symptoms and PSCI at 1 and 3 years following stroke, retaining the significant and relevant clinical factors as covariates in a final adjusted logistic regression model. RESULTS We analysed data on 5435 patients with recent (median 33 days) stroke or transient ischaemic attack (TIA). Mean (±SD) age was 62.6 (±12.6) years; 3476 (65%) patients were male. Follow-up data were available for 2270 and 1294 patients at 1 and 3 years, respectively. At 1 year, 781 (34%) patients had MMSE≤26; at 3 years, 391 (30%) had MMSE≤26. After adjusting for age, stroke severity, hypertension, diabetes and type of qualifying event, initial stroke impairment (leg paralysis) was associated with increased rate of PSCI at 1 year (OR=1.62; 95% CI=1.20-2.20) and at 3 years (OR=1.95; 95% CI=1.23-3.09). Associations were consistent on subgroup analysis restricted to ischaemic stroke and transient ischaemic attack (N=4992). CONCLUSIONS Besides well-known determinants of PSCI such as age, stroke severity and the presence of vascular risk factors, also leg paralysis is associated with subsequent of PSCI up to 3 years after stroke.
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Affiliation(s)
- F. Arba
- NEUROFARBA Department; University of Florence; Florence Italy
- Institute of Cardiovascular and Medical Sciences; Queen Elizabeth University Hospital Glasgow; Glasgow UK
| | - T. Quinn
- Institute of Cardiovascular and Medical Sciences; Glasgow Royal Infirmary; University of Glasgow; Glasgow UK
| | - G. J. Hankey
- School of Medicine and Pharmacology; Harry Perkins Institute of Medical Research; QEII Medical Centre; University of Western Australia; Perth WA Australia
| | - D. Inzitari
- NEUROFARBA Department; University of Florence; Florence Italy
| | - M. Ali
- Institute of Cardiovascular and Medical Sciences; Queen Elizabeth University Hospital Glasgow; Glasgow UK
| | - K. R. Lees
- Institute of Cardiovascular & Medical Sciences; University of Glasgow; Glasgow UK
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Quinn T, Bs MF, von Heideken J, Iannaccone C, Shadick NA, Weinblatt M, Iversen MD. Validity of the Nurses' health study physical activity questionnaire in estimating physical activity in adults with rheumatoid arthritis. BMC Musculoskelet Disord 2017; 18:234. [PMID: 28569163 PMCID: PMC5452372 DOI: 10.1186/s12891-017-1589-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 05/17/2017] [Indexed: 02/08/2023] Open
Abstract
Background Patients with rheumatoid arthritis (RA) demonstrate reduced aerobic capacity, excess cardiovascular risk, mobility limitations and are less physically active than their healthy peers. Physical activity may decrease RA disease activity through its anti-inflammatory effects and psychological and health benefits. To successfully manage RA symptoms and reduce cardiovascular risks associated with RA through increased physical activity (PA), accurate physical activity assessments are critical. Accelerometry is an objective physical activity measure, but not widely used. Validity of the Nurses’ Health Study physical activity questionnaire II (NHSPAQ) has not been determined for estimation of physical activity in RA. This study examined NHSPAQ validity in adults with RA compared to accelerometry-based metabolic equivalents determined (METs) and results of performance tests. We hypothesized NHSPAQ scores would correlate moderately (0.4–0.5) with accelerometer physical activity estimates. Methods Thirty-five adults with RA (mean age [SD] 62 (Williams et. al, Health Qual Life Outcomes10:28, 2012) years, 28 females (80%) recruited from a hospital-based clinic registry participated in a one-week accelerometry trial. Medical data was compiled. Participants completed the NHSPAQ, a self-paced 20-m walk test, and modified timed step test. Participants wore an accelerometer for 7 consecutive days, then completed a physical activity log and another NHSPAQ. Metabolic equivalents (METs) were derived from NHSPAQ and accelerometers using standardized formulas. NHSPAQ METs were correlated with accelerometer METs and data from performance measures. Results Average disease duration was 21 years (SD = 11), 63% patients took biologics. The average weekly METs reported were 29 (SD = 33) and accelerometer METs were 33 (SD = 22). NHSPAQ METs correlated moderately with accelerometer-derived METs (r = 0.48 95% CI (0.15–0.70). Self-reported PA correlated moderately with Step Test performance (r = 0.50 95% CI (0.18–0.72). Conclusion Patients with RA exhibit low physical activity levels. General fitness measures were moderately correlated with physical activity levels. A moderate significant correlation existed between NHSPAQ and accelerometry METs. These preliminary data suggest the NHSPAQ may be useful to describe physical activity levels in this population.
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Affiliation(s)
- Thomas Quinn
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Michelle Frits Bs
- Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital, Boston, MA, USA
| | - Johan von Heideken
- Department of Women and Children's Health Karolinska Institutet, Stockholm, Sweden
| | - Christine Iannaccone
- Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital, Boston, MA, USA
| | - Nancy A Shadick
- Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Michael Weinblatt
- Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Maura D Iversen
- Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital, Boston, MA, USA. .,Department of Women and Children's Health Karolinska Institutet, Stockholm, Sweden. .,Harvard Medical School, Boston, MA, USA. .,Department of Physical Therapy, Movement and Rehabilitation Sciences, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue Rm 301c Robinson Hall, Boston, MA, 02115, USA.
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Schlusser KE, Pilcher C, Kallas EG, Santos BR, Deeks SG, Facente S, Keating SM, Busch MP, Murphy G, Welte A, Quinn T, Eshleman SH, Laeyendecker O. Comparison of cross-sectional HIV incidence assay results from dried blood spots and plasma. PLoS One 2017; 12:e0172283. [PMID: 28231277 PMCID: PMC5322916 DOI: 10.1371/journal.pone.0172283] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 02/02/2017] [Indexed: 11/18/2022] Open
Abstract
Background Assays have been developed for cross-sectional HIV incidence estimation using plasma samples. Large scale surveillance programs are planned using dried blood spot (DBS) specimens for incidence assessment. However, limited information exists on the performance of HIV cross-sectional incidence assays using DBS. Methods The assays evaluated were: Maxim HIV-1 Limiting Antigen Avidity EIA (LAg-Avidity), Sedia HIV-1 BED-Capture EIA (BED-CEIA), and CDC modified BioRad HIV-1/2 Plus O Avidity-based Assay (CDC-BioRad Avidity) using pre-determined cutoff values. 100 matched HIV-1 positive plasma and DBS samples, with known duration of infection, from the Consortium for the Evaluation and Performance of HIV Incidence Assays repository were tested. All assays were run in duplicate. To examine the degree of variability within and between results for each sample type, both categorical and continuous results were analyzed. Associations were assessed with Bland Altman, R2 values and Cohen’s kappa coefficient (ĸ). Results Intra-assay variability using the same sample type was similar for all assays (R2 0.96 to 1.00). The R2 values comparing DBS and plasma results for LAg-Avidity, BED-CEIA, and CDC-BioRad Avidity were 0.96, 0.94, and 0.84, respectively. The concordance and ĸ values between DBS and plasma for all three assays were >87% and >0.64, respectively. The Bland-Altman analysis showed significant differences between plasma and DBS samples. For all three assays, a higher number of samples were classified as recent infections using DBS samples. Conclusions DBS and plasma sample results were highly correlated. However, when compared to plasma, each assay performed somewhat differently in DBS at the lower and higher ends of the dynamic range. DBS samples were more likely to be classified as recently infected by all three assays, which may lead to overestimation of incidence in surveys using performance criteria derived for plasma samples.
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Affiliation(s)
- Katherine E. Schlusser
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Christopher Pilcher
- Department of Medicine, School of Medicine, University of California at San Francisco, San Francisco, CA, United States of America
| | | | | | - Steven G. Deeks
- Department of Medicine, School of Medicine, University of California at San Francisco, San Francisco, CA, United States of America
| | - Shelley Facente
- Department of Medicine, School of Medicine, University of California at San Francisco, San Francisco, CA, United States of America
| | - Sheila M. Keating
- Department of Medicine, School of Medicine, University of California at San Francisco, San Francisco, CA, United States of America
- Blood Systems Research Institute, San Francisco, California, United States of America
| | - Michael P. Busch
- Department of Medicine, School of Medicine, University of California at San Francisco, San Francisco, CA, United States of America
- Blood Systems Research Institute, San Francisco, California, United States of America
| | - Gary Murphy
- Public Health England, London, United Kingdom
| | - Alex Welte
- The South African DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Thomas Quinn
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Baltimore, MD, United States of America
| | - Susan H. Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Oliver Laeyendecker
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Baltimore, MD, United States of America
- * E-mail:
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Calzada V, Moreno M, Newton J, González J, Fernández M, Gambini JP, Ibarra M, Chabalgoity A, Deutscher S, Quinn T, Cabral P, Cerecetto H. Development of new PTK7-targeting aptamer-fluorescent and -radiolabelled probes for evaluation as molecular imaging agents: Lymphoma and melanoma in vivo proof of concept. Bioorg Med Chem 2016; 25:1163-1171. [PMID: 28089349 DOI: 10.1016/j.bmc.2016.12.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/05/2016] [Accepted: 12/19/2016] [Indexed: 11/26/2022]
Abstract
Aptamers are single-stranded oligonucleotides that recognize molecular targets with high affinity and specificity. Aptamer that selectively bind to the protein tyrosine kinase-7 (PTK7) receptor, overexpressed on many cancers, has been labelled as probes for molecular imaging of cancer. Two new PTK7-targeting aptamer probes were developed by coupling frameworks from the fluorescent dye AlexaFluor647 or the 6-hydrazinonicotinamide (HYNIC) chelator-labelled to 99mTc. The derivatizations via a 5'-aminohexyl terminal linker were done at room temperature and under mild buffer conditions. Physicochemical and biological controls for both imaging agents were performed verifying the integrity of the aptamer-conjugates by HPLC. Recognition of melanoma (B16F1) and lymphoma (A20) mouse cell lines by the aptamer was studied using cell binding, flow cytometry and confocal microscopy. Finally, in vivo imaging studies in tumour-bearing mice were performed. The new probes were able to bind to melanoma and lymphoma cell lines in vitro, the in vivo imaging in tumour-bearing mice showed different uptake behaviours showing for the fluorescent conjugate good uptake by B cell lymphoma while the radiolabelled conjugate did not display tumour uptake due to its high extravascular distribution, and both showed rapid clearance properties in tumour-bearing mice.
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Affiliation(s)
- Victoria Calzada
- Área de Radiofarmacia-Centro de Investigaciones Nucleares, Facultad de Ciencias, Universidad de la República, 11400 Montevideo, Uruguay
| | - María Moreno
- Departamento de Desarrollo Biotecnológico-Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Jessica Newton
- Department of Biochemistry, University of Missouri, Columbia, MO, USA; Harry S Truman Veterans' Administration Hospital, Columbia, MO, USA
| | - Joel González
- Laboratorio de Experimentación Animal-Centro de Investigaciones Nucleares, Facultad de Ciencias-Universidad de la República, Montevideo, Uruguay
| | - Marcelo Fernández
- Laboratorio de Experimentación Animal-Centro de Investigaciones Nucleares, Facultad de Ciencias-Universidad de la República, Montevideo, Uruguay
| | - Juan Pablo Gambini
- Centro de Medicina Nuclear-Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Manuel Ibarra
- Centro de Evaluación de Biodisponibilidad y Bioequivalencia de Medicamentos, Universidad de la República, Montevideo, Uruguay
| | - Alejandro Chabalgoity
- Departamento de Desarrollo Biotecnológico-Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Susan Deutscher
- Department of Biochemistry, University of Missouri, Columbia, MO, USA; Harry S Truman Veterans' Administration Hospital, Columbia, MO, USA
| | - Thomas Quinn
- Department of Biochemistry, University of Missouri, Columbia, MO, USA; Harry S Truman Veterans' Administration Hospital, Columbia, MO, USA
| | - Pablo Cabral
- Área de Radiofarmacia-Centro de Investigaciones Nucleares, Facultad de Ciencias, Universidad de la República, 11400 Montevideo, Uruguay
| | - Hugo Cerecetto
- Área de Radiofarmacia-Centro de Investigaciones Nucleares, Facultad de Ciencias, Universidad de la República, 11400 Montevideo, Uruguay.
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Bale SD, Goetz K, Harvey PR, Turin P, Bonnell JW, de Wit TD, Ergun RE, MacDowall RJ, Pulupa M, Andre M, Bolton M, Bougeret JL, Bowen TA, Burgess D, Cattell CA, Chandran BDG, Chaston CC, Chen CHK, Choi MK, Connerney JE, Cranmer S, Diaz-Aguado M, Donakowski W, Drake JF, Farrell WM, Fergeau P, Fermin J, Fischer J, Fox N, Glaser D, Goldstein M, Gordon D, Hanson E, Harris SE, Hayes LM, Hinze JJ, Hollweg JV, Horbury TS, Howard RA, Hoxie V, Jannet G, Karlsson M, Kasper JC, Kellogg PJ, Kien M, Klimchuk JA, Krasnoselskikh VV, Krucker S, Lynch JJ, Maksimovic M, Malaspina DM, Marker S, Martin P, Martinez-Oliveros J, McCauley J, McComas DJ, McDonald T, Meyer-Vernet N, Moncuquet M, Monson SJ, Mozer FS, Murphy SD, Odom J, Oliverson R, Olson J, Parker EN, Pankow D, Phan T, Quataert E, Quinn T, Ruplin SW, Salem C, Seitz D, Sheppard DA, Siy A, Stevens K, Summers D, Szabo A, Timofeeva M, Vaivads A, Velli M, Yehle A, Werthimer D, Wygant JR. The FIELDS Instrument Suite for Solar Probe Plus: Measuring the Coronal Plasma and Magnetic Field, Plasma Waves and Turbulence, and Radio Signatures of Solar Transients. Space Sci Rev 2016; 204:49-82. [PMID: 29755144 PMCID: PMC5942226 DOI: 10.1007/s11214-016-0244-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
NASA's Solar Probe Plus (SPP) mission will make the first in situ measurements of the solar corona and the birthplace of the solar wind. The FIELDS instrument suite on SPP will make direct measurements of electric and magnetic fields, the properties of in situ plasma waves, electron density and temperature profiles, and interplanetary radio emissions, amongst other things. Here, we describe the scientific objectives targeted by the SPP/FIELDS instrument, the instrument design itself, and the instrument concept of operations and planned data products.
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Affiliation(s)
- S D Bale
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
- Physics Department, University of California, Berkeley, CA, USA
| | - K Goetz
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
| | - P R Harvey
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - P Turin
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - J W Bonnell
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - T Dudok de Wit
- LPC2E, CNRS, 3A avenue de la Recherche Scientifique, Orléans, France
| | - R E Ergun
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - R J MacDowall
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - M Pulupa
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - M Andre
- Swedish Institute of Space Physics (IRF), Uppsala, Sweden
| | - M Bolton
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | | | - T A Bowen
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
- Physics Department, University of California, Berkeley, CA, USA
| | - D Burgess
- Astronomy Unit, Queen Mary, University of London, London, UK
| | - C A Cattell
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
| | - B D G Chandran
- Department of Physics, University of New Hampshire, Durham, NH, USA
| | - C C Chaston
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - C H K Chen
- Department of Physics, Imperial College, London, UK
| | - M K Choi
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - J E Connerney
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - S Cranmer
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - M Diaz-Aguado
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - W Donakowski
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - J F Drake
- Department of Physics, University of Maryland, College Park, MD, USA
| | - W M Farrell
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - P Fergeau
- LPC2E, CNRS, 3A avenue de la Recherche Scientifique, Orléans, France
| | - J Fermin
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - J Fischer
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - N Fox
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA
| | - D Glaser
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - M Goldstein
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - D Gordon
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - E Hanson
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
- Physics Department, University of California, Berkeley, CA, USA
| | - S E Harris
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - L M Hayes
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - J J Hinze
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
| | - J V Hollweg
- Department of Physics, University of New Hampshire, Durham, NH, USA
| | - T S Horbury
- Department of Physics, Imperial College, London, UK
| | - R A Howard
- Space Science Division, Naval Research Laboratory, Washington, DC, USA
| | - V Hoxie
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - G Jannet
- LPC2E, CNRS, 3A avenue de la Recherche Scientifique, Orléans, France
| | - M Karlsson
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - J C Kasper
- University of Michigan, Ann Arbor, MI, USA
| | - P J Kellogg
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
| | - M Kien
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - J A Klimchuk
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | | | - S Krucker
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - J J Lynch
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
| | | | - D M Malaspina
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - S Marker
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - P Martin
- LPC2E, CNRS, 3A avenue de la Recherche Scientifique, Orléans, France
| | | | - J McCauley
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - D J McComas
- Southwest Research Institute, San Antonio, TX, USA
| | - T McDonald
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | | | - M Moncuquet
- LESIA, Observatoire de Paris, Meudon, France
| | - S J Monson
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
| | - F S Mozer
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - S D Murphy
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - J Odom
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - R Oliverson
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - J Olson
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - E N Parker
- Department of Astronomy and Astrophysics, University of Chicago, Chicago, IL, USA
| | - D Pankow
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - T Phan
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - E Quataert
- Astronomy Department, University of California, Berkeley, CA, USA
| | - T Quinn
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | | | - C Salem
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - D Seitz
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - D A Sheppard
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - A Siy
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - K Stevens
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - D Summers
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - A Szabo
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - M Timofeeva
- LPC2E, CNRS, 3A avenue de la Recherche Scientifique, Orléans, France
| | - A Vaivads
- Swedish Institute of Space Physics (IRF), Uppsala, Sweden
| | - M Velli
- Earth, Planetary, and Space Sciences, UCLA, Los Angelos, CA, USA
| | - A Yehle
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - D Werthimer
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - J R Wygant
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
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Rajagopal S, Kaye C, Lall R, Deakin C, Gates S, Pocock H, Quinn T, Rees N, Smyth M, Perkins G. Characteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest. Resuscitation 2016; 109:110-115. [DOI: 10.1016/j.resuscitation.2016.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/14/2016] [Accepted: 09/14/2016] [Indexed: 01/25/2023]
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Arba F, Quinn T, Hankey GJ, Ali M, Lees KR, Inzitari D. Cerebral small vessel disease, medial temporal lobe atrophy and cognitive status in patients with ischaemic stroke and transient ischaemic attack. Eur J Neurol 2016; 24:276-282. [PMID: 27862654 DOI: 10.1111/ene.13191] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 09/16/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Small vessel disease (SVD) and Alzheimer's disease (AD) are two common causes of cognitive impairment and dementia, traditionally considered as distinct processes. The relationship between radiological features suggestive of AD and SVD was explored, and the association of each of these features with cognitive status at 1 year was investigated in patients with stroke or transient ischaemic attack. METHODS Anonymized data were accessed from the Virtual International Stroke Trials Archive (VISTA). Medial temporal lobe atrophy (MTA; a marker of AD) and markers of SVD were rated using validated ordinal visual scales. Cognitive status was evaluated with the Mini Mental State Examination (MMSE) 1 year after the index stroke. Logistic regression models were used to investigate independent associations between (i) baseline SVD features and MTA and (ii) all baseline neuroimaging features and cognitive status 1 year post-stroke. RESULTS In all, 234 patients were included, mean (±SD) age 65.7 ± 13.1 years, 145 (62%) male. Moderate to severe MTA was present in 104 (44%) patients. SVD features were independently associated with MTA (P < 0.001). After adjusting for age, sex, disability after stroke, hypertension and diabetes mellitus, MTA was the only radiological feature independently associated with cognitive impairment, defined using thresholds of MMSE ≤ 26 (odds ratio 1.94; 95% confidence interval 1.28-2.94) and MMSE ≤ 23 (odds ratio 2.31; 95% confidence interval 1.48-3.62). CONCLUSION In patients with ischaemic cerebrovascular disease, SVD features are associated with MTA, which is a common finding in stroke survivors. SVD and AD type neurodegeneration coexist, but the AD marker MTA, rather than SVD markers, is associated with post-stroke cognitive impairment.
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Affiliation(s)
- F Arba
- NEUROFARBA Department, University of Florence, Florence, Italy.,Institute of Cardiovascular and Medical Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow, UK
| | - T Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - G J Hankey
- School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Institute of Medical Research, QEII Medical Centre, Perth, Australia
| | - M Ali
- Institute of Cardiovascular and Medical Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow, UK
| | - K R Lees
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - D Inzitari
- NEUROFARBA Department, University of Florence, Florence, Italy
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Kim SE, Zhang L, Ma K, Riegman M, Chen F, Ingold I, Conrad M, Turker MZ, Gao M, Jiang X, Monette S, Pauliah M, Gonen M, Zanzonico P, Quinn T, Wiesner U, Bradbury MS, Overholtzer M. Ultrasmall nanoparticles induce ferroptosis in nutrient-deprived cancer cells and suppress tumour growth. Nat Nanotechnol 2016; 11:977-985. [PMID: 27668796 PMCID: PMC5108575 DOI: 10.1038/nnano.2016.164] [Citation(s) in RCA: 392] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 08/05/2016] [Indexed: 04/14/2023]
Abstract
The design of cancer-targeting particles with precisely tuned physicochemical properties may enhance the delivery of therapeutics and access to pharmacological targets. However, a molecular-level understanding of the interactions driving the fate of nanomedicine in biological systems remains elusive. Here, we show that ultrasmall (<10 nm in diameter) poly(ethylene glycol)-coated silica nanoparticles, functionalized with melanoma-targeting peptides, can induce a form of programmed cell death known as ferroptosis in starved cancer cells and cancer-bearing mice. Tumour xenografts in mice intravenously injected with nanoparticles using a high-dose multiple injection scheme exhibit reduced growth or regression, in a manner that is reversed by the pharmacological inhibitor of ferroptosis, liproxstatin-1. These data demonstrate that ferroptosis can be targeted by ultrasmall silica nanoparticles and may have therapeutic potential.
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Affiliation(s)
- Sung Eun Kim
- Cell Biology Program, Sloan Kettering Institute for Cancer Research, New York, New York 10065, USA
- BCMB Allied Program, Weill Cornell Medical College, New York, New York 10065, USA
| | - Li Zhang
- Department of Radiology, Sloan Kettering Institute for Cancer Research, New York, New York 10065, USA
| | - Kai Ma
- Department of Materials Science &Engineering, Cornell University, Ithaca, New York 14853, USA
| | - Michelle Riegman
- Cell Biology Program, Sloan Kettering Institute for Cancer Research, New York, New York 10065, USA
| | - Feng Chen
- Department of Radiology, Sloan Kettering Institute for Cancer Research, New York, New York 10065, USA
| | - Irina Ingold
- Helmholtz Zentrum München, Institute of Developmental Genetics, 85764 Neuherberg, Germany
| | - Marcus Conrad
- Helmholtz Zentrum München, Institute of Developmental Genetics, 85764 Neuherberg, Germany
| | - Melik Ziya Turker
- Department of Materials Science &Engineering, Cornell University, Ithaca, New York 14853, USA
| | - Minghui Gao
- Cell Biology Program, Sloan Kettering Institute for Cancer Research, New York, New York 10065, USA
| | - Xuejun Jiang
- Cell Biology Program, Sloan Kettering Institute for Cancer Research, New York, New York 10065, USA
- BCMB Allied Program, Weill Cornell Medical College, New York, New York 10065, USA
| | - Sebastien Monette
- Tri-Institutional Laboratory of Comparative Pathology, The Rockefeller University, Sloan Kettering Institute for Cancer Research, Weill Cornell Medical College, New York, New York 10065, USA
| | - Mohan Pauliah
- Department of Radiology, Sloan Kettering Institute for Cancer Research, New York, New York 10065, USA
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Sloan Kettering Institute for Cancer Research, New York, New York 10065, USA
| | - Pat Zanzonico
- Department of Medical Physics, Sloan Kettering Institute for Cancer Research, New York, New York 10065, USA
| | - Thomas Quinn
- Department of Biochemistry, University of Missouri, Columbia, Missouri 65211, USA
| | - Ulrich Wiesner
- Department of Materials Science &Engineering, Cornell University, Ithaca, New York 14853, USA
| | - Michelle S Bradbury
- Department of Radiology, Sloan Kettering Institute for Cancer Research, New York, New York 10065, USA
- Molecular Pharmacology Program, Sloan Kettering Institute for Cancer Research, New York, New York 10065, USA
| | - Michael Overholtzer
- Cell Biology Program, Sloan Kettering Institute for Cancer Research, New York, New York 10065, USA
- BCMB Allied Program, Weill Cornell Medical College, New York, New York 10065, USA
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Abstract
Machine learning plays a major role in many scientific investigations. However, non-expert programmers may struggle to implement the elaborate pipelines necessary to build highly accurate and generalizable models. We introduce exprso, a new R package that is an intuitive machine learning suite designed specifically for non-expert programmers. Built initially for the classification of high-dimensional data, exprso uses an object-oriented framework to encapsulate a number of common analytical methods into a series of interchangeable modules. This includes modules for feature selection, classification, high-throughput parameter grid-searching, elaborate cross-validation schemes (e.g., Monte Carlo and nested cross-validation), ensemble classification, and prediction. In addition, exprso also supports multi-class classification (through the 1-vs-all generalization of binary classifiers) and the prediction of continuous outcomes.
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Affiliation(s)
- Thomas Quinn
- Bioinformatics Core Research Facility, Deakin University, Victoria, Australia
| | - Daniel Tylee
- PsychGENe Lab, SUNY Upstate Medical University, Syracuse, USA
| | - Stephen Glatt
- PsychGENe Lab, SUNY Upstate Medical University, Syracuse, USA
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Abstract
Machine learning plays a major role in many scientific investigations. However, non-expert programmers may struggle to implement the elaborate pipelines necessary to build highly accurate and generalizable models. We introduce here a new R package, exprso, as an intuitive machine learning suite designed specifically for non-expert programmers. Built primarily for the classification of high-dimensional data, exprso uses an object-oriented framework to encapsulate a number of common analytical methods into a series of interchangeable modules. This includes modules for feature selection, classification, high-throughput parameter grid-searching, elaborate cross-validation schemes (e.g., Monte Carlo and nested cross-validation), ensemble classification, and prediction. In addition, exprso provides native support for multi-class classification through the 1-vs-all generalization of binary classifiers. In contrast to other machine learning suites, we have prioritized simplicity of use over expansiveness when designing exprso.
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Affiliation(s)
- Thomas Quinn
- Bioinformatics Core Research Facility, Deakin University, Victoria, Australia
| | - Daniel Tylee
- PsychGENe Lab, SUNY Upstate Medical University, Syracuse, USA
| | - Stephen Glatt
- PsychGENe Lab, SUNY Upstate Medical University, Syracuse, USA
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Abbas M, Berka N, Khraiwesh M, Ramadan A, Apprey V, Furbert-Harris P, Quinn T, Brim H, Dunston G. Genetic Polymorphisms of TLR4 and MICA are Associated with Severity of Trachoma Disease in Tanzania. ACTA ACUST UNITED AC 2016; 2. [PMID: 27559544 PMCID: PMC4993598 DOI: 10.16966/2470-1025.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Aim To examine the association of TLR4 Asp299Gly and MICA exon 5 microsatellites polymorphisms with severity of trachoma in a sub-Saharan East Africa population of Tanzanian villagers. Methods The samples were genotyped for MICA exon 5 microsatellites and the TLR4 299 A/G polymorphism by Restriction Fragment Length Polymorphism (RFLP), and GeneScan®, respectively. The association of TLR4 Asp299Gly and MICA exon 5 microsatellites with inflammatory trachoma (TI) and trichiasis (TI) were examined. Results The results showed an association between TLR4 and MICA polymorphisms and trachoma disease severity, as well as with protection. TLR4 an allele was significantly associated with inflammatory trachoma (p=0.0410), while the G allele (p=0.0410) was associated with protection. Conclusion TLR4 and MICA may modulate the risk of severity to trachoma disease by modulating the immune response to Ct. In addition; the increased frequency of MICA-A9 heterozygote in controls may suggest a positive selection of these alleles in adaptation to environments where Ct is endemic.
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Affiliation(s)
- Muneer Abbas
- Department of Microbiology, Howard University, Washington, DC, USA
| | | | - Mozna Khraiwesh
- Division of Experimental Therapeutics, Department of Drug Discovery, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Ali Ramadan
- Department of Pathology, Howard University Hospital, Washington, DC, USA
| | - Victor Apprey
- Department of Microbiology, Howard University, Washington, DC, USA; Department of Community Health and Family Medicine, Howard University, Washington DC, USA
| | | | - Thomas Quinn
- International Health, School of Medicine, Johns Hopkins University, Baltimore Maryland, USA
| | - Hassan Brim
- Department of Pathology, Howard University Hospital, Washington, DC, USA
| | - Georgia Dunston
- Department of Microbiology, Howard University, Washington, DC, USA
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Quinn T, Morell M, Garachtchenko T, Lee L, Fong M, Haugwitz M, Farmer A. 313. Gesicle Mediated Delivery of a Cas9-sgRNA Protein Complex. Mol Ther 2016. [DOI: 10.1016/s1525-0016(16)33122-7] [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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