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Chan J, Dong T, Angelini GD. The performance of large language models in intercollegiate Membership of the Royal College of Surgeons examination. Ann R Coll Surg Engl 2024. [PMID: 38445611 DOI: 10.1308/rcsann.2024.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION Large language models (LLM), such as Chat Generative Pre-trained Transformer (ChatGPT) and Bard utilise deep learning algorithms that have been trained on a massive data set of text and code to generate human-like responses. Several studies have demonstrated satisfactory performance on postgraduate examinations, including the United States Medical Licensing Examination. We aimed to evaluate artificial intelligence performance in Part A of the intercollegiate Membership of the Royal College of Surgeons (MRCS) examination. METHODS The MRCS mock examination from Pastest, a commonly used question bank for examinees, was used to assess the performance of three LLMs: GPT-3.5, GPT 4.0 and Bard. Three hundred mock questions were input into the three LLMs, and the responses provided by the LLMs were recorded and analysed. The pass mark was set at 70%. RESULTS The overall accuracies for GPT-3.5, GPT 4.0 and Bard were 67.33%, 71.67% and 65.67%, respectively (p = 0.27). The performances of GPT-3.5, GPT 4.0 and Bard in Applied Basic Sciences were 68.89%, 72.78% and 63.33% (p = 0.15), respectively. Furthermore, the three LLMs obtained correct answers in 65.00%, 70.00% and 69.17% of the Principles of Surgery in General questions (p = 0.67). There were no differences in performance in the overall and subcategories among the three LLMs. CONCLUSIONS Our findings demonstrated satisfactory performance for all three LLMs in the MRCS Part A examination, with GPT 4.0 the only LLM that achieved the pass mark set.
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Affiliation(s)
- J Chan
- Bristol Heart Institute, University of Bristol, UK
| | - T Dong
- Bristol Heart Institute, University of Bristol, UK
| | - G D Angelini
- Bristol Heart Institute, University of Bristol, UK
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Chan J, Narayan P, Fudulu DP, Dong T, Angelini GD. Trend in mitral valve prostheses of choice and early outcomes in the United Kingdom. Int J Cardiol 2024; 397:131607. [PMID: 38013051 DOI: 10.1016/j.ijcard.2023.131607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Despite the superiority of mitral valve repair, surgical mitral valve replacement (SMVR) remains an important intervention for patients with valve stenosis, infective endocarditis and complex mitral valve degeneration. There has been an increasing popularity in the worldwide use of biological valves due to the avoidance of long-term anti-coagulation and recent advancements in transcatheter techniques. We aim to evaluate the trend, early clinical outcomes and the choice of prostheses use in isolated SMVR over a 23 years period in the United Kingdom. METHODS All patients (n = 13,147) who underwent elective or urgent isolated SMVR from March 1996 to April 2019 were identified from the National Adult Cardiac Surgery Audit database. Trends in clinical outcomes, predicted/observed mortality of patients and the utilization of biological prostheses across 5 different age groups: <50, 50-59, 60-69, 70-79 and ≥80 years old were investigated. Early clinical outcomes associated with the use of mechanical and biological mitral valve prostheses in patients between the age of 60-70 years old were analysed. RESULTS The number of isolated SMVR performed has remained stable with approximately 600 cases annually since 2010. The in-hospital/30-day mortality rate has decreased from 7.41% (1996) to 3.92% (2018), despite the EuroScore II increasing from 1.42% in 1996 to 2.43% in 2018. Biological prostheses usage increased across all age group, and particularly in the 60-69 and 70-79 group, from 17.86% and 53.85% in 1996 to 48.85% and 82.38% in 2018, respectively. The use of mechanical prostheses was reduced in patients between the age of 50-59 from 100% in 1996 to 80.65% in 2018. There were no differences in short term outcomes among patients aged 60-70 years who received either a biological or mechanical prostheses. CONCLUSION There has been a significant reduction in surgical mitral valve replacement early in-hospital mortality, despite an observed increase in the risk profile of patients over 23 years. A shifting trend in valve replacement choices was observed with a rise in the use of biological prostheses, particularly within the 60-69 and 70-79 age group. Early in hospital outcomes for patients aged 60-70 were not determined by the implanted valve type.
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Affiliation(s)
- Jeremy Chan
- Bristol Heart Institute, University of Bristol, Marlborough Street, Bristol BS2 8ED, United Kingdom
| | - Pradeep Narayan
- Bristol Heart Institute, University of Bristol, Marlborough Street, Bristol BS2 8ED, United Kingdom
| | - Daniel P Fudulu
- Bristol Heart Institute, University of Bristol, Marlborough Street, Bristol BS2 8ED, United Kingdom
| | - Tim Dong
- Bristol Heart Institute, University of Bristol, Marlborough Street, Bristol BS2 8ED, United Kingdom
| | - Gianni D Angelini
- Bristol Heart Institute, University of Bristol, Marlborough Street, Bristol BS2 8ED, United Kingdom.
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Niu C, Lv W, Zhu X, Dong Z, Yuan K, Jin Q, Zhang P, Li P, Mao M, Dong T, Chen Z, Luo J, Hou L, Zhang C, Hao K, Chen S, Huang Z. Intestinal Translocation of Live Porphyromonas gingivalis Drives Insulin Resistance. J Dent Res 2024; 103:197-207. [PMID: 38185909 DOI: 10.1177/00220345231214195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Periodontitis has been emphasized as a risk factor of insulin resistance-related systemic diseases. Accumulating evidence has suggested a possible "oral-gut axis" linking oral infection and extraoral diseases, but it remains unclear whether periodontal pathogens can survive the barriers of the digestive tract and how they play their pathogenic roles. The present study established a periodontitis mouse model through oral ligature plus Porphyromonas gingivalis inoculation and demonstrated that periodontitis aggravated diet-induced obesity and insulin resistance, while also causing P. gingivalis enrichment in the intestine. Metabolic labeling strategy validated that P. gingivalis could translocate to the gastrointestinal tract in a viable state. Oral administration of living P. gingivalis elicited insulin resistance, while administration of pasteurized P. gingivalis had no such effect. Combination analysis of metagenome sequencing and nontargeted metabolomics suggested that the tryptophan metabolism pathway, specifically indole and its derivatives, was involved in the pathogenesis of insulin resistance caused by oral administration of living P. gingivalis. Moreover, liquid chromatography-high-resolution mass spectrometry analysis confirmed that the aryl hydrocarbon receptor (AhR) ligands, mainly indole acetic acid, tryptamine, and indole-3-aldehyde, were reduced in diet-induced obese mice with periodontitis, leading to inactivation of AhR signaling. Supplementation with Ficz (6-formylindolo (3,2-b) carbazole), an AhR agonist, alleviated periodontitis-associated insulin resistance, in which the restoration of gut barrier function might play an important role. Collectively, these findings reveal that the oral-gut translocation of viable P. gingivalis works as a fuel linking periodontitis and insulin resistance, in which reduction of AhR ligands and inactivation of AhR signaling are involved. This study provides novel insight into the role of the oral-gut axis in the pathogenesis of periodontitis-associated comorbidities.
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Affiliation(s)
- C Niu
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, P. R. China
- National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai, P. R. China
- Shanghai Key Laboratory of Stomatology, Shanghai, P. R. China
| | - W Lv
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, P. R. China
| | - X Zhu
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, P. R. China
- National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai, P. R. China
- Shanghai Key Laboratory of Stomatology, Shanghai, P. R. China
| | - Z Dong
- Department of Oral Implantology, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, P. R. China
| | - K Yuan
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, P. R. China
- National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai, P. R. China
- Shanghai Key Laboratory of Stomatology, Shanghai, P. R. China
| | - Q Jin
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, P. R. China
- National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai, P. R. China
- Shanghai Key Laboratory of Stomatology, Shanghai, P. R. China
| | - P Zhang
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, P. R. China
- National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai, P. R. China
- Shanghai Key Laboratory of Stomatology, Shanghai, P. R. China
| | - P Li
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, P. R. China
- National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai, P. R. China
- Shanghai Key Laboratory of Stomatology, Shanghai, P. R. China
| | - M Mao
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, P. R. China
- National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai, P. R. China
- Shanghai Key Laboratory of Stomatology, Shanghai, P. R. China
| | - T Dong
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, P. R. China
- National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai, P. R. China
- Shanghai Key Laboratory of Stomatology, Shanghai, P. R. China
| | - Z Chen
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, P. R. China
- National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai, P. R. China
- Shanghai Key Laboratory of Stomatology, Shanghai, P. R. China
| | - J Luo
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, P. R. China
- National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai, P. R. China
- Shanghai Key Laboratory of Stomatology, Shanghai, P. R. China
| | - L Hou
- Department of Nursing, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P. R. China
| | - C Zhang
- Department of Oral Implantology, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, P. R. China
| | - K Hao
- Department of Oral Implantology, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, P. R. China
| | - S Chen
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, P. R. China
- Department of Oral Implantology, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, P. R. China
| | - Z Huang
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, P. R. China
- National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai, P. R. China
- Shanghai Key Laboratory of Stomatology, Shanghai, P. R. China
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Narayan P, Dong T, Dimagli A, Fudulu DP, Chan J, Sinha S, Angelini GD. Impact of explanted valve type on aortic valve reoperations: nationwide UK experience. Eur J Cardiothorac Surg 2024; 65:ezae031. [PMID: 38305431 PMCID: PMC10902681 DOI: 10.1093/ejcts/ezae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES This nationwide retrospective cohort study assessed the impact of the explanted valve type on reoperative outcomes in aortic valve surgery within the UK over a 23-year period. METHODS Data were sourced from the National Institute for Cardiovascular Outcomes Research (NICOR) database. All patients undergoing first-time isolated reoperative aortic valve replacement between 1996 and 2019 in the UK were included. Concomitant procedures, homograft implantation or aortic root enlargement were excluded. Propensity score matching was utilized to compare outcomes and risk factors for in-hospital mortality was evaluated through multivariable logistic regression. Final model selection was conducted using Akaike Information Criterion through bootstrapping. The primary end point was in-hospital mortality, and secondary end points included postoperative morbidities. RESULTS Out of 2371 patients, 24.9% had mechanical and 75% had bioprosthetic valves implanted during the primary procedure. Propensity matched groups of 324 patients each, were compared. In-hospital mortality for mechanical and bioprosthetic valve explants was 7.1% and 5.9%, respectively (P = 0.632). On multivariable logistic regression analysis, valve type was not a risk factor for mortality [odds ratio (OR) 0.62, 95% confidence interval (CI) 0.37-1.05; P = 0.1]. Age (OR 1.03, 95% CI 1.01-1.05; P < 0.05), left ventricular ejection fraction (OR 1.62, 95% CI 1.08-2.42; P < 0.05), creatinine ≥ 200 mg/dl (OR 2.21, 95% CI 1.17-4.04; P < 0.05) and endocarditis (OR 2.66, 95% CI 1.71-4.14; P < 0.05) emerged as risk factors for mortality. CONCLUSIONS The type of valve initially implanted (mechanical or bioprosthetic) did not determine mortality. Instead, age, left ventricular ejection fraction, renal impairment and endocarditis were significant risk factors for in-hospital mortality.
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Affiliation(s)
- Pradeep Narayan
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, India
| | - Tim Dong
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
| | - Arnaldo Dimagli
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
| | - Daniel P Fudulu
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
| | - Jeremy Chan
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
| | - Shubhra Sinha
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
| | - Gianni D Angelini
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
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Kota R, Gemelli M, Dimagli A, Suleiman MS, Moscarelli M, Dong T, Angelini G, Fudulu DP. Corrigendum: Patterns of cytokine release and association with new onset of post-cardiac surgery atrial fibrillation. Front Surg 2024; 11:1320769. [PMID: 38274983 PMCID: PMC10808732 DOI: 10.3389/fsurg.2024.1320769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/03/2024] [Indexed: 01/27/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fsurg.2023.1205396.].
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Affiliation(s)
- Rahul Kota
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Marco Gemelli
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, United Kingdom
| | - Arnaldo Dimagli
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, United Kingdom
| | - M.-Saadeh Suleiman
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, United Kingdom
| | - Marco Moscarelli
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, United Kingdom
| | - Tim Dong
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, United Kingdom
| | - Gianni Angelini
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, United Kingdom
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Fudulu DP, Dong T, Kota R, Sinha S, Chan J, Rajakaruna C, Dimagli A, Angelini GD, Ahmed EM. In-hospital outcomes predictors and trends of redo sternotomy aortic root replacements: insights from a UK registry analysis. Front Cardiovasc Med 2024; 10:1295968. [PMID: 38259318 PMCID: PMC10801157 DOI: 10.3389/fcvm.2023.1295968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Background Redo sternotomy aortic root surgery is technically demanding, and the evidence on outcomes is mostly from retrospective, small sample, single-centre studies. We report the trend, early clinical results and outcome predictors of redo aortic root replacement over 20 years in the United Kingdom. Methods We retrospectively analysed collected data from the UK National Adult Cardiac Surgery Audit (NACSA) on all redo sternotomy aortic root replacements performed between 30th January 1998 and 19th March 2019. We analysed trends in the volume of operations, characteristics of hospital survivors vs. non-survivors, and predictors of in-hospital outcomes. Results During the study period, 1,107 redo sternotomy aortic root replacements were performed (median age 59, 26% of patients were females). Eighty-four per cent of cases (N = 931) underwent a composite root replacement, 11% (N = 119) had homograft root replacement and valve-sparing root replacement was performed in 5.1% (N = 57) of cases. There was a steady increase in the volume of redo sternotomy root replacements beyond 2006, from an annual volume of 22 procedures in 2006 to 106 procedures in 2017. Hospital mortality was 17% (n = 192), postoperative stroke or TIA occurred in 5.2% (n = 58), and postoperative dialysis was required in 11% (n = 109) of patients. Return to the theatre for bleeding/tamponade was required in 9% (n = 102) and median in-hospital stay was 9 days. Age >59 (OR: 2.99, CI: 1.92-4.65, P < 0.001), recent myocardial infarction (OR: 6.42, CI: 2.24-18.41, P = 0.001) were associated with increased in-hospital mortality. Emergency surgery (OR: 3.95, 2.27-6.86, P < 0.001), surgery for endocarditis (OR: 2.05, CI: 1.26-3.33, P = 0.001), salvage coronary artery bypass grafting (OR: 2.20, CI: 1.37-3.54, P < 0.001), arch surgery (OR: 2.47, CI: 1.30-3.61, P = 0.018) and aortic cross-clamp longer than 169 min (OR: 2.17, CI: 1.00-1.01, P = 0.003) were associated with increased risk of mortality. We found no effect of the centre or surgeon volume on mortality (P > 0.05). Conclusions Redo sternotomy aortic root replacement still carries significant morbidity and mortality and is sporadically performed across surgeons and centres in the UK.
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Affiliation(s)
- Daniel P. Fudulu
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Tim Dong
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Rahul Kota
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Shubhra Sinha
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Jeremy Chan
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Cha Rajakaruna
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Arnaldo Dimagli
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Gianni D. Angelini
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Eltayeb Mohamed Ahmed
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
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Dong T, Sunderland N, Nightingale A, Fudulu DP, Chan J, Zhai B, Freitas A, Caputo M, Dimagli A, Mires S, Wyatt M, Benedetto U, Angelini GD. Development and Evaluation of a Natural Language Processing System for Curating a Trans-Thoracic Echocardiogram (TTE) Database. Bioengineering (Basel) 2023; 10:1307. [PMID: 38002431 PMCID: PMC10669818 DOI: 10.3390/bioengineering10111307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Although electronic health records (EHR) provide useful insights into disease patterns and patient treatment optimisation, their reliance on unstructured data presents a difficulty. Echocardiography reports, which provide extensive pathology information for cardiovascular patients, are particularly challenging to extract and analyse, because of their narrative structure. Although natural language processing (NLP) has been utilised successfully in a variety of medical fields, it is not commonly used in echocardiography analysis. OBJECTIVES To develop an NLP-based approach for extracting and categorising data from echocardiography reports by accurately converting continuous (e.g., LVOT VTI, AV VTI and TR Vmax) and discrete (e.g., regurgitation severity) outcomes in a semi-structured narrative format into a structured and categorised format, allowing for future research or clinical use. METHODS 135,062 Trans-Thoracic Echocardiogram (TTE) reports were derived from 146967 baseline echocardiogram reports and split into three cohorts: Training and Validation (n = 1075), Test Dataset (n = 98) and Application Dataset (n = 133,889). The NLP system was developed and was iteratively refined using medical expert knowledge. The system was used to curate a moderate-fidelity database from extractions of 133,889 reports. A hold-out validation set of 98 reports was blindly annotated and extracted by two clinicians for comparison with the NLP extraction. Agreement, discrimination, accuracy and calibration of outcome measure extractions were evaluated. RESULTS Continuous outcomes including LVOT VTI, AV VTI and TR Vmax exhibited perfect inter-rater reliability using intra-class correlation scores (ICC = 1.00, p < 0.05) alongside high R2 values, demonstrating an ideal alignment between the NLP system and clinicians. A good level (ICC = 0.75-0.9, p < 0.05) of inter-rater reliability was observed for outcomes such as LVOT Diam, Lateral MAPSE, Peak E Velocity, Lateral E' Velocity, PV Vmax, Sinuses of Valsalva and Ascending Aorta diameters. Furthermore, the accuracy rate for discrete outcome measures was 91.38% in the confusion matrix analysis, indicating effective performance. CONCLUSIONS The NLP-based technique yielded good results when it came to extracting and categorising data from echocardiography reports. The system demonstrated a high degree of agreement and concordance with clinician extractions. This study contributes to the effective use of semi-structured data by providing a useful tool for converting semi-structured text to a structured echo report that can be used for data management. Additional validation and implementation in healthcare settings can improve data availability and support research and clinical decision-making.
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Affiliation(s)
- Tim Dong
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol BS2 8HW, UK (A.N.); (J.C.); (M.C.); (A.D.); (U.B.); (G.D.A.)
| | - Nicholas Sunderland
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol BS2 8HW, UK (A.N.); (J.C.); (M.C.); (A.D.); (U.B.); (G.D.A.)
| | - Angus Nightingale
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol BS2 8HW, UK (A.N.); (J.C.); (M.C.); (A.D.); (U.B.); (G.D.A.)
| | - Daniel P. Fudulu
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol BS2 8HW, UK (A.N.); (J.C.); (M.C.); (A.D.); (U.B.); (G.D.A.)
| | - Jeremy Chan
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol BS2 8HW, UK (A.N.); (J.C.); (M.C.); (A.D.); (U.B.); (G.D.A.)
| | - Ben Zhai
- School of Computing Science, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Alberto Freitas
- Faculty of Medicine, University of Porto, 4100 Porto, Portugal;
| | - Massimo Caputo
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol BS2 8HW, UK (A.N.); (J.C.); (M.C.); (A.D.); (U.B.); (G.D.A.)
| | - Arnaldo Dimagli
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol BS2 8HW, UK (A.N.); (J.C.); (M.C.); (A.D.); (U.B.); (G.D.A.)
| | - Stuart Mires
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol BS2 8HW, UK (A.N.); (J.C.); (M.C.); (A.D.); (U.B.); (G.D.A.)
| | - Mike Wyatt
- University Hospitals Bristol and Weston, Marlborough St, Bristol BS1 3NU, UK;
| | - Umberto Benedetto
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol BS2 8HW, UK (A.N.); (J.C.); (M.C.); (A.D.); (U.B.); (G.D.A.)
| | - Gianni D. Angelini
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol BS2 8HW, UK (A.N.); (J.C.); (M.C.); (A.D.); (U.B.); (G.D.A.)
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Raman B, McCracken C, Cassar MP, Moss AJ, Finnigan L, Samat AHA, Ogbole G, Tunnicliffe EM, Alfaro-Almagro F, Menke R, Xie C, Gleeson F, Lukaschuk E, Lamlum H, McGlynn K, Popescu IA, Sanders ZB, Saunders LC, Piechnik SK, Ferreira VM, Nikolaidou C, Rahman NM, Ho LP, Harris VC, Shikotra A, Singapuri A, Pfeffer P, Manisty C, Kon OM, Beggs M, O'Regan DP, Fuld J, Weir-McCall JR, Parekh D, Steeds R, Poinasamy K, Cuthbertson DJ, Kemp GJ, Semple MG, Horsley A, Miller CA, O'Brien C, Shah AM, Chiribiri A, Leavy OC, Richardson M, Elneima O, McAuley HJC, Sereno M, Saunders RM, Houchen-Wolloff L, Greening NJ, Bolton CE, Brown JS, Choudhury G, Diar Bakerly N, Easom N, Echevarria C, Marks M, Hurst JR, Jones MG, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Howard LS, Jacob J, Man WDC, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Singh SJ, Thomas DC, Toshner M, Lewis KE, Heaney LG, Harrison EM, Kerr S, Docherty AB, Lone NI, Quint J, Sheikh A, Zheng B, Jenkins RG, Cox E, Francis S, Halling-Brown M, Chalmers JD, Greenwood JP, Plein S, Hughes PJC, Thompson AAR, Rowland-Jones SL, Wild JM, Kelly M, Treibel TA, Bandula S, Aul R, Miller K, Jezzard P, Smith S, Nichols TE, McCann GP, Evans RA, Wain LV, Brightling CE, Neubauer S, Baillie JK, Shaw A, Hairsine B, Kurasz C, Henson H, Armstrong L, Shenton L, Dobson H, Dell A, Lucey A, Price A, Storrie A, Pennington C, Price C, Mallison G, Willis G, Nassa H, Haworth J, Hoare M, Hawkings N, Fairbairn S, Young S, Walker S, Jarrold I, Sanderson A, David C, Chong-James K, Zongo O, James WY, Martineau A, King B, Armour C, McAulay D, Major E, McGinness J, McGarvey L, Magee N, Stone R, Drain S, Craig T, Bolger A, Haggar A, Lloyd A, Subbe C, Menzies D, Southern D, McIvor E, Roberts K, Manley R, Whitehead V, Saxon W, Bularga A, Mills NL, El-Taweel H, Dawson J, Robinson L, Saralaya D, Regan K, Storton K, Brear L, Amoils S, Bermperi A, Elmer A, Ribeiro C, Cruz I, Taylor J, Worsley J, Dempsey K, Watson L, Jose S, Marciniak S, Parkes M, McQueen A, Oliver C, Williams J, Paradowski K, Broad L, Knibbs L, Haynes M, Sabit R, Milligan L, Sampson C, Hancock A, Evenden C, Lynch C, Hancock K, Roche L, Rees M, Stroud N, Thomas-Woods T, Heller S, Robertson E, Young B, Wassall H, Babores M, Holland M, Keenan N, Shashaa S, Price C, Beranova E, Ramos H, Weston H, Deery J, Austin L, Solly R, Turney S, Cosier T, Hazelton T, Ralser M, Wilson A, Pearce L, Pugmire S, Stoker W, McCormick W, Dewar A, Arbane G, Kaltsakas G, Kerslake H, Rossdale J, Bisnauthsing K, Aguilar Jimenez LA, Martinez LM, Ostermann M, Magtoto MM, Hart N, Marino P, Betts S, Solano TS, Arias AM, Prabhu A, Reed A, Wrey Brown C, Griffin D, Bevan E, Martin J, Owen J, Alvarez Corral M, Williams N, Payne S, Storrar W, Layton A, Lawson C, Mills C, Featherstone J, Stephenson L, Burdett T, Ellis Y, Richards A, Wright C, Sykes DL, Brindle K, Drury K, Holdsworth L, Crooks MG, Atkin P, Flockton R, Thackray-Nocera S, Mohamed A, Taylor A, Perkins E, Ross G, McGuinness H, Tench H, Phipps J, Loosley R, Wolf-Roberts R, Coetzee S, Omar Z, Ross A, Card B, Carr C, King C, Wood C, Copeland D, Calvelo E, Chilvers ER, Russell E, Gordon H, Nunag JL, Schronce J, March K, Samuel K, Burden L, Evison L, McLeavey L, Orriss-Dib L, Tarusan L, Mariveles M, Roy M, Mohamed N, Simpson N, Yasmin N, Cullinan P, Daly P, Haq S, Moriera S, Fayzan T, Munawar U, Nwanguma U, Lingford-Hughes A, Altmann D, Johnston D, Mitchell J, Valabhji J, Price L, Molyneaux PL, Thwaites RS, Walsh S, Frankel A, Lightstone L, Wilkins M, Willicombe M, McAdoo S, Touyz R, Guerdette AM, Warwick K, Hewitt M, Reddy R, White S, McMahon A, Hoare A, Knighton A, Ramos A, Te A, Jolley CJ, Speranza F, Assefa-Kebede H, Peralta I, Breeze J, Shevket K, Powell N, Adeyemi O, Dulawan P, Adrego R, Byrne S, Patale S, Hayday A, Malim M, Pariante C, Sharpe C, Whitney J, Bramham K, Ismail K, Wessely S, Nicholson T, Ashworth A, Humphries A, Tan AL, Whittam B, Coupland C, Favager C, Peckham D, Wade E, Saalmink G, Clarke J, Glossop J, Murira J, Rangeley J, Woods J, Hall L, Dalton M, Window N, Beirne P, Hardy T, Coakley G, Turtle L, Berridge A, Cross A, Key AL, Rowe A, Allt AM, Mears C, Malein F, Madzamba G, Hardwick HE, Earley J, Hawkes J, Pratt J, Wyles J, Tripp KA, Hainey K, Allerton L, Lavelle-Langham L, Melling L, Wajero LO, Poll L, Noonan MJ, French N, Lewis-Burke N, Williams-Howard SA, Cooper S, Kaprowska S, Dobson SL, Marsh S, Highett V, Shaw V, Beadsworth M, Defres S, Watson E, Tiongson GF, Papineni P, Gurram S, Diwanji SN, Quaid S, Briggs A, Hastie C, Rogers N, Stensel D, Bishop L, McIvor K, Rivera-Ortega P, Al-Sheklly B, Avram C, Faluyi D, Blaikely J, Piper Hanley K, Radhakrishnan K, Buch M, Hanley NA, Odell N, Osbourne R, Stockdale S, Felton T, Gorsuch T, Hussell T, Kausar Z, Kabir T, McAllister-Williams H, Paddick S, Burn D, Ayoub A, Greenhalgh A, Sayer A, Young A, Price D, Burns G, MacGowan G, Fisher H, Tedd H, Simpson J, Jiwa K, Witham M, Hogarth P, West S, Wright S, McMahon MJ, Neill P, Dougherty A, Morrow A, Anderson D, Grieve D, Bayes H, Fallon K, Mangion K, Gilmour L, Basu N, Sykes R, Berry C, McInnes IB, Donaldson A, Sage EK, Barrett F, Welsh B, Bell M, Quigley J, Leitch K, Macliver L, Patel M, Hamil R, Deans A, Furniss J, Clohisey S, Elliott A, Solstice AR, Deas C, Tee C, Connell D, Sutherland D, George J, Mohammed S, Bunker J, Holmes K, Dipper A, Morley A, Arnold D, Adamali H, Welch H, Morrison L, Stadon L, Maskell N, Barratt S, Dunn S, Waterson S, Jayaraman B, Light T, Selby N, Hosseini A, Shaw K, Almeida P, Needham R, Thomas AK, Matthews L, Gupta A, Nikolaidis A, Dupont C, Bonnington J, Chrystal M, Greenhaff PL, Linford S, Prosper S, Jang W, Alamoudi A, Bloss A, Megson C, Nicoll D, Fraser E, Pacpaco E, Conneh F, Ogg G, McShane H, Koychev I, Chen J, Pimm J, Ainsworth M, Pavlides M, Sharpe M, Havinden-Williams M, Petousi N, Talbot N, Carter P, Kurupati P, Dong T, Peng Y, Burns A, Kanellakis N, Korszun A, Connolly B, Busby J, Peto T, Patel B, Nolan CM, Cristiano D, Walsh JA, Liyanage K, Gummadi M, Dormand N, Polgar O, George P, Barker RE, Patel S, Price L, Gibbons M, Matila D, Jarvis H, Lim L, Olaosebikan O, Ahmad S, Brill S, Mandal S, Laing C, Michael A, Reddy A, Johnson C, Baxendale H, Parfrey H, Mackie J, Newman J, Pack J, Parmar J, Paques K, Garner L, Harvey A, Summersgill C, Holgate D, Hardy E, Oxton J, Pendlebury J, McMorrow L, Mairs N, Majeed N, Dark P, Ugwuoke R, Knight S, Whittaker S, Strong-Sheldrake S, Matimba-Mupaya W, Chowienczyk P, Pattenadk D, Hurditch E, Chan F, Carborn H, Foot H, Bagshaw J, Hockridge J, Sidebottom J, Lee JH, Birchall K, Turner K, Haslam L, Holt L, Milner L, Begum M, Marshall M, Steele N, Tinker N, Ravencroft P, Butcher R, Misra S, Walker S, Coburn Z, Fairman A, Ford A, Holbourn A, Howell A, Lawrie A, Lye A, Mbuyisa A, Zawia A, Holroyd-Hind B, Thamu B, Clark C, Jarman C, Norman C, Roddis C, Foote D, Lee E, Ilyas F, Stephens G, Newell H, Turton H, Macharia I, Wilson I, Cole J, McNeill J, Meiring J, Rodger J, Watson J, Chapman K, Harrington K, Chetham L, Hesselden L, Nwafor L, Dixon M, Plowright M, Wade P, Gregory R, Lenagh R, Stimpson R, Megson S, Newman T, Cheng Y, Goodwin C, Heeley C, Sissons D, Sowter D, Gregory H, Wynter I, Hutchinson J, Kirk J, Bennett K, Slack K, Allsop L, Holloway L, Flynn M, Gill M, Greatorex M, Holmes M, Buckley P, Shelton S, Turner S, Sewell TA, Whitworth V, Lovegrove W, Tomlinson J, Warburton L, Painter S, Vickers C, Redwood D, Tilley J, Palmer S, Wainwright T, Breen G, Hotopf M, Dunleavy A, Teixeira J, Ali M, Mencias M, Msimanga N, Siddique S, Samakomva T, Tavoukjian V, Forton D, Ahmed R, Cook A, Thaivalappil F, Connor L, Rees T, McNarry M, Williams N, McCormick J, McIntosh J, Vere J, Coulding M, Kilroy S, Turner V, Butt AT, Savill H, Fraile E, Ugoji J, Landers G, Lota H, Portukhay S, Nasseri M, Daniels A, Hormis A, Ingham J, Zeidan L, Osborne L, Chablani M, Banerjee A, David A, Pakzad A, Rangelov B, Williams B, Denneny E, Willoughby J, Xu M, Mehta P, Batterham R, Bell R, Aslani S, Lilaonitkul W, Checkley A, Bang D, Basire D, Lomas D, Wall E, Plant H, Roy K, Heightman M, Lipman M, Merida Morillas M, Ahwireng N, Chambers RC, Jastrub R, Logan S, Hillman T, Botkai A, Casey A, Neal A, Newton-Cox A, Cooper B, Atkin C, McGee C, Welch C, Wilson D, Sapey E, Qureshi H, Hazeldine J, Lord JM, Nyaboko J, Short J, Stockley J, Dasgin J, Draxlbauer K, Isaacs K, Mcgee K, Yip KP, Ratcliffe L, Bates M, Ventura M, Ahmad Haider N, Gautam N, Baggott R, Holden S, Madathil S, Walder S, Yasmin S, Hiwot T, Jackson T, Soulsby T, Kamwa V, Peterkin Z, Suleiman Z, Chaudhuri N, Wheeler H, Djukanovic R, Samuel R, Sass T, Wallis T, Marshall B, Childs C, Marouzet E, Harvey M, Fletcher S, Dickens C, Beckett P, Nanda U, Daynes E, Charalambou A, Yousuf AJ, Lea A, Prickett A, Gooptu B, Hargadon B, Bourne C, Christie C, Edwardson C, Lee D, Baldry E, Stringer E, Woodhead F, Mills G, Arnold H, Aung H, Qureshi IN, Finch J, Skeemer J, Hadley K, Khunti K, Carr L, Ingram L, Aljaroof M, Bakali M, Bakau M, Baldwin M, Bourne M, Pareek M, Soares M, Tobin M, Armstrong N, Brunskill N, Goodman N, Cairns P, Haldar P, McCourt P, Dowling R, Russell R, Diver S, Edwards S, Glover S, Parker S, Siddiqui S, Ward TJC, Mcnally T, Thornton T, Yates T, Ibrahim W, Monteiro W, Thickett D, Wilkinson D, Broome M, McArdle P, Upthegrove R, Wraith D, Langenberg C, Summers C, Bullmore E, Heeney JL, Schwaeble W, Sudlow CL, Adeloye D, Newby DE, Rudan I, Shankar-Hari M, Thorpe M, Pius R, Walmsley S, McGovern A, Ballard C, Allan L, Dennis J, Cavanagh J, Petrie J, O'Donnell K, Spears M, Sattar N, MacDonald S, Guthrie E, Henderson M, Guillen Guio B, Zhao B, Lawson C, Overton C, Taylor C, Tong C, Mukaetova-Ladinska E, Turner E, Pearl JE, Sargant J, Wormleighton J, Bingham M, Sharma M, Steiner M, Samani N, Novotny P, Free R, Allen RJ, Finney S, Terry S, Brugha T, Plekhanova T, McArdle A, Vinson B, Spencer LG, Reynolds W, Ashworth M, Deakin B, Chinoy H, Abel K, Harvie M, Stanel S, Rostron A, Coleman C, Baguley D, Hufton E, Khan F, Hall I, Stewart I, Fabbri L, Wright L, Kitterick P, Morriss R, Johnson S, Bates A, Antoniades C, Clark D, Bhui K, Channon KM, Motohashi K, Sigfrid L, Husain M, Webster M, Fu X, Li X, Kingham L, Klenerman P, Miiler K, Carson G, Simons G, Huneke N, Calder PC, Baldwin D, Bain S, Lasserson D, Daines L, Bright E, Stern M, Crisp P, Dharmagunawardena R, Reddington A, Wight A, Bailey L, Ashish A, Robinson E, Cooper J, Broadley A, Turnbull A, Brookes C, Sarginson C, Ionita D, Redfearn H, Elliott K, Barman L, Griffiths L, Guy Z, Gill R, Nathu R, Harris E, Moss P, Finnigan J, Saunders K, Saunders P, Kon S, Kon SS, O'Brien L, Shah K, Shah P, Richardson E, Brown V, Brown M, Brown J, Brown J, Brown A, Brown A, Brown M, Choudhury N, Jones S, Jones H, Jones L, Jones I, Jones G, Jones H, Jones D, Davies F, Davies E, Davies K, Davies G, Davies GA, Howard K, Porter J, Rowland J, Rowland A, Scott K, Singh S, Singh C, Thomas S, Thomas C, Lewis V, Lewis J, Lewis D, Harrison P, Francis C, Francis R, Hughes RA, Hughes J, Hughes AD, Thompson T, Kelly S, Smith D, Smith N, Smith A, Smith J, Smith L, Smith S, Evans T, Evans RI, Evans D, Evans R, Evans H, Evans J. Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study. Lancet Respir Med 2023; 11:1003-1019. [PMID: 37748493 PMCID: PMC7615263 DOI: 10.1016/s2213-2600(23)00262-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. METHODS In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. FINDINGS Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. INTERPRETATION After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification. FUNDING UK Research and Innovation and National Institute for Health Research.
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Li B, Yang L, Jiang C, Li H, Qin W, Dong T, Wang L. Outcome Supervised Deep Learning Model on Pathological Whole Slide Images for Survival Prediction of Immunotherapy in Non-Small Cell Lung Cancer Patients: A Multicenter Study. Int J Radiat Oncol Biol Phys 2023; 117:e35. [PMID: 37785211 DOI: 10.1016/j.ijrobp.2023.06.724] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Although PD-(L)1 inhibitors were marked by durable efficacy in non-small cell lung cancer patients (NSCLC), about 60% of patients still suffer from recurrence and metastasis after PD-(L)1 inhibitors treatment. And there were no robust biomarkers of the response of PD-(L)1 inhibitors. Whole slide images (WSIs) of H&E-stained specimens have been found to characterize the tumor microenvironment, and might be the potential prognostic predictors of NSCLC patients. To accurately predict the response to PD-(L)1 inhibitors, we presented the deep learning model based on WSI of H&E-stained specimens of NSCLC patients. MATERIALS/METHODS Two independent cohorts of NSCLC patients receiving PD-(L)1 inhibitors from two hospitals were enrolled for model training and testing respectively. The WSI images of H&E-stained histological specimens were obtained from these patients, and patched into 1024×1024 pixels. The labels of patched images were determined due to their progression free survival (PFS) with the interval of 4 months. The patch-level model was firstly trained based on Vit to identify the predictive patches in training cohort, and patch-level probability distribution was performed. Then we trained patient-level survival model-based Vit-RNN framework, and tested it in external validation cohort. RESULTS A total of 291 WSI images of H&E-stained histological specimens from 198 NSCLC patients in primary cohort and 62 WSI images from 30 NSCLC patients in testing cohort were included for model training and external validation. All patients were divided into 4 groups due to their PFS after PD-(L)1 inhibitors. There were 246,318 patches from 291 images in primary cohort after image pre-processing, and all images were randomly divided into train cohort and validation cohort with the proportion of 7:3. The patch-level Vit model with the highest accuracy was saved and the predictive patches were selected after 50 epochs training. All patches were ranked by the probability of correct prediction, and the first 50 top-ranked patches from each WSI image are sequentially passed to the patient-level Vit-RNN model. The Vit-RNN survival achieved an accuracy of 88.6% in the validation cohort, and an accuracy of 81% in the testing cohort. The multivariate cox analysis also indicated the Vit-RNN survival model remained a statistically independent predictor of survival from PD-(L)1 inhibitors (P = 0.0085). CONCLUSION The outcome supervised Vit-RNN survival model based on pathological WSIs could be used to predict the efficacy the PD-(L)1 inhibitors in NSCLC patients, laying the foundation for the deployment of computational pathomics in clinical practice of immunotherapy.
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Affiliation(s)
- B Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - L Yang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - C Jiang
- Department of Otorhinolaryngology & Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - H Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - W Qin
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - T Dong
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - L Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Narayan P, Dimagli A, Fudulu DP, Sinha S, Dong T, Chan J, Angelini GD. Risk Factors and Outcomes of Reoperative Surgical Aortic Valve Replacement in the United Kingdom. Ann Thorac Surg 2023; 116:759-766. [PMID: 36716908 DOI: 10.1016/j.athoracsur.2022.12.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 12/07/2022] [Accepted: 12/29/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Mortality after reoperative aortic valve surgery continues to decline but remains high compared with primary isolated replacement. We sought to examine temporal trends, morbidity, and mortality among patients undergoing isolated first-time reoperative aortic valve surgery. METHODS The study included all patients undergoing reoperative aortic valve surgery in the United Kingdom between January 2007 and March 2019. Patients undergoing isolated reoperative aortic valve replacement (AVR) were compared with a propensity matched cohort of patients undergoing isolated primary AVR. Outcomes measured included inhospital mortality, neurologic dysfunction, postoperative dialysis, deep sternal wound infections, and hospital length of stay. RESULTS During the study period, 40,858 primary isolated AVRs and 3015 first-time isolated reoperative AVRs were carried out in the United Kingdom. In the propensity matched reoperative group, median age of participants was 69.8 years (60.8-76.2) with median duration between the initial surgery and the reoperation being 7.69 years. Overall mortality was 3.1% (94) for reoperative AVR compared with 1.9% (56) for primary AVR. Mortality of both primary and reoperative AVR declined during the study period. Reoperation, age, New York Heart Association class, and chronic kidney disease were independently associated with early mortality. CONCLUSIONS Reoperative isolated AVR can be performed with acceptable inhospital mortality and provides a benchmark against which alternative strategies should be compared.
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Affiliation(s)
- Pradeep Narayan
- Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Mukundapur, Kolkata, West Bengal, India
| | - Arnaldo Dimagli
- Bristol Heart Institute, Bristol University, Bristol, United Kingdom
| | - Daniel P Fudulu
- Bristol Heart Institute, Bristol University, Bristol, United Kingdom
| | - Shubhra Sinha
- Bristol Heart Institute, Bristol University, Bristol, United Kingdom
| | - Tim Dong
- Bristol Heart Institute, Bristol University, Bristol, United Kingdom
| | - Jeremy Chan
- Bristol Heart Institute, Bristol University, Bristol, United Kingdom
| | - Gianni D Angelini
- Bristol Heart Institute, Bristol University, Bristol, United Kingdom.
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Chan J, Dimagli A, Dong T, Fudulu DP, Sinha S, Angelini GD. Trend and early clinical outcomes of off-pump coronary artery bypass grafting in the UK. Eur J Cardiothorac Surg 2023; 64:ezad272. [PMID: 37522886 PMCID: PMC10876163 DOI: 10.1093/ejcts/ezad272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/21/2023] [Accepted: 07/29/2023] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVES The popularity of off-pump coronary artery bypass grafting (CABG) varies across the world, ranging from 20% in Europe and the USA to 56% in Asia. We present the trend and early clinical outcomes in off pump in the UK. METHODS All patients who underwent elective or urgent isolated CABG from 1996 to 2019 were extracted from the National Adult Cardiac Surgery Audit database. The trend in operating surgeons and units volume and training in off pump were analysed. Early clinical outcomes between off- and on-pump CABG were compared using propensity score matching. RESULTS A total of 351 422 patients were included. The overall off-pump rate during the study period was 15.17%, it peaked in 2008 (19.8%), followed by a steady decreased to 2018 (7.63%). Its adoption varied across centres and surgeons, ranging from <1% to 48.36% and <1% to 85.5%, respectively, of total cases performed. After propensity score matching for the period 1996-2019, off pump, when compared to on pump, was associated with a lower in-hospital/30-day mortality (1.2% vs 1.5%, P < 0.001), return to theatre (3.7% vs 4.5%, P < 0.001), cerebrovascular accident (transient ischaemic attack: 0.3% vs 0.6%, stroke: 0.3% vs 0.6%, P < 0.001) and deep sternal wound infection (0.8% vs 1.2%, P ≤ 0.001). In a sub-analysis from the introduction of EuroScore II (2012-2019), there were no differences in-hospital/30-day mortality (1.0% vs 1.0%, P = 0.71). However, on pump, had a higher return to theatre (4.2% vs 2.7%, P < 0.001), cerebrovascular accident (transient ischaemic attack: 0.4% vs 0.2%, stroke: 0.5% vs 0.3%, P = 0.003) and deep sternal wound infection (1.0% vs 0.6%, P = 0.004). CONCLUSIONS Our data show a decreasing trend in the use of off pump in the UK since 2008. This is likely to be multifactorial and raises the question of whether it should be a specialized revascularization technique.
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Affiliation(s)
- Jeremy Chan
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | | | - Tim Dong
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | | | - Shubhra Sinha
- Bristol Heart Institute, University of Bristol, Bristol, UK
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Sinha S, Dong T, Dimagli A, Vohra HA, Holmes C, Benedetto U, Angelini GD. Comparison of machine learning techniques in prediction of mortality following cardiac surgery: analysis of over 220 000 patients from a large national database. Eur J Cardiothorac Surg 2023; 63:ezad183. [PMID: 37154705 PMCID: PMC10275911 DOI: 10.1093/ejcts/ezad183] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/19/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES To perform a systematic comparison of in-hospital mortality risk prediction post-cardiac surgery, between the predominant scoring system-European System for Cardiac Operative Risk Evaluation (EuroSCORE) II, logistic regression (LR) retrained on the same variables and alternative machine learning techniques (ML)-random forest (RF), neural networks (NN), XGBoost and weighted support vector machine. METHODS Retrospective analyses of prospectively routinely collected data on adult patients undergoing cardiac surgery in the UK from January 2012 to March 2019. Data were temporally split 70:30 into training and validation subsets. Mortality prediction models were created using the 18 variables of EuroSCORE II. Comparisons of discrimination, calibration and clinical utility were then conducted. Changes in model performance, variable-importance over time and hospital/operation-based model performance were also reviewed. RESULTS Of the 227 087 adults who underwent cardiac surgery during the study period, there were 6258 deaths (2.76%). In the testing cohort, there was an improvement in discrimination [XGBoost (95% confidence interval (CI) area under the receiver operator curve (AUC), 0.834-0.834, F1 score, 0.276-0.280) and RF (95% CI AUC, 0.833-0.834, F1, 0.277-0.281)] compared with EuroSCORE II (95% CI AUC, 0.817-0.818, F1, 0.243-0.245). There was no significant improvement in calibration with ML and retrained-LR compared to EuroSCORE II. However, EuroSCORE II overestimated risk across all deciles of risk and over time. The calibration drift was lowest in NN, XGBoost and RF compared with EuroSCORE II. Decision curve analysis showed XGBoost and RF to have greater net benefit than EuroSCORE II. CONCLUSIONS ML techniques showed some statistical improvements over retrained-LR and EuroSCORE II. The clinical impact of this improvement is modest at present. However the incorporation of additional risk factors in future studies may improve upon these findings and warrants further study.
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Affiliation(s)
- Shubhra Sinha
- Division of Cardiac Surgery, Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Tim Dong
- Division of Cardiac Surgery, Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Arnaldo Dimagli
- Division of Cardiac Surgery, Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Hunaid A Vohra
- Division of Cardiac Surgery, Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Chris Holmes
- Alan Turing Institute, London, UK
- Department of Statistics, University of Oxford, Oxford, UK
| | - Umberto Benedetto
- Division of Cardiac Surgery, Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Gianni D Angelini
- Division of Cardiac Surgery, Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol, UK
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Kota R, Gemelli M, Dimagli A, Suleiman S, Moscarelli M, Dong T, Angelini GD, Fudulu DP. Patterns of cytokine release and association with new onset of post-cardiac surgery atrial fibrillation. Front Surg 2023; 10:1205396. [PMID: 37325422 PMCID: PMC10266410 DOI: 10.3389/fsurg.2023.1205396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/17/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Postoperative Atrial Fibrillation (POAF) is a common complication of cardiac surgery, associated with increased mortality, stroke risk, cardiac failure and prolonged hospital stay. Our study aimed to assess the patterns of release of systemic cytokines in patients with and without POAF. Methods A post-hoc analysis of the Remote Ischemic Preconditioning (RIPC) trial, including 121 patients (93 males and 28 females, mean age of 68 years old) who underwent isolated coronary artery bypass grafting (CABG) and aortic valve replacement (AVR). Mixed-effect models were used to analyze patterns of release of cytokines in POAF and non-AF patients. A logistic regression model was used to assess the effect of peak cytokine concentration (6 h after the aortic cross-clamp release) alongside other clinical predictors on the development of POAF. Results We found no significant difference in the patterns of release of IL-6 (p = 0.52), IL-10 (p = 0.39), IL-8 (p = 0.20) and TNF-α (p = 0.55) between POAF and non-AF patients. Also, we found no significant predictive value in peak concentrations of IL-6 (p = 0.2), IL-8 (p = >0.9), IL-10 (p = >0.9) and Tumour Necrosis Factor Alpha (TNF-α)(p = 0.6), however age and aortic cross-clamp time were significant predictors of POAF development across all models. Conclusions Our study suggests no significant association exists between cytokine release patterns and the development of POAF. Age and Aortic Cross-clamp time were found to be significant predictors of POAF.
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Affiliation(s)
- Rahul Kota
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Marco Gemelli
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, United Kingdom
| | - Arnaldo Dimagli
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, United Kingdom
| | - Saadeh Suleiman
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, United Kingdom
| | - Marco Moscarelli
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, United Kingdom
| | - Tim Dong
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, United Kingdom
| | - Gianni D. Angelini
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, United Kingdom
| | - Daniel P. Fudulu
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, United Kingdom
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Dong T, Xu S, Chen ZY, Liang YJ, Meng XQ, Niu CG, Yuan KY, Li PL, Duan SZ, Huang ZW. Prevotella intermedia Aggravates Subclinical Hypothyroidism. J Dent Res 2023:220345231168052. [PMID: 37204148 DOI: 10.1177/00220345231168052] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Subclinical hypothyroidism (SCH) has been shown to be associated with microbiota. However, the association between SCH and oral microbiota has not yet been elucidated. The results of our previous clinical studies showed that Prevotella intermedia was abundant in the oral microbiota of SCH patients. This study aimed to investigate the relationship between SCH and oral microbiota, verify the pathogenicity of P. intermedia in SCH, and preliminarily explore the possible mechanism. The SCH mouse model with oral application of P. intermedia was established, and the variance in the mouse oral microbiota and changes in thyroid function and metabolism were detected in mice. Student's t test and analysis of variance were used for statistical analysis. Oral application of P. intermedia changed the composition of the oral microbiota of SCH mice, which enhanced the damage to the thyroid and decreased the expression of functional genes of the thyroid. Moreover, P. intermedia decreased oxygen consumption and aggravated glucose and lipid metabolism disorders in SCH mice. Glucose tolerance and insulin tolerance decreased, and the triglyceride content of the liver and inflammatory infiltration in adipose tissue increased in SCH mice after P. intermedia stimulation. Mechanistically, P. intermedia increased the proportion of CD4+ T cells in cervical lymph nodes and thyroids in SCH mice. Th1 cells were suggested to play an important role in the pathogenesis of SCH involving P. intermedia. In conclusion, P. intermedia aggravated SCH manifestations, including thyroid dysfunction and glucose and lipid metabolism disorders, by causing immune imbalance in mice. This study sheds new light on the pathogenesis of SCH from the perspective of oral microbiota.
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Affiliation(s)
- T Dong
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
- Laboratory of Oral Microbiota and Systemic Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
| | - S Xu
- Laboratory of Oral Microbiota and Systemic Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
| | - Z-Y Chen
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
- Laboratory of Oral Microbiota and Systemic Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
| | - Y-J Liang
- Laboratory of Oral Microbiota and Systemic Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
- Department of Nursing, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - X-Q Meng
- Laboratory of Oral Microbiota and Systemic Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
| | - C-G Niu
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
- Laboratory of Oral Microbiota and Systemic Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
| | - K-Y Yuan
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
- Laboratory of Oral Microbiota and Systemic Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
| | - P-L Li
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
| | - S-Z Duan
- Laboratory of Oral Microbiota and Systemic Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
| | - Z-W Huang
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
- Laboratory of Oral Microbiota and Systemic Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, China
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15
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Dong T, Sinha S, Zhai B, Fudulu DP, Chan J, Narayan P, Judge A, Caputo M, Dimagli A, Benedetto U, Angelini GD. Cardiac surgery risk prediction using ensemble machine learning to incorporate legacy risk scores: A benchmarking study. Digit Health 2023; 9:20552076231187605. [PMID: 37492033 PMCID: PMC10363892 DOI: 10.1177/20552076231187605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/23/2023] [Indexed: 07/27/2023] Open
Abstract
Objective The introduction of new clinical risk scores (e.g. European System for Cardiac Operative Risk Evaluation (EuroSCORE) II) superseding original scores (e.g. EuroSCORE I) with different variable sets typically result in disparate datasets due to high levels of missingness for new score variables prior to time of adoption. Little is known about the use of ensemble learning to incorporate disparate data from legacy scores. We tested the hypothesised that Homogenenous and Heterogeneous Machine Learning (ML) ensembles will have better performance than ensembles of Dynamic Model Averaging (DMA) for combining knowledge from EuroSCORE I legacy data with EuroSCORE II data to predict cardiac surgery risk. Methods Using the National Adult Cardiac Surgery Audit dataset, we trained 12 different base learner models, based on two different variable sets from either EuroSCORE I (LogES) or EuroScore II (ES II), partitioned by the time of score adoption (1996-2016 or 2012-2016) and evaluated on holdout set (2017-2019). These base learner models were ensembled using nine different combinations of six ML algorithms to produce homogeneous or heterogeneous ensembles. Performance was assessed using a consensus metric. Results Xgboost homogenous ensemble (HE) was the highest performing model (clinical effectiveness metric (CEM) 0.725) with area under the curve (AUC) (0.8327; 95% confidence interval (CI) 0.8323-0.8329) followed by Random Forest HE (CEM 0.723; AUC 0.8325; 95%CI 0.8320-0.8326). Across different heterogenous ensembles, significantly better performance was obtained by combining siloed datasets across time (CEM 0.720) than building ensembles of either 1996-2011 (t-test adjusted, p = 1.67×10-6) or 2012-2019 (t-test adjusted, p = 1.35×10-193) datasets alone. Conclusions Both homogenous and heterogenous ML ensembles performed significantly better than DMA ensemble of Bayesian Update models. Time-dependent ensemble combination of variables, having differing qualities according to time of score adoption, enabled previously siloed data to be combined, leading to increased power, clinical interpretability of variables and usage of data.
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Affiliation(s)
- Tim Dong
- Translational Health Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Shubhra Sinha
- Translational Health Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Ben Zhai
- School of Computing Science, Northumbria University, Newcastle upon Tyne, UK
| | - Daniel P Fudulu
- Translational Health Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Jeremy Chan
- Translational Health Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Pradeep Narayan
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Andy Judge
- Translational Health Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Massimo Caputo
- Translational Health Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Arnaldo Dimagli
- Translational Health Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Umberto Benedetto
- Translational Health Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Gianni D Angelini
- Translational Health Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
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16
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Chan J, Dimagli A, Fudulu DP, Dong T, Mikova E, Angelini GD. On- versus off-pump CABG in octogenarians: A propensity-matched analysis from the UK National Database. J Card Surg 2022; 37:4705-4712. [PMID: 36321671 PMCID: PMC10092246 DOI: 10.1111/jocs.17068] [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: 08/25/2022] [Revised: 10/01/2022] [Accepted: 10/12/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Coronary artery bypass grafting (CABG) remains a good revascularization strategy in octogenarians with excellent clinical outcomes and quality of life postoperatively. However, the benefits of off-pump over on-pump CABG in the elderly population are still controversial. We investigated this issue in the UK National Audit database. METHOD We retrospectively analyzed all octogenarians undergoing nonemergency, isolated CABG from 1996 to 2019. Propensity score matching (PSM) was conducted to adjust for imbalance in the baseline characteristics between the off-pump and on-pump groups. Primary outcome was in-hospital mortality and postoperative cerebrovascular accidents. Secondary outcomes were bleeding requiring reoperation, deep sternal wound infection, and postoperative dialysis. RESULT A total of 6436 patients were included for analysis. No differences were observed between off- and on-pump group in-hospital mortality (4% vs. 3.8%, p = .89), return to theater rate (5.4% vs. 6.2%, p = .16) and incidence of deep sternal wound infection (1.1% vs. 1.6%, p = .34). However, octogenarian undergoing off-pump CABG were less likely to experience postoperative transient ischemic attack (TIA)/stroke (1.4% vs. 2.3%, p = .004) but more likely to require renal dialysis (4.8% vs. 3.5%, p = .03). CONCLUSION The data show similar in-hospital mortality in octogenarians regardless of the revascularization technique used. Off-pump when compared with on-pump CABG is associated with a lower incidence in postoperative neurological events but a higher need for renal dialysis.
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Affiliation(s)
- Jeremy Chan
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | | | | | - Tim Dong
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Ester Mikova
- Bristol Heart Institute, University of Bristol, Bristol, UK
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17
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Clement M, Forbester JL, Marsden M, Sabberwal P, Sommerville MS, Wellington D, Dimonte S, Clare S, Harcourt K, Yin Z, Nobre L, Antrobus R, Jin B, Chen M, Makvandi-Nejad S, Lindborg JA, Strittmatter SM, Weekes MP, Stanton RJ, Dong T, Humphreys IR. IFITM3 restricts virus-induced inflammatory cytokine production by limiting Nogo-B mediated TLR responses. Nat Commun 2022; 13:5294. [PMID: 36075894 PMCID: PMC9454482 DOI: 10.1038/s41467-022-32587-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/08/2022] [Indexed: 11/20/2022] Open
Abstract
Interferon-induced transmembrane protein 3 (IFITM3) is a restriction factor that limits viral pathogenesis and exerts poorly understood immunoregulatory functions. Here, using human and mouse models, we demonstrate that IFITM3 promotes MyD88-dependent, TLR-mediated IL-6 production following exposure to cytomegalovirus (CMV). IFITM3 also restricts IL-6 production in response to influenza and SARS-CoV-2. In dendritic cells, IFITM3 binds to the reticulon 4 isoform Nogo-B and promotes its proteasomal degradation. We reveal that Nogo-B mediates TLR-dependent pro-inflammatory cytokine production and promotes viral pathogenesis in vivo, and in the case of TLR2 responses, this process involves alteration of TLR2 cellular localization. Nogo-B deletion abrogates inflammatory cytokine responses and associated disease in virus-infected IFITM3-deficient mice. Thus, we uncover Nogo-B as a driver of viral pathogenesis and highlight an immunoregulatory pathway in which IFITM3 fine-tunes the responsiveness of myeloid cells to viral stimulation.
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Affiliation(s)
- M Clement
- Division of Infection and Immunity/Systems Immunity University Research Institute, Cardiff University, Cardiff, CF14 4XN, UK
| | - J L Forbester
- Division of Infection and Immunity/Systems Immunity University Research Institute, Cardiff University, Cardiff, CF14 4XN, UK
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, Oxford University, Oxford, OX3 9DS, UK
| | - M Marsden
- Division of Infection and Immunity/Systems Immunity University Research Institute, Cardiff University, Cardiff, CF14 4XN, UK
| | - P Sabberwal
- Division of Infection and Immunity/Systems Immunity University Research Institute, Cardiff University, Cardiff, CF14 4XN, UK
| | - M S Sommerville
- Division of Infection and Immunity/Systems Immunity University Research Institute, Cardiff University, Cardiff, CF14 4XN, UK
| | - D Wellington
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, Oxford University, Oxford, OX3 9DS, UK
- Chinese Academy of Medical Sciences (CAMS) Oxford Institute (COI), University of Oxford, Oxford, UK
| | - S Dimonte
- Division of Infection and Immunity/Systems Immunity University Research Institute, Cardiff University, Cardiff, CF14 4XN, UK
| | - S Clare
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, CB10 1SA, UK
| | - K Harcourt
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, CB10 1SA, UK
| | - Z Yin
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, Oxford University, Oxford, OX3 9DS, UK
- Chinese Academy of Medical Sciences (CAMS) Oxford Institute (COI), University of Oxford, Oxford, UK
| | - L Nobre
- Cambridge Institute for Medical Research, University of Cambridge, Hills Road, Cambridge, CB2 0XY, UK
| | - R Antrobus
- Cambridge Institute for Medical Research, University of Cambridge, Hills Road, Cambridge, CB2 0XY, UK
| | - B Jin
- Fourth Military Medical University, Xian, China
| | - M Chen
- Department of Microbial Pathogenesis, Yale University School of Medicine, New Haven, CT, 06536, USA
| | - S Makvandi-Nejad
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, Oxford University, Oxford, OX3 9DS, UK
| | - J A Lindborg
- Departments of Neurology and Neuroscience, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - S M Strittmatter
- Departments of Neurology and Neuroscience, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - M P Weekes
- Cambridge Institute for Medical Research, University of Cambridge, Hills Road, Cambridge, CB2 0XY, UK
| | - R J Stanton
- Division of Infection and Immunity/Systems Immunity University Research Institute, Cardiff University, Cardiff, CF14 4XN, UK
| | - T Dong
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, Oxford University, Oxford, OX3 9DS, UK
- Chinese Academy of Medical Sciences (CAMS) Oxford Institute (COI), University of Oxford, Oxford, UK
| | - I R Humphreys
- Division of Infection and Immunity/Systems Immunity University Research Institute, Cardiff University, Cardiff, CF14 4XN, UK.
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Jia W, Suo LM, Fan P, Dong T, Li YJ, Ji JM, Xue YF, An CQ, Zhao YX, Zhang JX, Duan J. [Clinical and genetic studies of a family with hereditary angioedema]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2022; 57:980-985. [PMID: 36058666 DOI: 10.3760/cma.j.cn115330-20211209-00789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To diagnose a large family of patients with hereditary angioedema, and to study its inheritance pattern and gene locus. Methods: A retrospective analysis was carried out from August 2021 to February 2022 in a proband (female, 48 years old) and 12 family members who underwent medical history collection and laboratory examinations in the Department of Otorhinolaryngology and Head and Neck Surgery, the Second Hospital of Shanxi Medical University. The clinical data of members and non-affected members [including 7 males and 5 females, aged 12-78 (median 24) years old], were drawn a family map while confirming the diagnosis. Whole exome sequencing technology was used to detect the genetic sequence of the proband and to verify its family members to map the genetic pedigree of the mutation. Results: The inheritance pattern of the family was autosomal dominant, and 8 members of the family were diagnosed with hereditary angioedema by laboratory examination, including 7 cases of type I and 1 case of type Ⅱ. Whole exome sequencing analysis was performed on 2 patients with 2 phenotypes, and it was found that they both carried the same pathogenic mutation locus, which was c.890-2A>G. The family members were verified by next-generation sequencing, and it was found that all members of the family who had a history of edema contained this mutation site, while the younger brother of the proband who had no history of edema did not have this mutation. Conclusion: Both type Ⅰ and type Ⅱ phenotypes are present in this hereditary angioedema family, and the mutation of SERPING1 gene c.890-2A>G causes the onset of each patient in this family.
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Affiliation(s)
- W Jia
- Department of Biochemistry and Molecular Biology, Basic Medical College, Shanxi Medical University, Taiyuan 030001, China
| | - L M Suo
- Department of Biochemistry and Molecular Biology, Basic Medical College, Shanxi Medical University, Taiyuan 030001, China Department of Otorhinolaryngology Head Neck Surgery, the Second Hospital, Shanxi Medical University, Key Research Laboratory of Airway Neuroimmunology, Taiyuan 030001, China
| | - P Fan
- Department of Otorhinolaryngology Head Neck Surgery, the Second Hospital, Shanxi Medical University, Key Research Laboratory of Airway Neuroimmunology, Taiyuan 030001, China
| | - T Dong
- Department of Otorhinolaryngology Head Neck Surgery, the Second Hospital, Shanxi Medical University, Key Research Laboratory of Airway Neuroimmunology, Taiyuan 030001, China
| | - Y J Li
- Department of Otorhinolaryngology Head Neck Surgery, the Second Hospital, Shanxi Medical University, Key Research Laboratory of Airway Neuroimmunology, Taiyuan 030001, China
| | - J M Ji
- Department of Otorhinolaryngology Head Neck Surgery, the Second Hospital, Shanxi Medical University, Key Research Laboratory of Airway Neuroimmunology, Taiyuan 030001, China
| | - Y F Xue
- Department of Otorhinolaryngology Head Neck Surgery, the Second Hospital, Shanxi Medical University, Key Research Laboratory of Airway Neuroimmunology, Taiyuan 030001, China
| | - C Q An
- Department of Otorhinolaryngology Head Neck Surgery, the Second Hospital, Shanxi Medical University, Key Research Laboratory of Airway Neuroimmunology, Taiyuan 030001, China
| | - Y X Zhao
- Department of Otorhinolaryngology Head Neck Surgery, the Second Hospital, Shanxi Medical University, Key Research Laboratory of Airway Neuroimmunology, Taiyuan 030001, China
| | - J X Zhang
- Shanxi Guoxin Caregeno Medical Laboratory, Taiyuan 030001, China
| | - Jianxiong Duan
- Shanxi Guoxin Caregeno Medical Laboratory, Taiyuan 030001, China Shanghai Lanwei Medical Laboratory Co., LTD., Shanghai 200335, China
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Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, Allsop L, Almeida P, Altmann D, Alvarez Corral M, Amoils S, Anderson D, Antoniades C, Arbane G, Arias A, Armour C, Armstrong L, Armstrong N, Arnold D, Arnold H, Ashish A, Ashworth A, Ashworth M, Aslani S, Assefa-Kebede H, Atkin C, Atkin P, Aung H, Austin L, Avram C, Ayoub A, Babores M, Baggott R, Bagshaw J, Baguley D, Bailey L, Baillie JK, Bain S, Bakali M, Bakau M, Baldry E, Baldwin D, Ballard C, Banerjee A, Bang B, Barker RE, Barman L, Barratt S, Barrett F, Basire D, Basu N, Bates M, Bates A, Batterham R, Baxendale H, Bayes H, Beadsworth M, Beckett P, Beggs M, Begum M, Bell D, Bell R, Bennett K, Beranova E, Bermperi A, Berridge A, Berry C, Betts S, Bevan E, Bhui K, Bingham M, Birchall K, Bishop L, Bisnauthsing K, Blaikely J, Bloss A, Bolger A, Bonnington J, Botkai A, Bourne C, Bourne M, Bramham K, Brear L, Breen G, Breeze J, Bright E, Brill S, Brindle K, Broad L, Broadley A, Brookes C, Broome M, Brown A, Brown A, Brown J, Brown J, Brown M, Brown M, Brown V, Brugha T, Brunskill N, Buch M, Buckley P, Bularga A, Bullmore E, Burden L, Burdett T, Burn D, Burns G, Burns A, Busby J, Butcher R, Butt A, Byrne S, Cairns P, Calder PC, Calvelo E, Carborn H, Card B, Carr C, Carr L, Carson G, Carter P, Casey A, Cassar M, Cavanagh J, Chablani M, Chambers RC, Chan F, Channon KM, Chapman K, Charalambou A, Chaudhuri N, Checkley A, Chen J, Cheng Y, Chetham L, Childs C, Chilvers ER, Chinoy H, Chiribiri A, Chong-James K, Choudhury N, Chowienczyk P, Christie C, Chrystal M, Clark D, Clark C, Clarke J, Clohisey S, Coakley G, Coburn Z, Coetzee S, Cole J, Coleman C, Conneh F, Connell D, Connolly B, Connor L, Cook A, Cooper B, Cooper J, Cooper S, Copeland D, Cosier T, Coulding M, Coupland C, Cox E, Craig T, Crisp P, Cristiano D, Crooks MG, Cross A, Cruz I, Cullinan P, Cuthbertson D, Daines L, Dalton M, Daly P, Daniels A, Dark P, Dasgin J, David A, David C, Davies E, Davies F, Davies G, Davies GA, Davies K, Dawson J, Daynes E, Deakin B, Deans A, Deas C, Deery J, Defres S, Dell A, Dempsey K, Denneny E, Dennis J, Dewar A, Dharmagunawardena R, Dickens C, Dipper A, Diver S, Diwanji SN, Dixon M, Djukanovic R, Dobson H, Dobson SL, Donaldson A, Dong T, Dormand N, Dougherty A, Dowling R, Drain S, Draxlbauer K, Drury K, Dulawan P, Dunleavy A, Dunn S, Earley J, Edwards S, Edwardson C, El-Taweel H, Elliott A, Elliott K, Ellis Y, Elmer A, Evans D, Evans H, Evans J, Evans R, Evans RI, Evans T, Evenden C, Evison L, Fabbri L, Fairbairn S, Fairman A, Fallon K, Faluyi D, Favager C, Fayzan T, Featherstone J, Felton T, Finch J, Finney S, Finnigan J, Finnigan L, Fisher H, Fletcher S, Flockton R, Flynn M, Foot H, Foote D, Ford A, Forton D, Fraile E, Francis C, Francis R, Francis S, Frankel A, Fraser E, Free R, French N, Fu X, Furniss J, Garner L, Gautam N, George J, George P, Gibbons M, Gill M, Gilmour L, Gleeson F, Glossop J, Glover S, Goodman N, Goodwin C, Gooptu B, Gordon H, Gorsuch T, Greatorex M, Greenhaff PL, Greenhalgh A, Greenwood J, Gregory H, Gregory R, Grieve D, Griffin D, Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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Brignoli T, Recker M, Lee WWY, Dong T, Bhamber R, Albur M, Williams P, Dowsey AW, Massey RC. Diagnostic MALDI-TOF MS can differentiate between high and low toxic Staphylococcus aureus bacteraemia isolates as a predictor of patient outcome. Microbiology (Reading) 2022; 168. [PMID: 35997594 DOI: 10.1099/mic.0.001223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Staphylococcus aureus bacteraemia (SAB) is a major cause of blood-stream infection (BSI) in both healthcare and community settings. While the underlying comorbidities of a patient significantly contributes to their susceptibility to and outcome following SAB, recent studies show the importance of the level of cytolytic toxin production by the infecting bacterium. In this study we demonstrate that this cytotoxicity can be determined directly from the diagnostic MALDI-TOF mass spectrum generated in a routine diagnostic laboratory. With further development this information could be used to guide the management and improve the outcomes for SAB patients.
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Affiliation(s)
- Tarcisio Brignoli
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, BS8 1TD, UK
| | - Mario Recker
- Centre for Ecology and Conservation, University of Exeter, Penryn, TR10 9FE, UK
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Winnie W Y Lee
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, BS8 1TD, UK
| | - Tim Dong
- Department of Population Health Sciences and Bristol Veterinary School, University of Bristol, Bristol, BS8 2BN, UK
| | - Ranjeet Bhamber
- Department of Population Health Sciences and Bristol Veterinary School, University of Bristol, Bristol, BS8 2BN, UK
| | | | - Philip Williams
- UK Health Security Agency, and University Hospitals Bristol & Weston NHS Trust
| | - Andrew W Dowsey
- Department of Population Health Sciences and Bristol Veterinary School, University of Bristol, Bristol, BS8 2BN, UK
| | - Ruth C Massey
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, BS8 1TD, UK
- Schools of Microbiology and Medicine and APC Microbiome Ireland, UCC, Cork, Ireland
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Fudulu DP, Dimagli A, Sinha S, Ackah J, Narayan P, Chan J, Gemelli M, Dong T, Benedetto U, Angelini GD. Impact of Preoperative Atrial Fibrillation on In-Hospital Outcomes of Coronary Artery Bypass Grafting. Semin Thorac Cardiovasc Surg 2022; 35:261-266. [PMID: 35842204 DOI: 10.1053/j.semtcvs.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/07/2022] [Indexed: 12/13/2022]
Abstract
Perioperative atrial fibrillation (AF) is associated with increased mortality, morbidity, and excess healthcare costs. The objective of our study was to assess if preoperative AF in patients undergoing coronary artery bypass grafting is a predictor of operative mortality, postoperative stroke, and need for postoperative dialysis by interrogating a large registry database. We included all isolated procedures performed between February 1996 and March 2019. We used a generalized linear mixed model to assess the effect of preoperative AF on mortality stroke and the need for postoperative dialysis after adjusting for the relevant confounders derived from EuroSCORE 2. Confounders considered included age, gender, neurological dysfunction, renal dysfunction, recent myocardial infarction, pulmonary disease, unstable angina, NYHA class, pulmonary hypertension, diabetes on insulin and peripheral vascular disease, and urgency of the operation. We treated the hospital and operating consultant as random effect variables. We also performed LV function subgroup analyses to assess the effect of preoperative AF on the outcomes of interest. The incidence of pre-existent AF in the cohort of patients we analyzed (N = 356,040 patients) was 3.5% (N = 12,664). In the unadjusted baseline characteristics, preoperative AF patients had more associated comorbidities. After adjustment, preoperative AF remained a significant predictor of increased mortality (odds ratio [OR]: 1.63, confidence interval [CI] 1.48-1.79, p < 0.001), stroke (OR: 1.33, CI 1.16-1.54, p = 0.001), and need for renal dialysis (OR:1.61, CI 1.46-1.78, p < 0.001). Preoperative AF was a significant predictor of adverse outcomes in patients with moderate and good LV function but not in patients with poor LV function (EF <30%). Our study suggests that preoperative AF is associated with an increased risk for perioperative mortality and stroke in patients undergoing coronary artery bypass grafting.
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Affiliation(s)
- Daniel Paul Fudulu
- Departement of Cardiac Surgery, Bristol Heart Institute, University of Bristol, UK.
| | - Arnaldo Dimagli
- Departement of Cardiac Surgery, Bristol Heart Institute, University of Bristol, UK
| | - Shubhra Sinha
- Departement of Cardiac Surgery, Bristol Heart Institute, University of Bristol, UK
| | - James Ackah
- Departement of Cardiac Surgery, Bristol Heart Institute, University of Bristol, UK
| | - Pradeep Narayan
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, India
| | - Jeremy Chan
- Departement of Cardiac Surgery, Bristol Heart Institute, University of Bristol, UK
| | - Marco Gemelli
- Departement of Cardiac Surgery, Bristol Heart Institute, University of Bristol, UK
| | - Tim Dong
- Departement of Cardiac Surgery, Bristol Heart Institute, University of Bristol, UK
| | - Umberto Benedetto
- Departement of Cardiac Surgery, Bristol Heart Institute, University of Bristol, UK
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Kong YJ, Bian P, Yang YN, Dong T, Niu SM, Yuan SJ, Dong XY. [Association of vitamin D deficiency with severity of symptoms in children with vasovagal syncope]. Zhonghua Er Ke Za Zhi 2022; 60:557-561. [PMID: 35658362 DOI: 10.3760/cma.j.cn112140-20211009-00854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To investigate the correlation between vitamin D deficiency and the severity of symptoms in children with vasovagal syncope (VVS). Methods: A prospective study was conducted. One hundred and twenty-two children diagnosed with VVS by head up tilt test in Department of Pediatric Cardiology and 130 healthy children without symptoms who underwent physical examination in the outpatient department of Child Healthcare Department of Second Hospital of Lanzhou University from December 2019 to May 2021 were selected and assigned to VVS group and control group, respectively. According to the diagnostic criteria of vitamin D deficiency, children in the VVS group were assigned to three subgroups: non-vitamin D deficiency, vitamin D deficiency, and severe vitamin D deficiency. All children underwent detailed history taking, physical examination, and level determination of serum 25 (OH) D. Children in the VVS group were scored for orthostatic intolerance (OI) symptoms including 10 symptoms: syncope, dizziness, nausea, palpitation, headache, tremor, chest tightness, blurred vision, profuse perspiration, and attention deficit. The differences in the age, gender, body mass index, blood pressure, and serum 25 (OH) D levels between VVS group and control group, and the differences regarding the age, gender, body mass index, blood pressure, serum 25 (OH) D levels and symptom scores among the three VVS subgroups were compared. Comparisons were performed using independent sample t test, ANOVA analysis, Chi square test and rank sum test. Pearson correlation analysis was used to analyze the correlation between serum 25 (OH) D levels and OI symptom scores in children with VVS. Results: The serum 25 (OH) D levels were significantly lower in the VVS group than those in the control group ((31±11) vs. (46±10) nmol/L, t=10.89, P<0.001). Vitamin D deficiency was more frequent in the VVS group (73.0% (89/122) vs. 24.6% (32/130), χ²=58.91, P<0.001). There were significant differences among the severe vitamin D deficiency subgroup, vitamin D deficiency subgroup, and non-vitamin D deficiency subgroup regarding the serum 25 (OH) D levels ((9.8±0.4) vs. (26.6±6.5) vs. (45.8±5.9) nmol/L, F=142.77, P<0.001) and the OI symptom scores ((14±1) vs. (10±2) vs. (7±2) scores, F=44.97, P<0.001). The scores of syncope, nausea, profuse perspiration, blurred vision and dizziness among the severe vitamin D deficiency subgroup, vitamin D deficiency subgroup, and non-vitamin D deficiency subgroup were statistically significant (H=9.01, 7.52, 12.11, 7.07 and 9.54, respectively, all P<0.05). Pearson correlation analysis showed that the serum 25 (OH) D levels were negatively correlated with OI symptom scores in children with VVS (r=-0.769, P<0.001). Conclusions: VVS children have significant vitamin D deficiency. The severity of symptoms increases with decreasing of vitamin D level. Syncope, nausea, and profuse perspiration are more likely to occur in children with severe vitamin D deficiency, and dizziness and blurred vision are more likely to occur in children with vitamin D deficiency.
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Affiliation(s)
- Y J Kong
- Department of Pediatric Cardiology, Second Hospital of Lanzhou University, Lanzhou 730000, China
| | - P Bian
- Department of Pediatric Cardiology, Second Hospital of Lanzhou University, Lanzhou 730000, China
| | - Y N Yang
- Department of Pediatric Cardiology, Second Hospital of Lanzhou University, Lanzhou 730000, China
| | - T Dong
- Department of Pediatric Cardiology, Second Hospital of Lanzhou University, Lanzhou 730000, China
| | - S M Niu
- Department of Pediatric Cardiology, Second Hospital of Lanzhou University, Lanzhou 730000, China
| | - S J Yuan
- Department of Pediatric Cardiology, Second Hospital of Lanzhou University, Lanzhou 730000, China
| | - X Y Dong
- Department of Pediatric Cardiology, Second Hospital of Lanzhou University, Lanzhou 730000, China
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Dong T, Benedetto U, Sinha S, Fudulu D, Dimagli A, Chan J, Caputo M, Angelini G. Deep recurrent reinforced learning model to compare the efficacy of targeted local versus national measures on the spread of COVID-19 in the UK. BMJ Open 2022; 12:e048279. [PMID: 35190408 PMCID: PMC8861888 DOI: 10.1136/bmjopen-2020-048279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To prevent the emergence of new waves of COVID-19 caseload and associated mortalities, it is imperative to understand better the efficacy of various control measures on the national and local development of this pandemic in space-time, characterise hotspot regions of high risk, quantify the impact of under-reported measures such as international travel and project the likely effect of control measures in the coming weeks. METHODS We applied a deep recurrent reinforced learning based model to evaluate and predict the spatiotemporal effect of a combination of control measures on COVID-19 cases and mortality at the local authority (LA) and national scale in England, using data from week 5 to 46 of 2020, including an expert curated control measure matrix, official statistics/government data and a secure web dashboard to vary magnitude of control measures. RESULTS Model predictions of the number of cases and mortality of COVID-19 in the upcoming 5 weeks closely matched the actual values (cases: root mean squared error (RMSE): 700.88, mean absolute error (MAE): 453.05, mean absolute percentage error (MAPE): 0.46, correlation coefficient 0.42; mortality: RMSE 14.91, MAE 10.05, MAPE 0.39, correlation coefficient 0.68). Local lockdown with social distancing (LD_SD) (overall rank 3) was found to be ineffective in preventing outbreak rebound following lockdown easing compared with national lockdown (overall rank 2), based on prediction using simulated control measures. The ranking of the effectiveness of adjunctive measures for LD_SD were found to be consistent across hotspot and non-hotspot regions. Adjunctive measures found to be most effective were international travel and quarantine restrictions. CONCLUSIONS This study highlights the importance of using adjunctive measures in addition to LD_SD following lockdown easing and suggests the potential importance of controlling international travel and applying travel quarantines. Further work is required to assess the effect of variant strains and vaccination measures.
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Affiliation(s)
- Tim Dong
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK
| | - Umberto Benedetto
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK
| | - Shubhra Sinha
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK
| | - Daniel Fudulu
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK
| | - Arnaldo Dimagli
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jeremy Chan
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK
| | - Massimo Caputo
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gianni Angelini
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK
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Fudulu DP, Dimagli A, Sinha S, Narayan P, Chan J, Dong T, Benedetto U, Angelini GD. Weekday and outcomes of elective cardiac surgery in the UK: a large retrospective database analysis. Eur J Cardiothorac Surg 2022; 61:1381-1388. [PMID: 35092280 PMCID: PMC9746893 DOI: 10.1093/ejcts/ezac038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/13/2021] [Accepted: 01/27/2022] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Several studies have shown worse outcomes in patients operated on later in the week. We tested this hypothesis in a large UK national audit database in elective patients undergoing adult cardiac surgery. METHODS We used a generalized additive model to evaluate the effect of the day of the week on the following postoperative outcomes: 30-day mortality, stroke, need for dialysis and return to theatre for bleeding. We have adjusted for the relevant European System for Cardiac Operative Risk Evaluation (EuroSCORE) II covariates, plus responsible consultant, hospital and year of operation and performed subgroup analysis for isolated coronary artery bypass grafting (CABG) procedures. RESULTS Out of 371 500 patients, 60 555 (16.3%) underwent AVR, 36 553 (9.8%) AVR plus CABG, 238 812 (64.3%) isolated CABG, 26 517 (7.1%) isolated mitral valve repair or replacement and 9063 (2.4%) mitral valve plus CABG. A total of 13 997 (3%) had surgery over the weekend. After covariate adjustment, we found no effect of day of surgery on mortality (P = 0.081), stroke (P = 0.137) and need for postop dialysis (P = 0.732). However, across all operations, there was evidence of a lower rate of return to theatre for bleeding/tamponade at the weekend (P = 0.039). In subgroup analysis of isolated CABG, the day of the week did not affect any outcomes. CONCLUSIONS We found no effect of the day of the week on risk-adjusted short-term mortality, stroke, and the requirement for postoperative dialysis after elective cardiac surgery. Overall, the patients operated on during the weekdays were less likely to return to theatre for bleeding. In isolated CABG, the day of the week did not affect any outcomes.
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Affiliation(s)
- Daniel Paul Fudulu
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK,Corresponding author. Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol BS2 8HW, UK. Tel: 07883776222; e-mail: (D.P. Fudulu)
| | - Arnaldo Dimagli
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Shubhra Sinha
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Pradeep Narayan
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Jeremy Chan
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Tim Dong
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Umberto Benedetto
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Gianni Davide Angelini
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
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Chan J, Dimagli A, Fudulu DP, Sinha S, Narayan P, Dong T, Angelini GD. Trend and early outcomes in isolated surgical aortic valve replacement in the United Kingdom. Front Cardiovasc Med 2022; 9:1077279. [PMID: 36698929 PMCID: PMC9868612 DOI: 10.3389/fcvm.2022.1077279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023] Open
Abstract
Objective Surgical aortic valve replacement (SAVR) is traditionally the gold-standard treatment in patients with aortic valve disease. The advancement of transcatheter aortic valve replacement (TAVR) provides an alternative treatment to patients with high surgical risks and those who had previous cardiac surgery. We aim to evaluate the trend, early clinical outcomes, and the choice of prosthesis use in isolated SAVR in the United Kingdom. Methods All patients (n = 79,173) who underwent elective or urgent isolated surgical aortic valve replacement (SAVR) from 1996 to 2018 were extracted from the National Adult Cardiac Surgery Audit database. Patients who underwent additional procedures and emergency or salvage SAVR were excluded from the study. Trend and clinical outcomes were investigated in the whole cohort. Patients who had previous cardiac surgery, high-risk groups (EuroSCORE II >4%), and predicted/observed mortality were evaluated. Furthermore, the use of biological prostheses in five different age groups, that are <50, 50-59, 60-69, 70-79, and >80, was investigated. Clinical outcomes between the use of mechanical and biological aortic valve prostheses in patients <65 years old were analyzed. Results The number of isolated SAVR increased across the study period with an average of 4,661 cases performed annually after 2010. The in-hospital/30-day mortality rate decreased from 5.28% (1996) to 1.06% (2018), despite an increasing trend in EuroSCORE II. The number of isolated SAVR performed in octogenarians increased from 596 to 2007 (the first year when TAVR was introduced in the UK) to 872 in 2015 and then progressively decreased to 681 in 2018. Biological prosthesis usage increased across all age groups, particularly in the 60-69 group, from 24.59% (1996) to 81.87% (2018). There were no differences in short-term outcomes in patients <65 years old who received biological or mechanical prostheses. Conclusion Surgical aortic valve replacement remains an effective treatment for patients with isolated aortic valve disease with a low in-hospital/30-day mortality rate. The number of patients with high-risk and octogenarians who underwent isolated SAVR and those requiring redo surgery has reduced since 2016, likely due to the advancement in TAVR. The use of biological aortic prostheses has increased significantly in recent years in all age groups.
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Affiliation(s)
- Jeremy Chan
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Arnaldo Dimagli
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Daniel P Fudulu
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Shubhra Sinha
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Pradeep Narayan
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.,NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Tim Dong
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Gianni D Angelini
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
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Liu QM, Wu D, Li ZA, Shi LY, Wang ZX, Zhang SJ, Lin T, Hu TC, Tian HF, Li JQ, Dong T, Wang NL. Photoinduced multistage phase transitions in Ta 2NiSe 5. Nat Commun 2021; 12:2050. [PMID: 33824351 PMCID: PMC8024274 DOI: 10.1038/s41467-021-22345-3] [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: 09/22/2020] [Accepted: 03/10/2021] [Indexed: 02/01/2023] Open
Abstract
Ultrafast control of material physical properties represents a rapidly developing field in condensed matter physics. Yet, accessing the long-lived photoinduced electronic states is still in its early stages, especially with respect to an insulator to metal phase transition. Here, by combining transport measurement with ultrashort photoexcitation and coherent phonon spectroscopy, we report on photoinduced multistage phase transitions in Ta2NiSe5. Upon excitation by weak pulse intensity, the system is triggered to a short-lived state accompanied by a structural change. Further increasing the excitation intensity beyond a threshold, a photoinduced steady new state is achieved where the resistivity drops by more than four orders at temperature 50 K. This new state is thermally stable up to at least 350 K and exhibits a lattice structure different from any of the thermally accessible equilibrium states. Transmission electron microscopy reveals an in-chain Ta atom displacement in the photoinduced new structure phase. We also found that nano-sheet samples with the thickness less than the optical penetration depth are required for attaining a complete transition.
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Affiliation(s)
- Q M Liu
- International Center for Quantum Materials, School of Physics, Peking University, Beijing, China
| | - D Wu
- International Center for Quantum Materials, School of Physics, Peking University, Beijing, China.
- Songshan Lake Materials Laboratory, Dongguan, Guangdong, China.
| | - Z A Li
- Beijing National Laboratory for Condensed Matter Physics, Institute of Physics, Chinese Academy of Sciences, Beijing, China
| | - L Y Shi
- International Center for Quantum Materials, School of Physics, Peking University, Beijing, China
| | - Z X Wang
- International Center for Quantum Materials, School of Physics, Peking University, Beijing, China
| | - S J Zhang
- International Center for Quantum Materials, School of Physics, Peking University, Beijing, China
| | - T Lin
- International Center for Quantum Materials, School of Physics, Peking University, Beijing, China
| | - T C Hu
- International Center for Quantum Materials, School of Physics, Peking University, Beijing, China
| | - H F Tian
- Beijing National Laboratory for Condensed Matter Physics, Institute of Physics, Chinese Academy of Sciences, Beijing, China
| | - J Q Li
- Beijing National Laboratory for Condensed Matter Physics, Institute of Physics, Chinese Academy of Sciences, Beijing, China
| | - T Dong
- International Center for Quantum Materials, School of Physics, Peking University, Beijing, China
| | - N L Wang
- International Center for Quantum Materials, School of Physics, Peking University, Beijing, China.
- Collaborative Innovation Center of Quantum Matter, Beijing, China.
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Keiser AA, Kramár EA, Dong T, Shanur S, Pirodan M, Ru N, Acharya MM, Baulch JE, Limoli CL, Wood MA. Systemic HDAC3 inhibition ameliorates impairments in synaptic plasticity caused by simulated galactic cosmic radiation exposure in male mice. Neurobiol Learn Mem 2021; 178:107367. [PMID: 33359392 PMCID: PMC8456980 DOI: 10.1016/j.nlm.2020.107367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 09/03/2020] [Revised: 12/05/2020] [Accepted: 12/15/2020] [Indexed: 12/18/2022]
Abstract
Deep space travel presents a number of measurable risks including exposure to a spectrum of radiations of varying qualities, termed galactic cosmic radiation (GCR) that are capable of penetrating the spacecraft, traversing through the body and impacting brain function. Using rodents, studies have reported that exposure to simulated GCR leads to cognitive impairments associated with changes in hippocampus function that can persist as long as one-year post exposure with no sign of recovery. Whether memory can be updated to incorporate new information in mice exposed to GCR is unknown. Further, mechanisms underlying long lasting impairments in cognitive function as a result of GCR exposure have yet to be defined. Here, we examined whether whole body exposure to simulated GCR using 6 ions and doses of 5 or 30 cGy interfered with the ability to update an existing memory or impact hippocampal synaptic plasticity, a cellular mechanism believed to underlie memory processes, by examining long term potentiation (LTP) in acute hippocampal slices from middle aged male mice 3.5-5 months after radiation exposure. Using a modified version of the hippocampus-dependent object location memory task developed by our lab termed "Objects in Updated Locations" (OUL) task we find that GCR exposure impaired hippocampus-dependent memory updating and hippocampal LTP 3.5-5 months after exposure. Further, we find that impairments in LTP are reversed through one-time systemic subcutaneous injection of the histone deacetylase 3 inhibitor RGFP 966 (10 mg/kg), suggesting that long lasting impairments in cognitive function may be mediated at least in part, through epigenetic mechanisms.
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Affiliation(s)
- A A Keiser
- Department of Neurobiology and Behavior, School of Biological Sciences University of California, Irvine 92697-2695, United States; Center for the Neurobiology of Learning and Memory (CNLM), University of California, Irvine 92697-2695, United States; Institute for Memory Impairments and Neurological Disorders (UCI MIND), University of California, Irvine 92697-2695, United States
| | - E A Kramár
- Department of Neurobiology and Behavior, School of Biological Sciences University of California, Irvine 92697-2695, United States; Center for the Neurobiology of Learning and Memory (CNLM), University of California, Irvine 92697-2695, United States; Institute for Memory Impairments and Neurological Disorders (UCI MIND), University of California, Irvine 92697-2695, United States
| | - T Dong
- Department of Neurobiology and Behavior, School of Biological Sciences University of California, Irvine 92697-2695, United States; Center for the Neurobiology of Learning and Memory (CNLM), University of California, Irvine 92697-2695, United States; Institute for Memory Impairments and Neurological Disorders (UCI MIND), University of California, Irvine 92697-2695, United States
| | - S Shanur
- Department of Neurobiology and Behavior, School of Biological Sciences University of California, Irvine 92697-2695, United States; Center for the Neurobiology of Learning and Memory (CNLM), University of California, Irvine 92697-2695, United States; Institute for Memory Impairments and Neurological Disorders (UCI MIND), University of California, Irvine 92697-2695, United States
| | - M Pirodan
- Department of Neurobiology and Behavior, School of Biological Sciences University of California, Irvine 92697-2695, United States; Center for the Neurobiology of Learning and Memory (CNLM), University of California, Irvine 92697-2695, United States; Institute for Memory Impairments and Neurological Disorders (UCI MIND), University of California, Irvine 92697-2695, United States
| | - N Ru
- Department of Radiation Oncology, University of California, Irvine 92697-2695, United States
| | - M M Acharya
- Department of Radiation Oncology, University of California, Irvine 92697-2695, United States
| | - J E Baulch
- Department of Radiation Oncology, University of California, Irvine 92697-2695, United States
| | - C L Limoli
- Department of Radiation Oncology, University of California, Irvine 92697-2695, United States.
| | - M A Wood
- Department of Neurobiology and Behavior, School of Biological Sciences University of California, Irvine 92697-2695, United States; Center for the Neurobiology of Learning and Memory (CNLM), University of California, Irvine 92697-2695, United States; Institute for Memory Impairments and Neurological Disorders (UCI MIND), University of California, Irvine 92697-2695, United States.
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Benedetto U, Dimagli A, Gibbison B, Sinha S, Pufulete M, Fudulu D, Cocomello L, Bryan AJ, Ohri S, Caputo M, Cooper G, Dong T, Akowuah E, Angelini GD. Disparity in clinical outcomes after cardiac surgery between private and public (NHS) payers in England. Lancet Reg Health Eur 2021; 1:100003. [PMID: 35104303 PMCID: PMC8454835 DOI: 10.1016/j.lanepe.2020.100003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND There is little known about how payer status impacts clinical outcomes in a universal single-payer system such as the UK National Health Service (NHS). The aim of this study was to evaluate the relationship between payer status (private or public) and clinical outcomes following cardiac surgery from NHS providers in England. METHODS The National Adult Cardiac Surgery Audit (NACSA) registry was interrogated for patients who underwent adult cardiac surgery in England from 2009 to 2018. Information on socioeconomic status were provided by linkage with the Iteration of the English Indices of Deprivation (IoD). The primary outcome was in-hospital mortality. Secondary outcomes included incidence of in-hospital postoperative cerebrovascular accident (CVA), renal dialysis, sternal wound infection, and re-exploration. To assess whether payer status was an independent predictor of in-hospital mortality, binomial generalized linear mixed models (GLMM) were fitted along with 17 items forming the EuroSCORE and the IoD domains. FINDINGS The final sample consisted of 280,209 patients who underwent surgery in 31 NHS hospitals in England from 2009 to 2018. Of them, 5,967 (2.1%) and 274,242 (97.9%) were private and NHS payers respectively. Private payer status was associated with a lower risk of in-hospital mortality (OR 0.79; 95%CI 0.65 - 0.97;P = 0.026), CVA (OR 0.77; 95%CI 0.60 - 0.99; P = 0.039), need for re-exploration (OR 0.84; 95%CI 0.72 - 0.97; P = 0.017) and with non-significant lower risk of dialysis (OR 0.84; 95%CI 0.69 - 1.02; P = 0.074). Private payer status was found to be independently associated with lower risk of in-hospital mortality in the elective subgroup (OR 0.76; 95%CI 0.61 - 0.96; P = 0.020) but not in the non-elective subgroup (OR 1.01; 95%CI 0.64 - 1.58; P = 0.976). INTERPRETATION In conclusion, using a national database, we have found evidence of significant beneficial effect of payer status on hospital outcomes following cardiac surgery in favour of private payers regardless their socioeconomic factors.
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Affiliation(s)
- Umberto Benedetto
- Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Arnaldo Dimagli
- Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Ben Gibbison
- Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Shubhra Sinha
- Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Maria Pufulete
- Clinical Trials and Evaluation Unit, University of Bristol, Bristol, UK
| | - Daniel Fudulu
- Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Lucia Cocomello
- Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Alan J. Bryan
- Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Sunil Ohri
- Wessex Cardiothoracic Centre, Southampton University Hospitals NHS Trust, Southampton, UK
| | - Massimo Caputo
- Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Graham Cooper
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
| | - Tim Dong
- Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Enoch Akowuah
- James Cook Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Gianni D. Angelini
- Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, UK
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Lee J, Garrido P, Kim E, Arslan C, Pujol J, Tsuboi M, Dong T, Blin C, Rodrik-Outmezguine V, Mookerjee B, Passos V, Mok T. MO01.23 Canakinumab or Pembrolizumab as Monotherapy or in Combination as Neoadjuvant Therapy in Patients with Surgically Resected Non-Small Cell Lung Cancer (NSCLC): CANOPY-N Trial. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2020.10.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Liu Y, Ma H, Dong T, Yan Y, Sun L, Wang W. Clinical significance of expression level of CX3CL1-CX3CR1 axis in bone metastasis of lung cancer. Clin Transl Oncol 2020; 23:378-388. [PMID: 32638214 DOI: 10.1007/s12094-020-02431-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/16/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate the clinical significance of CX3 chemokine ligand 1(CX3CL1) and CX3CR1 in patients with bone metastasis from lung cancer. The expression levels of CX3CL1 and CX3CR1 mRNA and protein in primary lung cancer and lung cancer bone metastasis were detected by qRT-PCR and Western blot. METHODS One hundred patients with lung cancer were divided into a boneless metastasis group (50 patients with bone metastasis) and a bone metastasis group (50 patients without distant metastasis). The bone transfer component was graded by Soloway classification (0 to III). The expression levels of serum CX3CL1-CX3CR1 axis were detected by enzyme-linked immunosorbent assay (ELISA). RT-qPCR and Western Blot were used to verify the transfection efficiency. The scratching assay was used to detect the migration of CX3CL1 to 95-D cells after down-regulating the expression of CX3CR1. RESULTS The expression levels of CX3CL1 and CX3CR1 mRNA and protein in the primary lung cancer and lung cancer bone metastasis were significantly higher than those in the adjacent tissues (P < 0.0001). The levels of serum CX3CL1 and CX3CR1 in bone metastasis group were significantly higher than those in boneless metastasis group and healthy control group (P < 0.05). In the bone metastasis group, the levels of serum CX3CL1 and CX3CR1 were significantly positively correlated with the degree of disease progression (P < 0.01). CONCLUSION The expression level of serum CX3CL1-CX3CR1 axis is expected to be an auxiliary reference index for monitoring bone metastasis of lung cancer.
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Affiliation(s)
- Y Liu
- Test Room of Clinical Laboratory, The First Affiliated Hospital of Harbin Medical University, 199 Dongdazhi Street, Nangang District, Harbin, 150001, Heilongjiang, China.
| | - H Ma
- Department of Human Resources, Xiamen Hospital of T.C.M, Xiamen, 361000, China
| | - T Dong
- Department of Obstetrics, Xiamen Hospital of T.C.M, Xiamen, 361000, China
| | - Y Yan
- Department of Clinical Laboratory, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - L Sun
- Ward 1, Department of Thoracic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - W Wang
- Department of Clinical Laboratory, The Second Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, 150001, China
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Dong T, Nguyen J, Cohen S, Kim B, Chopra M, Chan N, Makaryus J. Male Gender Is The Most Powerful Predictor Of CAD Severity In Older Patients Presenting To The Emergency Department With Cardiovascular Symptoms. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dong D, Dong T, Wang R. Prognostic Value of BARF1-Specific T Cell Responses in Stage III and Iva Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1658] [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: 10/26/2022]
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Cole R, Minto J, Flattery M, Parikh A, Dong T, Roy R, Bogar L, Morris A, Vega J, Gupta D, Bhatt K, Smith A, Laskar S, Lala A, Shah K, Shah P. Effects of Induction on the Risk of Post-Transplant De Novo DSA. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Dong T, Demoss B, Roy R, Smith A, Vega J, Laskar S, Bhatt K, Gupta D, Morris A, Cole R. Sensitization in LVAD Recipients with and without Transfusions. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bennett G, Besuyen J, Krenkel S, O'Gorman T, Dong T, Bellows M. CODE BLUE: AN INNOVATIVE APPROACH TO IMPROVE THE RESPONSE. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Ji J, Liu T, Xiang B, Liu Z, Jia Y, Lian Y, Lin Z, Xu F, Liu W, Zhu H, Niu T, Pan L, Gong Y, Chang H, Huang J, Wu Y, Li J, He C, Xie L, Ma H, Tang Y, Guo Y, Kuang P, Dong T. A MULTI-CENTER STUDY OF GLIDE CHEMOTHERAPY CONSOLIDATED WITH AUTOLOGOUS STEM CELL TRANSPLANTATION FOR NEWLY DIAGNOSED STAGE IV AND RELAPSED EXTRANODAL NATURAL KILLER/T-CELL LYMPHOMA PATIENTS. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_105] [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: 02/05/2023]
Affiliation(s)
- J. Ji
- Hematology; West China Hospital of Sichuan University; Chengdu China
| | - T. Liu
- Hematology; West China Hospital of Sichuan University; Chengdu China
| | - B. Xiang
- Hematology; West China Hospital of Sichuan University; Chengdu China
| | - Z. Liu
- Hematology; West China Hospital of Sichuan University; Chengdu China
| | - Y. Jia
- Hematology; West China Hospital of Sichuan University; Chengdu China
| | - Y. Lian
- Hematology; Chengdu First People's Hospital; Chengdu China
| | - Z. Lin
- Hematology; Affiliated Hospital & Clinical Medical College of Chengdu University; Chengdu China
| | - F. Xu
- Hematology; Mianyang Central Hospital; Mianyang China
| | - W. Liu
- Pathology; West China Hospital of Sichuan University; Chengdu China
| | - H. Zhu
- Hematology; West China Hospital of Sichuan University; Chengdu China
| | - T. Niu
- Hematology; West China Hospital of Sichuan University; Chengdu China
| | - L. Pan
- Hematology; West China Hospital of Sichuan University; Chengdu China
| | - Y. Gong
- Hematology; West China Hospital of Sichuan University; Chengdu China
| | - H. Chang
- Hematology; West China Hospital of Sichuan University; Chengdu China
| | - J. Huang
- Hematology; West China Hospital of Sichuan University; Chengdu China
| | - Y. Wu
- Hematology; West China Hospital of Sichuan University; Chengdu China
| | - J. Li
- Hematology; West China Hospital of Sichuan University; Chengdu China
| | - C. He
- Hematology; West China Hospital of Sichuan University; Chengdu China
| | - L. Xie
- Hematology; West China Hospital of Sichuan University; Chengdu China
| | - H. Ma
- Hematology; West China Hospital of Sichuan University; Chengdu China
| | - Y. Tang
- Hematology; West China Hospital of Sichuan University; Chengdu China
| | - Y. Guo
- Hematology; West China Hospital of Sichuan University; Chengdu China
| | - P. Kuang
- Hematology; West China Hospital of Sichuan University; Chengdu China
| | - T. Dong
- Hematology; West China Hospital of Sichuan University; Chengdu China
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Zhang XZ, Imachi H, Lyu JY, Fukunaga K, Sato S, Ibata T, Kobayashi T, Yoshimoto T, Kikuchi F, Dong T, Murao K. Prolactin regulatory element-binding protein is involved in suppression of the adiponectin gene in vivo. J Endocrinol Invest 2017; 40:437-445. [PMID: 27914036 DOI: 10.1007/s40618-016-0589-3] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Prolactin regulatory element-binding protein (PREB), a member of the WD-repeat protein family, has been recognized as a transcriptional factor that regulates prolactin promoter activity in the anterior pituitary of rats. PREB is expressed not only in the pituitary but also in various other tissues, including the adipose tissue. Previous studies have shown that PREB acts as a transcriptional regulator and suppresses the expression of the adiponectin gene in cultured 3T3L1 preadipocytes. The aim of this study was to further examine the potential role of PREB in adipose tissue in vivo. METHODS Transgenic mice that overexpressing PREB (PREB transgenic mice) were generated. Insulin resistance was evaluated in PREB transgenic mice using glucose and insulin tolerance tests. Adiponectin expression in the adipose tissue was examined by western blot analysis and quantitative polymerase chain reaction (qPCR). The expression levels of stearoyl-CoA desaturase (Scd) and adiponectin receptor 2(ADIPOR2) were quantified by qPCR. RESULTS Glucose and insulin tolerance tests revealed insulin resistance in PREB transgenic mice. Serum adiponectin and leptin concentrations were decreased. Adiponectin gene expression was decreased in the adipose tissue, which was confirmed by the downregulation of the adiponectin-dependent hepatic Scd gene and upregulation of the ADIPOR2 gene in the liver of PREB transgenic mice. We also found that pioglitazone, an agonist for the peroxisome proliferator-activated receptor-r, improved the insulin resistance in the PREB transgenic mice after a 10-day feeding period. CONCLUSIONS These results demonstrated that PREB might contribute to the regulation of adiponectin gene expression in vivo.
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Affiliation(s)
- X Z Zhang
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, 1750-1, ikenobe, Miki-CHO, 761-0793, Kagawa, Japan.
| | - H Imachi
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, 1750-1, ikenobe, Miki-CHO, 761-0793, Kagawa, Japan
| | - J Y Lyu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, 1750-1, ikenobe, Miki-CHO, 761-0793, Kagawa, Japan
| | - K Fukunaga
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, 1750-1, ikenobe, Miki-CHO, 761-0793, Kagawa, Japan
| | - S Sato
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, 1750-1, ikenobe, Miki-CHO, 761-0793, Kagawa, Japan
| | - T Ibata
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, 1750-1, ikenobe, Miki-CHO, 761-0793, Kagawa, Japan
| | - T Kobayashi
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, 1750-1, ikenobe, Miki-CHO, 761-0793, Kagawa, Japan
| | - T Yoshimoto
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, 1750-1, ikenobe, Miki-CHO, 761-0793, Kagawa, Japan
| | - F Kikuchi
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, 1750-1, ikenobe, Miki-CHO, 761-0793, Kagawa, Japan
| | - T Dong
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, 1750-1, ikenobe, Miki-CHO, 761-0793, Kagawa, Japan
| | - K Murao
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kagawa University, 1750-1, ikenobe, Miki-CHO, 761-0793, Kagawa, Japan
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38
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Chen RY, Zhang SJ, Zhang MY, Dong T, Wang NL. Revealing Extremely Low Energy Amplitude Modes in the Charge-Density-Wave Compound LaAgSb_{2}. Phys Rev Lett 2017; 118:107402. [PMID: 28339262 DOI: 10.1103/physrevlett.118.107402] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Indexed: 06/06/2023]
Abstract
Using infrared spectroscopy and ultrafast pump probe measurement, we have studied the two charge-density-wave (CDW) instabilities in the layered compound LaAgSb_{2}. The development of CDW energy gaps was clearly observed by optical spectroscopy, which removed most of the free carrier spectral weight. More interestingly, our time-resolved measurements revealed two coherent oscillations that softened by approaching the two phase transition temperatures, respectively. We addressed that these two oscillations come from the amplitude modes of CDW collective excitations, the surprisingly low energies (0.12 THz and 0.34 THz for the higher and lower temperature ones, respectively) of which are associated with the extremely small nesting wave vectors. Additionally, the amplitude and relaxation time of photoinduced reflectivity of LaAgSb_{2} single crystals stayed unchanged across the CDW phase transitions, which is quite rare and deserves further investigation.
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Affiliation(s)
- R Y Chen
- International Center for Quantum Materials, School of Physics, Peking University, Beijing 100871, China
- Center for Advanced Quantum Studies, Department of Physics, Beijing Normal University, Beijing 100875, China
| | - S J Zhang
- International Center for Quantum Materials, School of Physics, Peking University, Beijing 100871, China
| | - M Y Zhang
- International Center for Quantum Materials, School of Physics, Peking University, Beijing 100871, China
| | - T Dong
- International Center for Quantum Materials, School of Physics, Peking University, Beijing 100871, China
| | - N L Wang
- International Center for Quantum Materials, School of Physics, Peking University, Beijing 100871, China
- Collaborative Innovation Center of Quantum Matter, Beijing 100871, China
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Gallagher RI, Yau C, Wolf DM, Dong T, Hirst G, Brown-Swigart L, Buxton M, DeMichele A, van't Veer L, Yee D, Paoloni M, Esserman L, Berry D, Park J, Petricoin EF, Wulfkuhle JD. Abstract P3-05-02: Quantitative ERα measurements in TNBC from the I-SPY 2 TRIAL correlate with HER2-EGFR co-activation and heterodimerization. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p3-05-02] [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: 11/16/2022]
Abstract
Abstract
Background: We have previously described that TNBC patients whose tumors have both HER2 Y1248 phosphorylation (pHER2) “high” and phospho-EGFR Y1173 (pEGFR) “high” have increased response (pCR) to neratinib in the I-SPY2 TRIAL. We hypothesize that the paradoxical finding of a response prediction signature comprised of HER2 activation in a HER2 IHC/FISH-negative population means there must be a ligand-driven biochemical event responsible for the HER2 phosphorylation because HER2 mutations were also not found to be significant. Exploratory analysis of additional cellular signaling events and protein expression levels in pre-treatment, LCM-purified tumor epithelium by reverse phase protein microarray (RPPA) included semi-quantitative measurement of total levels of estrogen receptor alpha (ERα), which has been previously shown to be able to act as a membrane non-genomic signaling molecule through direct interaction with various tyrosine kinases including EGFR and HER2. Since ERα has been previously shown to act as a ligand and co-stimulate (activate) HER2 and EGFR when present at low levels, we investigated whether or not RPPA-measured ERα levels in the TNBC cohort analyzed to date were higher in tumors with both pHER2 “high” and pEGFR “high” levels and thus provide evidence explaining how HER2-EGFR activation is occurring in TNBC.
Methods: Using RPPA analysis, we measured 118 analytes in lysates of LCM tumor epithelium obtained from the pre-treatment biopsy samples of 86 TNBC (Allred=0) patients in the I-SPY2 TRIAL analyzed to date. Cutpoints for pEGFR and pHER2 were determined previously by ROC analysis for pCR correlation in the neratinib treated TNBC population, and used here to dichotomize the pHER2 and pEGFR data in the larger TNBC population. Wilcoxon Rank Sum testing was performed using the continuous variable total ERα data and compared the TNBC that were both pHER2 and pEGFR “high” (N=39) to the rest of the TNBC population (N=47). Total ERα values were then divided into “high” and “low” groups based on the TNBC population median value in order to determine frequency/percentages within each class. Our study is exploratory with no claims for generalizability of the data, and calculations are descriptive (e.g. p-values are measures of distance with no inferential content).
Results: Total ERα values were obtained in 84/86 TNBC tumors analyzed. Total levels of ERα were higher (p< 0.006) in TNBC tumors with pHER2 and pEGFR “high” levels. 68% (26/38) of tumors in the pHER2 and pEGFR “high” group had ERα levels above the population median compared to 35% (16/46) in the rest of the TNBC population.
Conclusion: Our exploratory analysis reveals that ERα levels are significantly higher in TNBC with pHER2 and pEGFR activation and may be behaving as a direct signaling ligand in TNBC and driving HER2-EGFR signaling. This ERα-pHER2/pEGFR association was missed by current ER and HER2 clinical laboratory testing techniques, and if validated in larger independent study sets could suggest that utilization of new protein-based techniques defining ER more quantitatively could be helpful to understand tumor biology and therapeutic response prediction, especially in the context of TNBC that are ostensibly ER negative.
Citation Format: Gallagher RI, Yau C, Wolf DM, Dong T, Hirst G, Brown-Swigart L, ISPY-2 TRIAL Investigators, Buxton M, DeMichele A, van't Veer L, Yee D, Paoloni M, Esserman L, Berry D, Park J, Petricoin EF, Wulfkuhle JD. Quantitative ERα measurements in TNBC from the I-SPY 2 TRIAL correlate with HER2-EGFR co-activation and heterodimerization [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-05-02.
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Affiliation(s)
- RI Gallagher
- George Mason University, Manassas, VA; University of California San Francisco School of Medicine, San Francisco, CA; Quantum Leap Healthcare Collaborative, San Francisco, CA; University of Pennsylvania School of Medicine, Philadelphia, PA; University of Minnesota School of Medicine; Berry Consultants, LLC
| | - C Yau
- George Mason University, Manassas, VA; University of California San Francisco School of Medicine, San Francisco, CA; Quantum Leap Healthcare Collaborative, San Francisco, CA; University of Pennsylvania School of Medicine, Philadelphia, PA; University of Minnesota School of Medicine; Berry Consultants, LLC
| | - DM Wolf
- George Mason University, Manassas, VA; University of California San Francisco School of Medicine, San Francisco, CA; Quantum Leap Healthcare Collaborative, San Francisco, CA; University of Pennsylvania School of Medicine, Philadelphia, PA; University of Minnesota School of Medicine; Berry Consultants, LLC
| | - T Dong
- George Mason University, Manassas, VA; University of California San Francisco School of Medicine, San Francisco, CA; Quantum Leap Healthcare Collaborative, San Francisco, CA; University of Pennsylvania School of Medicine, Philadelphia, PA; University of Minnesota School of Medicine; Berry Consultants, LLC
| | - G Hirst
- George Mason University, Manassas, VA; University of California San Francisco School of Medicine, San Francisco, CA; Quantum Leap Healthcare Collaborative, San Francisco, CA; University of Pennsylvania School of Medicine, Philadelphia, PA; University of Minnesota School of Medicine; Berry Consultants, LLC
| | - L Brown-Swigart
- George Mason University, Manassas, VA; University of California San Francisco School of Medicine, San Francisco, CA; Quantum Leap Healthcare Collaborative, San Francisco, CA; University of Pennsylvania School of Medicine, Philadelphia, PA; University of Minnesota School of Medicine; Berry Consultants, LLC
| | - M Buxton
- George Mason University, Manassas, VA; University of California San Francisco School of Medicine, San Francisco, CA; Quantum Leap Healthcare Collaborative, San Francisco, CA; University of Pennsylvania School of Medicine, Philadelphia, PA; University of Minnesota School of Medicine; Berry Consultants, LLC
| | - A DeMichele
- George Mason University, Manassas, VA; University of California San Francisco School of Medicine, San Francisco, CA; Quantum Leap Healthcare Collaborative, San Francisco, CA; University of Pennsylvania School of Medicine, Philadelphia, PA; University of Minnesota School of Medicine; Berry Consultants, LLC
| | - L van't Veer
- George Mason University, Manassas, VA; University of California San Francisco School of Medicine, San Francisco, CA; Quantum Leap Healthcare Collaborative, San Francisco, CA; University of Pennsylvania School of Medicine, Philadelphia, PA; University of Minnesota School of Medicine; Berry Consultants, LLC
| | - D Yee
- George Mason University, Manassas, VA; University of California San Francisco School of Medicine, San Francisco, CA; Quantum Leap Healthcare Collaborative, San Francisco, CA; University of Pennsylvania School of Medicine, Philadelphia, PA; University of Minnesota School of Medicine; Berry Consultants, LLC
| | - M Paoloni
- George Mason University, Manassas, VA; University of California San Francisco School of Medicine, San Francisco, CA; Quantum Leap Healthcare Collaborative, San Francisco, CA; University of Pennsylvania School of Medicine, Philadelphia, PA; University of Minnesota School of Medicine; Berry Consultants, LLC
| | - L Esserman
- George Mason University, Manassas, VA; University of California San Francisco School of Medicine, San Francisco, CA; Quantum Leap Healthcare Collaborative, San Francisco, CA; University of Pennsylvania School of Medicine, Philadelphia, PA; University of Minnesota School of Medicine; Berry Consultants, LLC
| | - D Berry
- George Mason University, Manassas, VA; University of California San Francisco School of Medicine, San Francisco, CA; Quantum Leap Healthcare Collaborative, San Francisco, CA; University of Pennsylvania School of Medicine, Philadelphia, PA; University of Minnesota School of Medicine; Berry Consultants, LLC
| | - J Park
- George Mason University, Manassas, VA; University of California San Francisco School of Medicine, San Francisco, CA; Quantum Leap Healthcare Collaborative, San Francisco, CA; University of Pennsylvania School of Medicine, Philadelphia, PA; University of Minnesota School of Medicine; Berry Consultants, LLC
| | - EF Petricoin
- George Mason University, Manassas, VA; University of California San Francisco School of Medicine, San Francisco, CA; Quantum Leap Healthcare Collaborative, San Francisco, CA; University of Pennsylvania School of Medicine, Philadelphia, PA; University of Minnesota School of Medicine; Berry Consultants, LLC
| | - JD Wulfkuhle
- George Mason University, Manassas, VA; University of California San Francisco School of Medicine, San Francisco, CA; Quantum Leap Healthcare Collaborative, San Francisco, CA; University of Pennsylvania School of Medicine, Philadelphia, PA; University of Minnesota School of Medicine; Berry Consultants, LLC
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Zhang C, Peng Y, Hublitz P, Dong T. Generation of immune checkpoint knock-out human antigen-specific T cells via CRISPR/Cas9-mediated genetic engineering. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw525.02] [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: 11/13/2022] Open
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41
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Ji J, Xiang B, Liu ZG, Jia YQ, Zhu HL, Niu T, Pan L, Chang H, Huang J, Wu Y, Li JJ, He C, Ma HB, Tang Y, Dong T, Liu T. [Efficacy of GLIDE chemotherapy for patients with newly diagnosed advanced-stage or relapsed/refractory extranodal natural killer cell lymphoma]. Zhonghua Xue Ye Xue Za Zhi 2016; 37:751-755. [PMID: 27719716 PMCID: PMC7342113 DOI: 10.3760/cma.j.issn.0253-2727.2016.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
目的 研究GLIDE(吉西他滨、门冬酰胺酶、异环磷酰胺、地塞米松、依托泊苷)方案治疗初发进展期及复发难治性结外鼻型NK/T细胞淋巴瘤(ENKL)患者的有效性及安全性。 方法 纳入2010年3月至2016年3月收治的初发进展期及复发难治性ENKL患者42例,给予GLIDE方案化疗,中位疗程数为3(2~6)个,评估化疗结束后缓解率及早期(2个疗程后)缓解率,采用Kaplan-Meier方法统计无进展生存(PFS)及总生存(OS),同时采用Cox回归方法进行多因素分析,寻找影响患者PFS及OS的独立预后因素。 结果 31例(73.8%)患者达到完全缓解(CR),其中22例(52.4%)为早期CR,31例CR患者中14例接受序贯自体造血干细胞移植(ASCT)。1年PFS与OS率分别为65.6%和82.7%,4年PFS与OS率分别为48.2%和63.1%,中位OS时间未达到,中位PFS时间为30.5个月。多因素分析提示美国东部肿瘤协作组体能状态评分(ECOG评分)0~1分以及CR后序贯ASCT为减少复发、延长患者生存的有利因素。 结论 GLIDE方案能够有效治疗初发进展期及复发难治性ENKL, ECOG评分0~1分及CR后序贯ASCT治疗是患者获得较长PFS和OS时间的独立预后因素。
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Affiliation(s)
- J Ji
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Dong T, Qiu J, Cheng HD, Dong WW, Huang P, Xu CS, Wang K, Yang WM. Impairment of time-based prospective memory in patients with Wilson's disease. Eur Rev Med Pharmacol Sci 2016; 20:1845-1851. [PMID: 27212179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the effect of basal ganglia lesion of Wilson's disease (WD) patients on event-based prospective memory (EBPM) and time-based prospective memory (TBPM). PATIENTS AND METHODS A total of 30 WD patients and 30 age and education level matched healthy controls were included. EBPM (an action whenever particular words were presented) and TBPM (an action at certain times) were performed to test the involvement of the prospective memory in WD. RESULTS A significant difference was found in the performance of TBPM (2.9±1.1 vs. 5.8±0.4, p<0.05), but not EBPM (5.4±0.7 vs. 5.5±0.7, p>0.05) in patients with WD compared with the healthy controls. CONCLUSIONS Our results demonstrated that basal ganglia are involved in the prospective memory in patients with WD.
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Affiliation(s)
- T Dong
- Collaborative Innovation Centre of Neuropsychiatric Disorders and Mental Health, Neuropsychological Laboratory, Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
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Pires NMM, Dong T. An integrated passive-flow microfluidic biosensor with organic photodiodes for ultra-sensitive pathogen detection in water. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2014:4411-4. [PMID: 25570970 DOI: 10.1109/embc.2014.6944602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This work reports on integrated passive-flow optical microfluidic devices to detect waterborne pathogens in the field. Ring-shaped organic photodiodes were integrated to a capillary-induced flow microfluidic channel for monitoring chemiluminescent sandwich immunoassays enhanced by gold nanoparticles. The integrated device yielded a resolution of 4×10(4) cells/mL for the detection of Legionella pneumophila, which represented a 25-fold improvement over chemiluminescence detection devices employing no gold-nanoparticle enhancement. This work demonstrates the feasibility of a low-cost but highly sensitive lab-on-a-chip device amenable for point-of-use applications.
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Bridgeman A, Maelfait J, Davenne T, Partridge T, Peng Y, Mayer A, Dong T, Kaever V, Borrow P, Rehwinkel J. Viruses transfer the antiviral second messenger cGAMP between cells. Science 2015; 349:1228-32. [PMID: 26229117 DOI: 10.1126/science.aab3632] [Citation(s) in RCA: 185] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/02/2015] [Indexed: 12/22/2022]
Abstract
Cyclic GMP-AMP synthase (cGAS) detects cytosolic DNA during virus infection and induces an antiviral state. cGAS signals by synthesis of a second messenger, cyclic GMP-AMP (cGAMP), which activates stimulator of interferon genes (STING). We show that cGAMP is incorporated into viral particles, including lentivirus and herpesvirus virions, when these are produced in cGAS-expressing cells. Virions transferred cGAMP to newly infected cells and triggered a STING-dependent antiviral program. These effects were independent of exosomes and viral nucleic acids. Our results reveal a way by which a signal for innate immunity is transferred between cells, potentially accelerating and broadening antiviral responses. Moreover, infection of dendritic cells with cGAMP-loaded lentiviruses enhanced their activation. Loading viral vectors with cGAMP therefore holds promise for vaccine development.
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Affiliation(s)
- A Bridgeman
- Medical Research Council Human Immunology Unit, Medical Research Council Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DS, UK
| | - J Maelfait
- Medical Research Council Human Immunology Unit, Medical Research Council Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DS, UK
| | - T Davenne
- Medical Research Council Human Immunology Unit, Medical Research Council Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DS, UK
| | - T Partridge
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | - Y Peng
- Medical Research Council Human Immunology Unit, Medical Research Council Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DS, UK
| | - A Mayer
- Medical Research Council Human Immunology Unit, Medical Research Council Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DS, UK
| | - T Dong
- Medical Research Council Human Immunology Unit, Medical Research Council Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DS, UK
| | - V Kaever
- Research Core Unit Metabolomics, Institute of Pharmacology, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany
| | - P Borrow
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | - J Rehwinkel
- Medical Research Council Human Immunology Unit, Medical Research Council Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DS, UK.
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Wang L, Zhang Y, Dong T, Rowland-Jones SL, Yindom LM. KIR3DS1*0130109: a novel activating three-domain KIR identified using sequence-based typing. ACTA ACUST UNITED AC 2015. [PMID: 26198089 DOI: 10.1111/tan.12617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
KIR3DS1*0130109 is similar to KIR3DS1*0130101 except for a A > G change in intron 4.
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Affiliation(s)
- L Wang
- Capital Medical University, Beijing Ditan Hospital, Beijing, China.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Y Zhang
- Beijing You'An Hospital, Capital Medical University, Beijing, China
| | - T Dong
- University of Oxford, Weatherall Institute of Molecular Medicine, Oxford, UK
| | | | - L-M Yindom
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Wang L, Zhang Y, Dong T, Rowland-Jones SL, Yindom LM. Detection of a novel KIR3DL1*0150210 allele by sequencing. ACTA ACUST UNITED AC 2015. [PMID: 26198309 DOI: 10.1111/tan.12621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
KIR3DL1*0150210 has seven point mutations compared to the common Asian allele KIR3DL1*0150201.
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Affiliation(s)
- L Wang
- Capital Medical University, Beijing Ditan Hospital, Beijing, China.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Y Zhang
- Beijing You'An Hospital, Capital Medical University, Beijing, China
| | - T Dong
- University of Oxford, Weatherall Institute of Molecular Medicine, Oxford, UK
| | | | - L-M Yindom
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Yindom LM, Wang L, Xu K, Dong T, Rowland-Jones SL. The identification of a killer cell immunoglobulin-like receptor 3DL1*0150209 in an Asian population using molecular techniques. ACTA ACUST UNITED AC 2015; 86:152-3. [PMID: 26105024 DOI: 10.1111/tan.12597] [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: 04/30/2015] [Accepted: 05/29/2015] [Indexed: 11/28/2022]
Abstract
Full-length sequences of KIR3DL1*0150209 differ from those of KIR3DL1*0150201 with seven single-nucleotide polymorphisms.
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Affiliation(s)
- L-M Yindom
- Department of Infectious Diseases, Capital Medical University, Beijing Ditan Hospital, Beijing, China
| | - L Wang
- Department of Infectious Diseases, Capital Medical University, Beijing Ditan Hospital, Beijing, China.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - K Xu
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - T Dong
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - S L Rowland-Jones
- Department of Infectious Diseases, Capital Medical University, Beijing Ditan Hospital, Beijing, China
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Wang L, Xu K, Dong T, Rowland-Jones SL, Yindom LM. KIR3DS1*0130111: a novel KIR allele identified using molecular typing methods. ACTA ACUST UNITED AC 2015; 85:296-7. [PMID: 25690942 DOI: 10.1111/tan.12533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/27/2015] [Indexed: 11/29/2022]
Abstract
KIR3DS1*0130111 differs from KIR3DS1*0130101 with two previously undescribed single nucleotide polymorphisms.
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Affiliation(s)
- L Wang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China; Nuffield Department of Medicine, University of Oxford, Oxford, UK
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49
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Shi ZY, Dong T. Coupling effect on thermal comfort in a typical cubicle-based office with personalized floor diffuser control. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2014:840-3. [PMID: 25570090 DOI: 10.1109/embc.2014.6943722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A typical office layout with cubicles, in which occupants have their own control of the micro-environment by adjusting supply air flow rate of the floor diffuser, is numerically investigated for the impact of the discrepancy in personal thermal sensation preference on thermal comfort. The comparison among different scenarios indicates that whether the local thermal comfort is significantly affected by the neighboring cubicle (coupling effect) depends on whether the doorway is closed or not whereas the "openness", of upper space has no influence on such coupling effect but observably on the thermal comfort. The effect of thermoregulation is also presented and compared with conventional constant heat flux assumption for the occupants.
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Abstract
A synthetic optimization of Pelton air turbine in dental handpieces concerning the power output, compressed air consumption and rotation speed in the mean time is implemented by employing a standard design procedure and variable limitation from practical dentistry. The Pareto optimal solution sets acquired by using the Normalized Normal Constraint method are mainly comprised of two piecewise continuous parts. On the Pareto frontier, the supply air stagnation pressure stalls at the lower boundary of the design space, the rotation speed is a constant value within the recommended range from literature, the blade tip clearance insensitive to while the nozzle radius increases with power output and mass flow rate of compressed air to which the residual geometric dimensions are showing an opposite trend within their respective "pieces" compared to the nozzle radius.
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