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Halagali P, Inamdar A, Singh J, Anand A, Sadhu P, Pathak R, Sharma H, Biswas D. Phytochemicals, Herbal Extracts, and Dietary Supplements for Metabolic Disease Management. Endocr Metab Immune Disord Drug Targets 2024; 24:EMIDDT-EPUB-140000. [PMID: 38676520 DOI: 10.2174/0118715303287911240409055710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/31/2024] [Accepted: 02/14/2024] [Indexed: 04/29/2024]
Abstract
Comprehensive and effective care techniques have become essential due to the global epidemic dimensions of metabolic disorders, including diabetes, obesity, and cardiovascular ailments. Recent research highlights the potential of dietary supplements, herbal extracts, and phytochemicals in treating metabolic diseases. This abstract conveys the current state of the science in this field by highlighting these findings' underlying mechanisms and potential therapeutic applications. Plant-based diets contain naturally occurring bioactive molecules termed phytochemicals, which have shown promise in treating various metabolic illnesses. Examples include curcumin, flavonoids, and polyphenols' insulin-sensitizing, antioxidant, and antiinflammatory properties. Herbal extracts, derived from ancient medicinal herbs, have been used by people for years to treat a wide range of ailments. Recent studies have shown the efficacy of these strategies in improving lipid profiles, glucose metabolism, and overall cardiovascular health. Omega-3 fatty acids, vitamins, and minerals are just a few of the numerous nutritional supplements that are critical to metabolic health. These vitamins improve insulin sensitivity, regulate blood sugar, and decrease inflammation. Probiotics and prebiotics also affect the gut flora, which significantly affects metabolic function. These natural medicines' ability to treat metabolic diseases either by themselves or in combination with conventional medical interventions. However, when using it therapeutically, one must consider the differences in doses, individual responses, and bioavailability. The article concludes that phytochemicals, plant extracts, and food supplements offer a promising avenue for the management of metabolic illnesses. Comprehensive research, including clinical studies, is needed to ascertain their safety and efficacy characteristics. When added to treatment strategies, these natural therapies could be helpful supplements that improve overall health and the quality of life among individuals with metabolic diseases. Naringenin, a citrus flavonoid, can potentially prevent kidney injury in hyperuricemia by reducing uric acid, inflammation, apoptosis, DNA damage, and activating antioxidants. Further research and professional consultation are essential. Factors contributing to metabolic diseases, current approaches to management nutritional approaches for managing obesityassociated metabolic impairments in the liver and small intestine, and nutritional approaches for managing obesity-associated metabolic dysregulation are also explained briefly.
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Affiliation(s)
- Praveen Halagali
- Department of Pharmaceutics, JSS College of Pharmacy, Mysuru, JSS Academy of Higher Education and Research, Mysuru, 570015, India
| | - Aparna Inamdar
- Department of Pharmaceutical Chemistry, KLE College of Pharmacy, KLE Academy of Higher Education and Research, Belagavi, Karnataka, 590001, India
| | - Jagroop Singh
- Department of Medicinal Chemistry, Sachdeva College of Pharmacy Kharar, Mohali Punjab, 140413, India
| | - Amit Anand
- Department of Pharmacognosy, JSS College of Pharmacy, Mysuru, JSS Academy of Higher Education and Research, Mysuru, 570015, India
| | - Poulami Sadhu
- Department of Pharmacology, Burdwan Institute of Pharmacy, Burdwan, West Bengal, 713103, India
| | - Rashmi Pathak
- Department of Pharmacy, Invertis University, Bareilly (UP), 243123, India
| | - Himanshu Sharma
- Teerthanker Mahaveer College of Pharmacy, Teerthanker Mahaveer University, Moradabad (UP), 244001, India
| | - Deepak Biswas
- Department of Medical Sciences, Kokshetau State Medical University, 020009, Kazakhstan
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Swati S, Raza A, Chowdhary S, Anand A, Shaveta S, Sharma AK, Kumar K, Kumar V. Rational Design and Synthesis of Isatin-Chalcone Hybrids Integrated with 1H-1,2,3-Triazole: Anti-Proliferative Profiling and Molecular Docking Insights. ChemMedChem 2024:e202400015. [PMID: 38638026 DOI: 10.1002/cmdc.202400015] [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: 01/06/2024] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 04/20/2024]
Abstract
In this study, a series of isatin-chalcone linked triazoles were synthesized using Cu-promoted Azide-Alkyne Cycloaddition (CuAAC) reaction and evaluated for their cytotoxicity against various cancer cell lines. The most potent compound displayed approximately 2.5 times greater activity compared to both reference compounds against ovarian cancer cell lines. These findings were supported by caspase-mediated apoptosis and molecular docking analyses. Docking revealed comparable VEGFR-2 affinities for 5 b and 5-FU but highlighted stronger interaction of 5 b with EGFR, evident from its lower docking score. Overall, these results signify the notable anti-proliferative potential of most synthesized hybrids, notably emphasizing the efficacy of compound 5 b in suppressing cancer cell growth.
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Affiliation(s)
- S Swati
- Department of Chemistry, Maharaja Ranjit Singh Punjab Technical University, Dabwali Road, Bathinda, India
| | - Asif Raza
- Department of Pharmacology, Penn State Cancer Institute, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | | | - Amit Anand
- Department of Chemistry, Khalsa College, Amritsar, India
| | - S Shaveta
- Department of Chemistry, Baba Farid College, Muktsar Road, Bathinda, India
| | - Arun K Sharma
- Department of Pharmacology, Penn State Cancer Institute, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Kewal Kumar
- Department of Chemistry, Maharaja Ranjit Singh Punjab Technical University, Dabwali Road, Bathinda, India
| | - Vipan Kumar
- Department of Chemistry, Guru Nanak Dev University, Amritsar, India
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Anand A, Maurya K, N R K, R R, Jatin CP, Mallya EV, Gilani S, V S A. Assessing Respiratory Tract Infections' Prevalence and Microbial Profiles in Mechanically Ventilated Patients: Insights From Broncho Alveolar Lavage Examination. Cureus 2024; 16:e58155. [PMID: 38741882 PMCID: PMC11089268 DOI: 10.7759/cureus.58155] [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] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction Chest infections represent a significant challenge in mechanically ventilated patients, often leading to adverse outcomes despite advancements in critical care. This prospective study was conducted in the intensive care unit of tertiary referral care, with objectives to assess chest infection prevalence, microbial profiles, and outcomes in mechanically ventilated patients through broncho-alveolar lavage (BAL) examination. Methodology This prospective study involved 38 patients aged 15 to 65 years who were receiving mechanical ventilation and underwent BAL. The procedure of BAL was followed as per the guidelines and recommendations outlined by the American Thoracic Society for Bronchoscopic Lavage. Microbial analysis involves the use of microscopic examination and quantitative culture methods. Different staining techniques were utilized to identify bacteria, fungi, and mycobacteria. Complications and adverse events were monitored and recorded. Results Out of the 38 patients who underwent BAL, the majority, 30 (78.94%), were found to have chest infections, with gram-negative bacteria, including Escherichia coli, Klebsiella pneumoniae, and Acinetobacter baumannii, being the causative agents. The antibiotic sensitivity profiles indicated that the organisms were susceptible to carbapenems and broad-spectrum β-lactam/β-lactamase inhibitor combinations while showing resistance to fluoroquinolones. Despite adequate treatment, mortality remained significant in 12 (31.57%) patients. Conclusion Study findings underscore the importance of proactive surveillance, early diagnosis, and targeted management strategies to mitigate the burden of respiratory infections in critical care settings.
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Affiliation(s)
- Amit Anand
- Anesthesiology and Critical Care, Autonomous State Medical College, Hardoi, IND
| | - Kriti Maurya
- Department of Microbiology, Autonomous State Medical College, Hardoi, IND
| | - Kaushik N R
- Department of General Medicine, Rajiv Gandhi Government General Hospital, Chennai, IND
| | - Ranjith R
- Department of General Medicine, Rajiv Gandhi Government General Hospital, Chennai, IND
| | - Chunawala Purvi Jatin
- Department of General Medicine, All India Institute of Medical Sciences, Rajkot, IND
| | - Ekta V Mallya
- Department of General Medicine, New Vision University School of Medicine, Tbilisi, GEO
| | - Sarosh Gilani
- Department of General Medicine, Bharati Vidyapeeth Deemed University, Pune, IND
| | - Afrin V S
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
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Jeyaraju DV, Alapa M, Polonskaia A, Risueño A, Subramanyam P, Anand A, Ghosh K, Kyriakopoulos C, Hemerich D, Hurren R, Wang X, Gronda M, Ahsan A, Chiu H, Thomas G, Lind EF, Menezes DL, Schimmer AD, Hagner PR, Gandhi A, Thakurta AG. Extended exposure to low doses of azacitidine induces differentiation of leukemic stem cells through activation of myeloperoxidase. Haematologica 2024; 109:1082-1094. [PMID: 37941406 PMCID: PMC10985425 DOI: 10.3324/haematol.2023.283437] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023] Open
Abstract
Oral azacitidine (oral-Aza) treatment results in longer median overall survival (OS) (24.7 vs. 14.8 months in placebo) in patients with acute myeloid leukemia (AML) in remission after intensive chemotherapy. The dosing schedule of oral-Aza (14 days/28-day cycle) allows for low exposure of Aza for an extended duration thereby facilitating a sustained therapeutic effect. However, the underlying mechanisms supporting the clinical impact of oral-Aza in maintenance therapy remain to be fully understood. In this preclinical work, we explore the mechanistic basis of oral-Aza/extended exposure to Aza through in vitro and in vivo modeling. In cell lines, extended exposure to Aza results in sustained DNMT1 loss, leading to durable hypomethylation, and gene expression changes. In mouse models, extended exposure to Aza, preferentially targets immature leukemic cells. In leukemic stem cell (LSC) models, the extended dose of Aza induces differentiation and depletes CD34+CD38- LSC. Mechanistically, LSC differentiation is driven in part by increased myeloperoxidase (MPO) expression. Inhibition of MPO activity either by using an MPO-specific inhibitor or blocking oxidative stress, a known mechanism of MPO, partly reverses the differentiation of LSC. Overall, our preclinical work reveals novel mechanistic insights into oral-Aza and its ability to target LSC.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Rose Hurren
- Princess Margaret Cancer Centre, Toronto, ON
| | | | | | | | | | | | - Evan F Lind
- Department of Molecular Microbiology and the Knight Cancer Institute, Oregon Health and Science University, Portland, OR
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Niemsiri V, Rosenthal SB, Nievergelt CM, Maihofer AX, Marchetto MC, Santos R, Shekhtman T, Alliey-Rodriguez N, Anand A, Balaraman Y, Berrettini WH, Bertram H, Burdick KE, Calabrese JR, Calkin CV, Conroy C, Coryell WH, DeModena A, Eyler LT, Feeder S, Fisher C, Frazier N, Frye MA, Gao K, Garnham J, Gershon ES, Goes FS, Goto T, Harrington GJ, Jakobsen P, Kamali M, Kelly M, Leckband SG, Lohoff FW, McCarthy MJ, McInnis MG, Craig D, Millett CE, Mondimore F, Morken G, Nurnberger JI, Donovan CO, Øedegaard KJ, Ryan K, Schinagle M, Shilling PD, Slaney C, Stapp EK, Stautland A, Tarwater B, Zandi PP, Alda M, Fisch KM, Gage FH, Kelsoe JR. Focal adhesion is associated with lithium response in bipolar disorder: evidence from a network-based multi-omics analysis. Mol Psychiatry 2024; 29:6-19. [PMID: 36991131 PMCID: PMC11078741 DOI: 10.1038/s41380-022-01909-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 12/23/2021] [Revised: 11/14/2022] [Accepted: 12/02/2022] [Indexed: 03/31/2023]
Abstract
Lithium (Li) is one of the most effective drugs for treating bipolar disorder (BD), however, there is presently no way to predict response to guide treatment. The aim of this study is to identify functional genes and pathways that distinguish BD Li responders (LR) from BD Li non-responders (NR). An initial Pharmacogenomics of Bipolar Disorder study (PGBD) GWAS of lithium response did not provide any significant results. As a result, we then employed network-based integrative analysis of transcriptomic and genomic data. In transcriptomic study of iPSC-derived neurons, 41 significantly differentially expressed (DE) genes were identified in LR vs NR regardless of lithium exposure. In the PGBD, post-GWAS gene prioritization using the GWA-boosting (GWAB) approach identified 1119 candidate genes. Following DE-derived network propagation, there was a highly significant overlap of genes between the top 500- and top 2000-proximal gene networks and the GWAB gene list (Phypergeometric = 1.28E-09 and 4.10E-18, respectively). Functional enrichment analyses of the top 500 proximal network genes identified focal adhesion and the extracellular matrix (ECM) as the most significant functions. Our findings suggest that the difference between LR and NR was a much greater effect than that of lithium. The direct impact of dysregulation of focal adhesion on axon guidance and neuronal circuits could underpin mechanisms of response to lithium, as well as underlying BD. It also highlights the power of integrative multi-omics analysis of transcriptomic and genomic profiling to gain molecular insights into lithium response in BD.
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Grants
- R01 MH095741 NIMH NIH HHS
- UL1 TR001442 NCATS NIH HHS
- U19 MH106434 NIMH NIH HHS
- U01 MH092758 NIMH NIH HHS
- T32 MH018399 NIMH NIH HHS
- U.S. Department of Health & Human Services | NIH | National Institute of Mental Health (NIMH)
- Department of Veterans Affairs | Veterans Affairs San Diego Healthcare System (VA San Diego Healthcare System)
- The Halifax group (MA, CVC, JG, CO, and CS) is supported by grants from Canadian Institutes of Health Research (#166098), ERA PerMed project PLOT-BD, Research Nova Scotia, Genome Atlantic, Nova Scotia Health Authority and Dalhousie Medical Research Foundation (Lindsay Family Fund).
- U.S. Department of Health & Human Services | NIH | National Center for Advancing Translational Sciences (NCATS)
- U19MH106434, part of the National Cooperative Reprogrammed Cell Research Groups (NCRCRG) to Study Mental Illness. AHA-Allen Initiative in Brain Health and Cognitive Impairment Award (19PABH134610000). The JPB Foundation, Bob and Mary Jane Engman, Annette C Merle-Smith, R01 MH095741, and Lynn and Edward Streim.
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Affiliation(s)
- Vipavee Niemsiri
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Sara Brin Rosenthal
- Center for Computational Biology and Bioinformatics, University of California, San Diego, La Jolla, CA, USA
| | | | - Adam X Maihofer
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Maria C Marchetto
- Department of Anthropology, University of California, San Diego, La Jolla, CA, USA
- Laboratory of Genetics, Salk Institute for Biological Studies, La Jolla, CA, USA
| | - Renata Santos
- Laboratory of Genetics, Salk Institute for Biological Studies, La Jolla, CA, USA
- University of Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1261266, Laboratory of Dynamics of Neuronal Structure in Health and Disease, Paris, France
| | - Tatyana Shekhtman
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Ney Alliey-Rodriguez
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
- Department of Psychiatry and Behavioral Neuroscience, Northwestern University, Chicago, IL, USA
| | - Amit Anand
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yokesh Balaraman
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Wade H Berrettini
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Holli Bertram
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Katherine E Burdick
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph R Calabrese
- Mood Disorders Program, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Mood Disorders Program, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Cynthia V Calkin
- Department of Psychiatry and Medical Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Carla Conroy
- Mood Disorders Program, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Mood Disorders Program, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Anna DeModena
- Psychiatry Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Lisa T Eyler
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Scott Feeder
- Department of Psychiatry, The Mayo Clinic, Rochester, MN, USA
| | - Carrie Fisher
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nicole Frazier
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Mark A Frye
- Department of Psychiatry, The Mayo Clinic, Rochester, MN, USA
| | - Keming Gao
- Mood Disorders Program, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Mood Disorders Program, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Julie Garnham
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Elliot S Gershon
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Toyomi Goto
- Mood Disorders Program, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Petter Jakobsen
- Norment, Division of Psychiatry, Haukeland University Hospital and Department of Clinical medicine, University of Bergen, Bergen, Norway
| | - Masoud Kamali
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Marisa Kelly
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Susan G Leckband
- Psychiatry Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Falk W Lohoff
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael J McCarthy
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - David Craig
- Department of Translational Genomics, University of Southern California, Los Angeles, CA, USA
| | - Caitlin E Millett
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Francis Mondimore
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Gunnar Morken
- Division of Mental Health Care, St Olavs University Hospital, and Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - John I Nurnberger
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Medical and Molecular Genetics, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Ketil J Øedegaard
- Norment, Division of Psychiatry, Haukeland University Hospital and Department of Clinical medicine, University of Bergen, Bergen, Norway
| | - Kelly Ryan
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Martha Schinagle
- Mood Disorders Program, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Paul D Shilling
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Claire Slaney
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Emma K Stapp
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Andrea Stautland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bruce Tarwater
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Peter P Zandi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- National Institute of Mental Health, Klecany, Czech Republic
| | - Kathleen M Fisch
- Center for Computational Biology and Bioinformatics, University of California, San Diego, La Jolla, CA, USA
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Diego, La Jolla, CA, USA
| | - Fred H Gage
- Laboratory of Genetics, Salk Institute for Biological Studies, La Jolla, CA, USA
| | - John R Kelsoe
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
- Institute for Genomic Medicine, University of California, San Diego, La Jolla, CA, USA.
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Chowdhary S, Raza A, Preeti, Kaur S, Anand A, Sharma AK, Kumar V. Isatin-indoloquinoxaline click adducts with a potential to overcome platinum-based drug-resistance in ovarian cancer. Bioorg Chem 2024; 142:106953. [PMID: 37925887 DOI: 10.1016/j.bioorg.2023.106953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/07/2023]
Abstract
Herein, a series of isatin tethered indolo[2,3-b]quinoxaline hybrids was synthesized by considering the pharmacophoric features of known DNA intercalators and topoisomerase II inhibitors. The anti-proliferative properties of the synthesized compounds were evaluated against ovarian cancer cell lines (SKOV-3 and Hey A8). Four of the compounds exhibited promising anti-proliferative activities, with one of them being 10-fold more potent than cisplatin against drug-resistant Hey A8 cells. Further investigations were carried out to determine the DNA intercalating affinities of the most active compounds as potential mechanisms for their anti-proliferative activities. ADMET in silico studies were performed to assess the physicochemical, pharmacokinetics, and toxicity parameters of active compounds. This study, to the best of our knowledge, is the first report on the potential of isatin-indoloquinoxaline hybrids as structural blueprints for the development of new DNA intercalators. Additionally, it explores their potential to circumvent platinum-based resistance in ovarian cancer.
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Affiliation(s)
| | - Asif Raza
- Department of Pharmacology, Penn State Cancer Institute, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Preeti
- Department of Chemistry, Guru Nanak Dev University, Amritsar, India
| | - Sukhmeet Kaur
- Department of Chemistry, Khalsa College, Amritsar, India
| | - Amit Anand
- Department of Chemistry, Khalsa College, Amritsar, India
| | - Arun K Sharma
- Department of Pharmacology, Penn State Cancer Institute, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA.
| | - Vipan Kumar
- Department of Chemistry, Guru Nanak Dev University, Amritsar, India.
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Mathew SJ, Jha MK, Anand A. Choosing Between Ketamine and Electroconvulsive Therapy for Outpatients With Treatment-Resistant Depression-Advantage Ketamine? JAMA Psychiatry 2023; 80:1187-1188. [PMID: 37878334 DOI: 10.1001/jamapsychiatry.2023.3979] [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] [Indexed: 10/26/2023]
Abstract
This Viewpoint examines key issues stemming from several recent reports of electroconvulsive therapy (ECT) vs ketamine for improving depressive symptoms in treatment-resistant depression (TRD).
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Affiliation(s)
- Sanjay J Mathew
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Manish K Jha
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas
- O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas
| | - Amit Anand
- Department of Psychiatry, Mass General Brigham and Harvard Medical School, Boston, Massachusetts
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Preeti, Raza A, Anand A, Henry N, Sharma AK, Roussel P, Kumar V. Stereo/regio-selective access to substituted 3-hydroxy-oxindoles with anti-proliferative assessment and in silico validation. RSC Adv 2023; 13:28434-28443. [PMID: 37771919 PMCID: PMC10523091 DOI: 10.1039/d3ra05869g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/20/2023] [Indexed: 09/30/2023] Open
Abstract
The manuscript focuses on a highly stereo-/regioselective approach for synthesizing a diverse array of substituted-3-hydroxy-2-oxindoles. The synthesized compounds were subsequently subjected to anti-proliferative assessment against various cell lines, including colorectal carcinoma, ovarian cancer, and human metastatic melanoma cancer. The structural characterization of the synthesized scaffolds was unambiguously confirmed using X-ray diffraction analysis. Among the synthesized compounds, one compound demonstrated exceptional potency within the series. It exhibited 1.2, 2.12, and 1.55 times greater potency than cisplatin against the HCT116, OVCAR10, and 1205Lu cell lines, respectively. These results were further supported by in vitro caspase-mediated apoptosis studies. Molecular docking studies of these compounds on the target VEGFR2 protein revealed their binding capability.
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Affiliation(s)
- Preeti
- Department of Chemistry, Guru Nanak Dev University Amritsar India
| | - Asif Raza
- Department of Pharmacology, Penn State Cancer Institute, The Pennsylvania State University College of Medicine Hershey PA 17033 USA
| | - Amit Anand
- Department of Chemistry, Khalsa College Amritsar India
| | - Natacha Henry
- Univ. Lille, CNRS, Centrale Lille, Univ. Artois, UMR 8181, Unité de Catalyse et Chimie du Solide (UCCS) F-59000 Lille France
| | - Arun K Sharma
- Department of Pharmacology, Penn State Cancer Institute, The Pennsylvania State University College of Medicine Hershey PA 17033 USA
| | - Pascal Roussel
- Univ. Lille, CNRS, Centrale Lille, Univ. Artois, UMR 8181, Unité de Catalyse et Chimie du Solide (UCCS) F-59000 Lille France
| | - Vipan Kumar
- Department of Chemistry, Guru Nanak Dev University Amritsar India
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Bartoli E, Devara E, Dang HQ, Rabinovich R, Mathura RK, Anand A, Pascuzzi BR, Adkinson J, Bijanki KR, Sheth SA, Shofty B. Default mode network spatio-temporal electrophysiological signature and causal role in creativity. bioRxiv 2023:2023.09.13.557639. [PMID: 37786678 PMCID: PMC10541614 DOI: 10.1101/2023.09.13.557639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
The default mode network (DMN) is a widely distributed, intrinsic brain network thought to play a crucial role in internally-directed cognition. It subserves self-referential thinking, recollection of the past, mind wandering, and creativity. Knowledge about the electrophysiology underlying DMN activity is scarce, due to the difficulty to simultaneously record from multiple distant cortical areas with commonly-used techniques. The present study employs stereo-electroencephalography depth electrodes in 13 human patients undergoing monitoring for epilepsy, obtaining high spatiotemporal resolution neural recordings across multiple canonical DMN regions. Our results offer a rare insight into the temporal evolution and spatial origin of theta (4-8Hz) and gamma signals (30-70Hz) during two DMN-associated higher cognitive functions: mind-wandering and alternate uses. During the performance of these tasks, DMN activity is defined by a specific pattern of decreased theta coupled with increased gamma power. Critically, creativity and mind wandering engage the DMN with different dynamics: creativity recruits the DMN strongly during the covert search of ideas, while mind wandering displays the strongest modulation of DMN during the later recall of the train of thoughts. Theta band power modulations, predominantly occurring during mind wandering, do not show a predominant spatial origin within the DMN. In contrast, gamma power effects were similar for mind wandering and creativity and more strongly associated to lateral temporal nodes. Interfering with DMN activity through direct cortical stimulation within several DMN nodes caused a decrease in creativity, specifically reducing the originality of the alternate uses, without affecting creative fluency or mind wandering. These results suggest that DMN activity is flexibly modulated as a function of specific cognitive processes and supports its causal role in creative thinking. Our findings shed light on the neural constructs supporting creative cognition and provide causal evidence for the role of DMN in the generation of original connections among concepts.
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Affiliation(s)
- E Bartoli
- Department of Neurosurgery, Baylor College of Medicine, USA
| | - E Devara
- Department of Neurosurgery, Baylor College of Medicine, USA
| | - H Q Dang
- Department of Neurosurgery, Baylor College of Medicine, USA
| | - R Rabinovich
- Department of Neurosurgery, University of Utah, USA
| | - R K Mathura
- Department of Neurosurgery, Baylor College of Medicine, USA
| | - A Anand
- Department of Neurosurgery, Baylor College of Medicine, USA
| | - B R Pascuzzi
- Department of Neurosurgery, Baylor College of Medicine, USA
| | - J Adkinson
- Department of Neurosurgery, Baylor College of Medicine, USA
| | - K R Bijanki
- Department of Neurosurgery, Baylor College of Medicine, USA
- Department of Neuroscience, Baylor College of Medicine, USA
| | - S A Sheth
- Department of Neurosurgery, Baylor College of Medicine, USA
- Department of Neuroscience, Baylor College of Medicine, USA
| | - B Shofty
- Department of Neurosurgery, University of Utah, USA
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10
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Feitosa BDS, Ferreira OO, Mali SN, Anand A, Cruz JN, Franco CDJP, Mahawer SK, Kumar R, Cascaes MM, de Oliveira MS, Andrade EHDA. Chemical Composition, Preliminary Toxicity, and Antioxidant Potential of Piper marginatum Sensu Lato Essential Oils and Molecular Modeling Study. Molecules 2023; 28:5814. [PMID: 37570784 PMCID: PMC10421147 DOI: 10.3390/molecules28155814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
The essential oils (OEs) of the leaves, stems, and spikes of P. marginatum were obtained by hydrodistillation, steam distillation, and simultaneous extraction. The chemical constituents were identified and quantified by GC/MS and GC-FID. The preliminary biological activity was determined by assessing the toxicity of the samples to Artemia salina Leach larvae and calculating the mortality rate and lethal concentration (LC50). The antioxidant activity of the EOs was determined by the DPPH radical scavenging method. Molecular modeling was performed using molecular docking and molecular dynamics, with acetylcholinesterase being the molecular target. The OES yields ranged from 1.49% to 1.83%. The EOs and aromatic constituents of P. marginatum are characterized by the high contents of (E)-isoosmorhizole (19.4-32.9%), 2-methoxy-4,5-methylenedioxypropiophenone (9.0-19.9%), isoosmorhizole (1.6-24.5%), and 2-methoxy-4,5-methylenedioxypropiophenone isomer (1.6-14.3%). The antioxidant potential was significant in the OE of the leaves and stems of P. marginatum extracted by SD in November (84.9 ± 4.0 mg TE·mL-1) and the OEs of the leaves extracted by HD in March (126.8 ± 12.3 mg TE·mL-1). Regarding the preliminary toxicity, the OEs of Pm-SD-L-St-Nov and Pm-HD-L-St-Nov had mortality higher than 80% in concentrations of 25 µg·mL-1. This in silico study on essential oils elucidated the potential mechanism of interaction of the main compounds, which may serve as a basis for advances in this line of research.
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Affiliation(s)
- Bruna de Souza Feitosa
- School of Chemistry, Universidade Federal do Pará, Rua Augusto Corrêa S/N, Guamá, Belém 66075-900, PA, Brazil (E.H.d.A.A.)
| | - Oberdan Oliveira Ferreira
- Graduate Program in Biodiversity and Biotechnology—Rede Bionorte, Universidade Federal do Pará, Rua Augusto Corrêa S/N, Guamá, Belém 66075-900, PA, Brazil;
| | - Suraj N. Mali
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Ranchi 835215, India
| | - Amit Anand
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Ranchi 835215, India
| | - Jorddy Nevez Cruz
- School of Chemistry, Universidade Federal do Pará, Rua Augusto Corrêa S/N, Guamá, Belém 66075-900, PA, Brazil (E.H.d.A.A.)
| | | | - Sonu Kumar Mahawer
- Department of Chemistry, College of Basic Sciences and Humanities, Govind Ballabh Pant University of Agriculture and Technology, Pantnagar 263145, India
| | - Ravendra Kumar
- Department of Chemistry, College of Basic Sciences and Humanities, Govind Ballabh Pant University of Agriculture and Technology, Pantnagar 263145, India
| | - Marcia Moraes Cascaes
- Graduate Program in Chemistry, Universidade Federal do Pará, Rua Augusto Corrêa S/N, Guamá, Belém 66075-900, PA, Brazil;
| | - Mozaniel Santana de Oliveira
- Programa de Pós-Graduação em Ciências Biológicas—Botânica Tropical, Universidade Federal Rural da Amazônia, Museu Paraense Emílio Goeldi, Av. Perimetral, 1901, Terra Firme, Belém 66077-830, PA, Brazil
- Adolpho Ducke Laboratory—Coordination of Botany, Museu Paraense Emílio Goeldi, Av. Perimetral, 1901, Terra Firme, Belém 66077-830, PA, Brazil
| | - Eloisa Helena de Aguiar Andrade
- School of Chemistry, Universidade Federal do Pará, Rua Augusto Corrêa S/N, Guamá, Belém 66075-900, PA, Brazil (E.H.d.A.A.)
- Graduate Program in Biodiversity and Biotechnology—Rede Bionorte, Universidade Federal do Pará, Rua Augusto Corrêa S/N, Guamá, Belém 66075-900, PA, Brazil;
- Graduate Program in Chemistry, Universidade Federal do Pará, Rua Augusto Corrêa S/N, Guamá, Belém 66075-900, PA, Brazil;
- Programa de Pós-Graduação em Ciências Biológicas—Botânica Tropical, Universidade Federal Rural da Amazônia, Museu Paraense Emílio Goeldi, Av. Perimetral, 1901, Terra Firme, Belém 66077-830, PA, Brazil
- Adolpho Ducke Laboratory—Coordination of Botany, Museu Paraense Emílio Goeldi, Av. Perimetral, 1901, Terra Firme, Belém 66077-830, PA, Brazil
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11
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Anand A, Mathew SJ, Sanacora G, Murrough JW, Goes FS, Altinay M, Aloysi AS, Asghar-Ali AA, Barnett BS, Chang LC, Collins KA, Costi S, Iqbal S, Jha MK, Krishnan K, Malone DA, Nikayin S, Nissen SE, Ostroff RB, Reti IM, Wilkinson ST, Wolski K, Hu B. Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression. N Engl J Med 2023; 388:2315-2325. [PMID: 37224232 DOI: 10.1056/nejmoa2302399] [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] [Indexed: 05/26/2023]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) and subanesthetic intravenous ketamine are both currently used for treatment-resistant major depression, but the comparative effectiveness of the two treatments remains uncertain. METHODS We conducted an open-label, randomized, noninferiority trial involving patients referred to ECT clinics for treatment-resistant major depression. Patients with treatment-resistant major depression without psychosis were recruited and assigned in a 1:1 ratio to receive ketamine or ECT. During an initial 3-week treatment phase, patients received either ECT three times per week or ketamine (0.5 mg per kilogram of body weight over 40 minutes) twice per week. The primary outcome was a response to treatment (i.e., a decrease of ≥50% from baseline in the score on the 16-item Quick Inventory of Depressive Symptomatology-Self-Report; scores range from 0 to 27, with higher scores indicating greater depression). The noninferiority margin was -10 percentage points. Secondary outcomes included scores on memory tests and patient-reported quality of life. After the initial treatment phase, the patients who had a response were followed over a 6-month period. RESULTS A total of 403 patients underwent randomization at five clinical sites; 200 patients were assigned to the ketamine group and 203 to the ECT group. After 38 patients had withdrawn before initiation of the assigned treatment, ketamine was administered to 195 patients and ECT to 170 patients. A total of 55.4% of the patients in the ketamine group and 41.2% of those in the ECT group had a response (difference, 14.2 percentage points; 95% confidence interval, 3.9 to 24.2; P<0.001 for the noninferiority of ketamine to ECT). ECT appeared to be associated with a decrease in memory recall after 3 weeks of treatment (mean [±SE] decrease in the T-score for delayed recall on the Hopkins Verbal Learning Test-Revised, -0.9±1.1 in the ketamine group vs. -9.7±1.2 in the ECT group; scores range from -300 to 200, with higher scores indicating better function) with gradual recovery during follow-up. Improvement in patient-reported quality-of-life was similar in the two trial groups. ECT was associated with musculoskeletal adverse effects, whereas ketamine was associated with dissociation. CONCLUSIONS Ketamine was noninferior to ECT as therapy for treatment-resistant major depression without psychosis. (Funded by the Patient-Centered Outcomes Research Institute; ELEKT-D ClinicalTrials.gov number, NCT03113968.).
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Affiliation(s)
- Amit Anand
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Sanjay J Mathew
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Gerard Sanacora
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - James W Murrough
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Fernando S Goes
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Murat Altinay
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Amy S Aloysi
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Ali A Asghar-Ali
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Brian S Barnett
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Lee C Chang
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Katherine A Collins
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Sara Costi
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Sidra Iqbal
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Manish K Jha
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Kamini Krishnan
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Donald A Malone
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Sina Nikayin
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Steven E Nissen
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Robert B Ostroff
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Irving M Reti
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Samuel T Wilkinson
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Kathy Wolski
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
| | - Bo Hu
- From the Department of Psychiatry, Mass General Brigham, and Harvard Medical School - both in Boston (A.A.); Baylor College of Medicine (S.J.M., A.A.A.-A., S.I., L.C.C.) and Michael E. DeBakey Veterans Affairs Medical Center, Houston (S.J.M., A.A.A.-A., S.I.), and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (M.K.J.) - all in Texas; the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (G.S., S.N., R.B.O., S.T.W.); the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (J.W.M., A.S.A.), and the Division of Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg (K.A.C.) - both in New York; the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (F.S.G., I.M.R.); the Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute (M.A., B.S.B., D.A.M.), Lou Ruvo Center for Brain Health (K.K.), Cleveland Clinic Center for Clinical Research (C5Research), Heart, Vascular, and Thoracic Institute (S.E.N., K.W.), and the Department of Quantitative Health Sciences (B.H.), Cleveland Clinic, Cleveland; and the Psychopharmacology Laboratory, Department of Psychiatry, University of Oxford, Oxford, United Kingdom (S.C.)
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Anand A, Garg VK, Agrawal A, Mangla S, Pathak A. Distribution and concentration pathway of particulate pollution during pandemic-induced lockdown in metropolitan cities in India. Int J Environ Sci Technol (Tehran) 2023:1-14. [PMID: 37360554 PMCID: PMC10258753 DOI: 10.1007/s13762-023-05025-1] [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] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 01/23/2023] [Accepted: 05/15/2023] [Indexed: 06/28/2023]
Abstract
To characterize the pollutant dispersal across major metropolitan cities in India, daily particulate matter (PM10 and PM2.5) data for the study areas were collected from the National Air Quality Monitoring stations database provided by the Central Pollution Control Board (CPCB) of India. The data were analysed for three temporal ranges, i.e. before the pandemic-induced lockdown, during the lockdown, and after the upliftment of lockdown restrictions. For the purpose, the time scale ranged from 1st April to 31st May for the years 2019 (pre), 2020, and 2021 (post). Statistical distributions (lognormal, Weibull, and Gamma), aerosol optical thickness, and back trajectories were assessed for all three time periods. Most cities followed the lognormal distribution for PM2.5 during the lockdown period except Mumbai and Hyderabad. For PM10, all the regions followed the lognormal distribution. Delhi and Kolkata observed a maximum decline in particulate pollution of 41% and 52% for PM2.5 and 49% and 53% for PM10, respectively. Air mass back trajectory suggests local transmission of air mass during the lockdown period, and an undeniable decline in aerosol optical thickness was observed from the MODIS sensor. It can be concluded that statistical distribution analysis coupled with pollution models can be a counterpart in studying the dispersal and developing pollution abatement policies for specific sites. Moreover, incorporating remote sensing in pollution study can enhance the knowledge about the origin and movement of air parcels and can be helpful in taking decisions beforehand.
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Affiliation(s)
- A. Anand
- Department of Environmental Sciences and Technology, Central University of Punjab, Ghudda, Bathinda, Punjab India
| | - V. K. Garg
- Department of Environmental Sciences and Technology, Central University of Punjab, Ghudda, Bathinda, Punjab India
| | - A. Agrawal
- Department of Mathematics and Statistics, Central University of Punjab, Ghudda, Bathinda, Punjab India
| | - S. Mangla
- International Institute for Population Sciences, Mumbai, India
| | - A. Pathak
- Department of Statistics, Ramjas College, University of Delhi, Delhi, India
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Raza A, Charagh S, Abbas S, Hassan MU, Saeed F, Haider S, Sharif R, Anand A, Corpas FJ, Jin W, Varshney RK. Assessment of proline function in higher plants under extreme temperatures. Plant Biol (Stuttg) 2023; 25:379-395. [PMID: 36748909 DOI: 10.1111/plb.13510] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
Climate change and abiotic stress factors are key players in crop losses worldwide. Among which, extreme temperatures (heat and cold) disturb plant growth and development, reduce productivity and, in severe cases, lead to plant death. Plants have developed numerous strategies to mitigate the detrimental impact of temperature stress. Exposure to stress leads to the accumulation of various metabolites, e.g. sugars, sugar alcohols, organic acids and amino acids. Plants accumulate the amino acid 'proline' in response to several abiotic stresses, including temperature stress. Proline abundance may result from de novo synthesis, hydrolysis of proteins, reduced utilization or degradation. Proline also leads to stress tolerance by maintaining the osmotic balance (still controversial), cell turgidity and indirectly modulating metabolism of reactive oxygen species. Furthermore, the crosstalk of proline with other osmoprotectants and signalling molecules, e.g. glycine betaine, abscisic acid, nitric oxide, hydrogen sulfide, soluble sugars, helps to strengthen protective mechanisms in stressful environments. Development of less temperature-responsive cultivars can be achieved by manipulating the biosynthesis of proline through genetic engineering. This review presents an overview of plant responses to extreme temperatures and an outline of proline metabolism under such temperatures. The exogenous application of proline as a protective molecule under extreme temperatures is also presented. Proline crosstalk and interaction with other molecules is also discussed. Finally, the potential of genetic engineering of proline-related genes is explained to develop 'temperature-smart' plants. In short, exogenous application of proline and genetic engineering of proline genes promise ways forward for developing 'temperature-smart' future crop plants.
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Affiliation(s)
- A Raza
- College of Agriculture, Fujian Agriculture and Forestry University (FAFU), Fuzhou, China
| | - S Charagh
- State Key Laboratory of Rice Biology, China National Rice Research Institute, Chinese Academy of Agricultural Sciences (CAAS), Hangzhou, China
| | - S Abbas
- Department of Botany, Faculty of Life Sciences, Government College University, Faisalabad, Pakistan
| | - M U Hassan
- Research Center on Ecological Sciences, Jiangxi Agricultural University, Nanchang, China
| | - F Saeed
- Department of Agricultural Genetic Engineering, Faculty of Agricultural Sciences and Technologies, Nigde Omer Halisdemir University, Nigde, Turkey
| | - S Haider
- Plant Biochemistry and Molecular Biology Lab, Department of Plant Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - R Sharif
- Department of Horticulture, School of Horticulture and Landscape, Yangzhou University, Yangzhou, China
| | - A Anand
- Division of Plant Physiology, ICAR-Indian Agricultural Research Institute, Pusa, New Delhi, India
| | - F J Corpas
- Group of Antioxidants, Free Radicals and Nitric Oxide in Biotechnology, Food and Agriculture, Department of Stress, Development and Signaling in Plants, Estación Experimental del Zaidín, Spanish National Research Council, CSIC, Granada, Spain
| | - W Jin
- Key Laboratory of Biology and Genetic Improvement of Horticultural Crops (North China), Institute of Forestry and Pomology, Beijing Academy of Agriculture and Forestry Sciences, Beijing, China
| | - R K Varshney
- State Agricultural Biotechnology Centre, Centre for Crop and Food Innovation, Murdoch University, Murdoch, WA, Australia
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Mali SN, Anand A, Zaki MEA, Al-Hussain SA, Jawarkar RD, Pandey A, Kuznetsov A. Theoretical and Anti- Klebsiella pneumoniae Evaluations of Substituted 2,7-dimethylimidazo[1,2-a]pyridine-3-carboxamide and Imidazopyridine Hydrazide Derivatives. Molecules 2023; 28:molecules28062801. [PMID: 36985773 PMCID: PMC10051578 DOI: 10.3390/molecules28062801] [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: 02/23/2023] [Revised: 03/08/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
A series of multistep synthesis protocols was adopted to synthesize substituted imidazopyridines (IMPs) (SM-IMP-01 to SM-IMP-13, and DA-01-05). All substituted IMPs were then characterized using standard spectroscopic techniques such as 1H-NMR, 13C-NMR, elemental analyses, and mass spectrometry. Our both in vitro qualitative and quantitative results for antibacterial analysis, against Klebsiella pneumoniae ATCC 4352 and Bacillus subtilis ATCC 6051 suggested that all compounds essentially exhibited activity against selected strains of bacteria. Our DFT analyses suggested that the compounds of the SM-IMP-01-SM-IMP-13 series have HOMO/LUMO gaps within 4.43-4.69 eV, whereas the compounds of the DA-01-DA-05 series have smaller values of the HOMO/LUMO gaps, 3.24-4.17 eV. The lowest value of the global hardness and the highest value of the global softness, 2.215 and 0.226 eV, respectively, characterize the compound SM-IMP-02; thus, it is the most reactive compound in the imidazopyridine carboxamide series (except hydrazide series). This compound also depicted lesser MIC values against Klebsiella pneumoniae ATCC 4352 and Bacillus subtilis ATCC 6051 as 4.8 µg/mL, each. In terms of another series, hydrazide DA-05 depicted strong antimicrobial actions (MIC: 4.8 µg/mL against both bacterial strains) and also had the lowest energy gap (3.24 eV), higher softness (0.309 eV), and lesser hardness (1.62 eV). Overall, when we compare qualitative and quantitative antimicrobial results, it is been very clear that compounds with dibromo substitutions on imidazopyridine (IMP) rings would act as better antimicrobial agents than those with -H at the eighth position on the IMP ring. Furthermore, substituents of higher electronegativities would tend to enhance the biological activities of dibromo-IMP compounds. DFT properties were also well comparable to this trend and overall, we can say that the electronic behavior of compounds under investigation has key roles in their bioactivities.
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Affiliation(s)
- Suraj N Mali
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Ranchi 835215, India
| | - Amit Anand
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Ranchi 835215, India
| | - Magdi E A Zaki
- Department of Chemistry, Faculty of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11623, Saudi Arabia
| | - Sami A Al-Hussain
- Department of Chemistry, Faculty of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11623, Saudi Arabia
| | - Rahul D Jawarkar
- Department of Medicinal Chemistry and Drug Discovery, Dr. Rajendra Gode Institute of Pharmacy, University Mardi Road, Amravati 444603, India
| | - Anima Pandey
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Ranchi 835215, India
| | - Aleksey Kuznetsov
- Department of Chemistry, Universidad Técnica Federico Santa Maria, Santiago 7660251, Chile
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Zabeeulla M, Sharma C, Anand A. Early Detection of Heart Disease Using Machine Learning Approach. CM 2023. [DOI: 10.18137/cardiometry.2023.26.342347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Heart attack is one of the leading causes of morbidity in the worldwide population. Cardiovascular disease is one of the major diseases involved in clinical data analysis or one of the most important part for forecasting. Early detection of cardiovascular diseases can help to reduce high-risk condition for heart patients to make individual decisions for their lifestyle adjustments, mitigating the challenges. Early detection of heart disease has been explored in this study using a machine-learning approach. Additionally, we used sampling strategies to deal with disparate datasets. The overall risk is estimated using a variety of machine-learning techniques. On Kaggle, the Heart Disease dataset is accessible and open for all. In present study testing set used this dataset. The ultimate objective is to determine whether the patient has a “10-year risk of developing coronary heart disease” (CHD). The dataset contained thirteen features that provided patient data, and the authors used machine learning algorithms to diagnose cardiac problems with 98.8% accuracy.
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Gomez Zapata D, Joshi P, Fogaing C, Anand A, Rajenderan R, Bhadranavar S, Toribio-Vázquez C, Kulkarni S. Redo panurethral stricture: A challenge in reconstructive urology. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00496-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Zioupos L, Kirkpatrick J, Anand A. 1272 A PILOT ROUTINE ELECTRONIC HEALTH RECORD FUNCTIONAL TRACKING SCORE FOR OLDER PATIENTS IN HOSPITAL. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
Introduction
Approximately one-third of older patients leave hospital with a new functional impairment. Tracking rehabilitation progress following acute illness could improve recognition and understanding of hospital-acquired disability. However, traditional mobility and functional scores include measures that are not part of routine rehabilitation therapy, adding a time burden for staff to report. Capturing data already recorded in routine electronic records could provide an efficient patient tracking measure of rehabilitation success.
Methods
A scoping literature review appraised existing scores of mobility and functional status. Analysis of 15 admissions through the Royal Infirmary of Edinburgh identified mobility and functional domains which were reliably recorded in free text electronic health records. A pilot score was drafted, comprising admission and discharge scores (0-30 points), medical progress (0-10), physiotherapy and occupational therapy tracking (0-30). Higher scores indicate greater functional independence. Expert feedback was obtained through focus group discussion with physiotherapists and occupational therapists. The approach was tested in a fresh set of six case studies. Two independent scorers applied the scoring schema and agreement was assessed using Cohen’s weighted-kappa coefficient.
Results
The selected electronic health records contained 438 medical, 352 nursing and 183 therapist entries. Existing measures such as the Barthel Index were not recorded for any patient. Focus group discussion identified value in the overall approach and informed item-weighting. The pilot functional score allowed visualisation of rehabilitation trajectories over the course of each admission. Excellent inter-rater reliability was demonstrated for the medical (Cohen’s Kappa 0.99, 95% confidence interval [CI] 0.96–1.00) and physiotherapy (Kappa 0.96, 95% CI 0.93–0.99) components.
Conclusions
A functional tracking score generated from routine health records proved feasible and reproducible in this pilot. Future development should assess validity, reliability and prognostic power in larger populations, exploring automation using natural language processing. Development of graphic visualisations may aid communication within multidisciplinary teams.
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Affiliation(s)
- L Zioupos
- University of Edinburgh Medical School
| | | | - A Anand
- University of Edinburgh Centre for Cardiovascular Science,
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18
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Ramaclus JV, Anand A. 4-[4-(4-methoxyphenyl)-1,3-butadienyl] 1methylpyridinium 4-chlorobenzene sulphonate (MBMPCBS) – An efficient nonlinear optical crystal with superior thermal stability. CrystEngComm 2023. [DOI: 10.1039/d3ce00090g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Organic crystals are considered to be one of the best THz emitters due to its high nonlinear optical susceptibility but are thermally fragile and vulnerable to damage when exposed to...
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Goldfine CE, Tom JJ, Im DD, Yudkoff B, Anand A, Taylor JJ, Chai PR, Suzuki J. The therapeutic use and efficacy of ketamine in alcohol use disorder and alcohol withdrawal syndrome: a scoping review. Front Psychiatry 2023; 14:1141836. [PMID: 37181899 PMCID: PMC10172666 DOI: 10.3389/fpsyt.2023.1141836] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/22/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Alcohol use disorder (AUD) is the most prevalent substance use disorder (SUD) globally. In 2019, AUD affected 14.5 million Americans and contributed to 95,000 deaths, with an annual cost exceeding 250 billion dollars. Current treatment options for AUD have moderate therapeutic effects and high relapse rates. Recent investigations have demonstrated the potential efficacy of intravenous ketamine infusions to increase alcohol abstinence and may be a safe adjunct to the existing alcohol withdrawal syndrome (AWS) management strategies. Methods We followed Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines to conduct a scoping review of two databases (PubMed and Google Scholar) for peer-reviewed manuscripts describing the use of ketamine in AUD and AWS. Studies that evaluated the use of ketamine in AUD and AWS in humans were included. We excluded studies that examined laboratory animals, described alternative uses of ketamine, or discussed other treatments of AUD and AWS. Results We identified 204 research studies in our database search. Of these, 10 articles demonstrated the use of ketamine in AUD or AWS in humans. Seven studies investigated the use of ketamine in AUD and three studies described its use in AWS. Ketamine used in AUD was beneficial in reducing cravings, alcohol consumption and longer abstinence rates when compared to treatment as usual. In AWS, ketamine was used as an adjunct to standard benzodiazepine therapy during severe refractory AWS and at signs of delirium tremens. Adjunctive use of ketamine demonstrated earlier resolution of delirium tremens and AWS, reduced ICU stay, and lowered likelihood of intubation. Oversedation, headache, hypertension, and euphoria were the documented adverse effects after ketamine administration for AUD and AWS. Conclusion The use of sub-dissociative doses of ketamine for the treatment of AUD and AWS is promising but more definitive evidence of its efficacy and safety is required before recommending it for broader clinical use.
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Affiliation(s)
- Charlotte E Goldfine
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Jeremiah J Tom
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Dana D Im
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Benjamin Yudkoff
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States
| | - Amit Anand
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States
| | - Joseph J Taylor
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, MA, United States
| | - Peter R Chai
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
- The Fenway Institute, Fenway Health, Boston, MA, United States
- Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Boston, MA, United States
| | - Joji Suzuki
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States
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20
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Taylor J, Frandsen S, Anand A, Gunning F, Silbersweig D, Burdick K, Brodtmann A, Corbetta M, Cotovio G, Egorova-Brumley N, Gozzi S, Grafman J, Naidech A, Oliveira-Maia A, Phan T, Voss J, Fox M, Siddiqi S. Deriving treatment targets for bipolar disorder: lesion network mapping across the valence spectrum. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.178] [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: 02/17/2023] Open
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21
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Kaur S, Kaur J, Islam N, Anand A. Organocatalytic Synthesis and DFT Study of Versatile Biologically Active Scaffold of Isatylidene Malononitrile Derivatives. ChemistrySelect 2022. [DOI: 10.1002/slct.202203894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sukhmeet Kaur
- Department of Chemistry Khalsa College Amritsar 143001 India
| | - Jasneet Kaur
- Department of Chemistry Khalsa College Amritsar 143001 India
| | - Nasarul Islam
- Department of Chemistry Govt. Degree College Bandipora- 193502 Kashmir India
| | - Amit Anand
- Department of Chemistry Khalsa College Amritsar 143001 India
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22
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Hobbis D, Yaddanapudi S, Brooks J, Pafundi D, Jackson A, Tryggestad E, Moseley D, Routman D, Stish B, Lucido J, Ma J, Fatyga M, Anand A, Rong Y, Foote R, Patel S. Comparisons of Clinical and Reference Standard Contours to AI Auto-Segmentation: An Evaluation of 5 Commercial Models in Head and Neck Organ at Risk Delineation. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Laughlin B, DeWees T, Rule W, Sio T, Ashman J, Ridgway A, Heinzerling D, Lara P, Tinnon K, Archuleta J, Korte S, Bues M, Liu W, Anand A. Evaluation of Planning Techniques Involving Inverse Optimization in SBPT to Assess for Organs at Risk in Anal Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2177] [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]
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24
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Lucido J, DeWees T, Leavitt T, Anand A, Beltran C, Brooke M, Buroker J, Foote R, Foss O, Hughes C, Hunzeker A, Laack N, Lenz T, Morigami M, Moseley D, Patel Y, Tryggestad E, Wilson M, Zverovitch A, Patel S. A Prospective Observational Study of Clinical Acceptability of Deep Learning Model for the Automated Segmentation of Organs at Risk for Head and Neck Radiotherapy Treatment Planning. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.940] [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: 10/31/2022]
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25
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Balakrishnan A, Jah A, Lesurtel M, Andersson B, Gibbs P, Harper SJF, Huguet EL, Kosmoliaptsis V, Liau SS, Praseedom RK, Ramia JM, Branes A, Lendoire J, Maithel S, Serrablo A, Achalandabaso M, Adham M, Ahmet A, Al-Sarireh B, Albiol Quer M, Alconchel F, Alejandro R, Alsammani M, Alseidi A, Anand A, Anselmo A, Antonakis P, Arabadzhieva E, de Aretxabala X, Aroori S, Ashley S, Ausania F, Banerjee A, Barabino M, Bartlett A, Bartsch F, Belli A, Beristain-Hernandez J, Berrevoet F, Bhatti A, Bhojwani R, Bjornsson B, Blaz T, Byrne M, Calvo M, Castellanos J, Castro M, Cavallucci D, Chang D, Christodoulis G, Ciacio O, Clavien P, Coker A, Conde-Rodriguez M, D'Amico F, D'Hondt M, Daams F, Dasari B, De Beillis M, de Meijer V, Dede K, Deiro G, Delgado F, Desai G, Di Gioia A, Di Martino M, Dixon M, Dorovinis P, Dumitrascu T, Ebata T, Eilard M, Erdmann J, Erkan M, Famularo S, Felli E, Fergadi M, Fernandez G, Fox A, Galodha S, Galun D, Ganandha S, Garcia R, Gemenetzis G, Giannone F, Gil L, Giorgakis E, Giovinazzo F, Giuffrida M, Giuliani T, Giuliante F, Gkekas I, Goel M, Goh B, Gomes A, Gruenberger T, Guevara O, Gulla A, Gupta A, Gupta R, Hakeem A, Hamid H, Heinrich S, Helton S, Heumann A, Higuchi R, Hughes D, Inarejos B, Ivanecz A, Iwao Y, Iype S, Jaen I, Jie M, Jones R, Kacirek K, Kalayarasan R, Kaldarov A, Kaman L, Kanhere H, Kapoor V, Karanicolas P, Karayiannakis A, Kausar A, Khan Z, Kim DS, Klose J, Knowles B, Koh P, Kolodziejczyk P, Komorowski A, Koong J, Kozyrin I, Krishna A, Kron P, Kumar N, van Laarhoven S, Lakhey P, Lanari J, Laurenzi A, Leow V, Limbu Y, Liu YB, Lob S, Lolis E, Lopez-Lopez V, Lozano R, Lundgren L, Machairas M, Magouliotis D, Mahamid A, Malde D, Malek A, Malik H, Malleo G, Marino M, Mayo S, Mazzola M, Memeo R, Menon K, Menzulin R, Mohan R, Morgul H, Moris D, Mulita F, Muttillo E, Nahm C, Nandasena M, Nashidengo P, Nickkholgh A, Nikov A, Noel C, O'Reilly D, O'Rourke T, Ohtsuka M, Omoshoro-Jones J, Pandanaboyana S, Pararas N, Patel R, Patkar S, Peng J, Perfecto A, Perinel J, Perivoliotis K, Perra T, Phan M, Piccolo G, Porcu A, Primavesi F, Primrose J, Pueyo-Periz E, Radenkovic D, Rammohan A, Rowcroft A, Sakata J, Saladino E, Schena C, Scholer A, Schwarz C, Serrano P, Silva M, Soreide K, Sparrelid E, Stattner S, Sturesson C, Sugiura T, Sumo M, Sutcliffe R, Teh C, Teo J, Tepetes K, Thapa P, Thepbunchonchai A, Torres J, Torres O, Torzili G, Tovikkai C, Troncoso A, Tsoulfas G, Tuzuher A, Tzimas G, Umar G, Urbani L, Vanagas T, Varga, Velayutham V, Vigano L, Wakai T, Yang Z, Yip V, Zacharoulis D, Zakharov E, Zimmitti G. Heterogeneity of management practices surrounding operable gallbladder cancer - results of the OMEGA-S international HPB surgical survey. HPB (Oxford) 2022; 24:2006-2012. [PMID: 35922277 DOI: 10.1016/j.hpb.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gallbladder cancer (GBC) is an aggressive, uncommon malignancy, with variation in operative approaches adopted across centres and few large-scale studies to guide practice. We aimed to identify the extent of heterogeneity in GBC internationally to better inform the need for future multicentre studies. METHODS A 34-question online survey was disseminated to members of the European-African Hepatopancreatobiliary Association (EAHPBA), American Hepatopancreatobiliary Association (AHPBA) and Asia-Pacific Hepatopancreatobiliary Association (A-PHPBA) regarding practices around diagnostic workup, operative approach, utilization of neoadjuvant and adjuvant therapies and surveillance strategies. RESULTS Two hundred and three surgeons responded from 51 countries. High liver resection volume units (>50 resections/year) organised HPB multidisciplinary team discussion of GBCs more commonly than those with low volumes (p < 0.0001). Management practices exhibited areas of heterogeneity, particularly around operative extent. Contrary to consensus guidelines, anatomical liver resections were favoured over non-anatomical resections for T3 tumours and above, lymphadenectomy extent was lower than recommended, and a minority of respondents still routinely excised the common bile duct or port sites. CONCLUSION Our findings suggest some similarities in the management of GBC internationally, but also specific areas of practice which differed from published guidelines. Transcontinental collaborative studies on GBC are necessary to establish evidence-based practice to minimise variation and optimise outcomes.
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Affiliation(s)
- Anita Balakrishnan
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
| | - Asif Jah
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Mickael Lesurtel
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University of Paris Cité, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Bodil Andersson
- Department of Surgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Paul Gibbs
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Simon J F Harper
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Emmanuel L Huguet
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Vasilis Kosmoliaptsis
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Siong S Liau
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Raaj K Praseedom
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Jose M Ramia
- Department of Surgery, Hospital General Universitario de Alicante, Avenida Pintor Baeza, 12 03010 Alicante, Spain
| | - Alejandro Branes
- Department of HPB Surgery, Hospital Sotero del Rio, Av. Concha y Toro 3459, Puente Alto, Región Metropolitana, Chile
| | - Javier Lendoire
- Department of Surgery, University of Buenos Aires, Hospital Dr Cosme Argerich, Buenos Aires, Argentina
| | - Shishir Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, 30322 USA
| | - Alejandro Serrablo
- Department of HPB Surgery, Miguel Servet University Hospital, Zaragoza, Spain
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Muacevic A, Adler JR, Deb Roy A, Anand A, Maiti P, Ray A. A Cross-Sectional Clinicomycological Study on Dermatophytosis: A Report From a Single Tertiary Healthcare Center in Eastern India. Cureus 2022; 14:e31728. [PMID: 36569693 PMCID: PMC9771525 DOI: 10.7759/cureus.31728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Dermatophytosis is a public health concern in tropical countries. In India, a scalable number of dermatophytosis cases from multiple states are reported. In the eastern part of India, very few studies were published assessing the clinicomycological profiles of patients. Hence, we conducted this study to ascertain the clinicomycological profile of patients suffering from dermatophytosis with special reference to associated socio-environmental factors. Materials and methods This cross-sectional observational study was conducted in a tertiary care hospital situated in Bihar state of India from January 2021 to December 2021. We included a total of 330 patients of all age groups who were clinically diagnosed with superficial mycosis from the Department of Dermatology and sent for investigations to the Department of Microbiology. The collected specimens from the lesions were prepared with wet potassium hydroxide and examined under the microscope. Then, the specimens were inoculated and incubated at 25°C for up to four weeks. Fungal isolates were identified by gross appearance and microscopy if growth was observed. Results Among the 330 patients, 186 (56.4%) were males and 144 (43.6%) were females. The majority of the patients (54.5%) were from the low socioeconomic group and living in overcrowded places. Direct microscopy was positive in 198 (60%) patients, and culture was positive in 68 (20.61%) patients. The majority of the patients who were found positive in direct microscopy were from the age group of 21-30 years (39.9%), followed by 1-10 years (25.25%). A total of 92 (46.4%) cases were of tinea capitis, followed by 68 (34.3%) patients of tinea corporis. Trichophyton was the predominant fungus isolated, and Trichophyton mentagrophytes was the most common species (52.6%). Conclusion Tinea capitis was the most common provisionally diagnosed dermatophytosis in our tertiary care hospital in Bihar, an Indian state in its eastern zone. Low socioeconomic status and poor personal hygiene were the factors associated with the high prevalence of dermatophyte infections in this region of India. A detailed analysis of all these epidemiological factors is needed to limit the prevalence of dermatophytosis in tropical regions.
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Agrawal MK, Kumar A, Fanai MH, Pal A, Anand A, Pahwa HS, Sonkar AA. P-065 PROSPECTIVE STUDY OF QUALITY OF LIFE OUTCOMES OF TOTALLY TRANSFASCIAL SUTURE FIXATION OF MESH WITH CLOSURE OF DEFECT IN LAPAROSCOPIC VENTRAL HERNIA REPAIR. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
To study the Quality of life Outcome in totally transfacial suture fixation of mesh with primary closure of defect in laparoscopic ventral hernia repair with regards to:
Materials & Methods
Patients who visited the OPD of General Surgery, KGMU, Lucknow, UP and was diagnosed as a case of symptomatic ventral and incisional hernia fulfilling the inclusion and exclusion criteria were enrolled.
Results
A total of 40 patients from OPD department of General Surgery were enrolled. Maximum numbers of patients in the study i.e. 14(35%) belong to M4. Mean BMI is 28.6. Mean defect size was 3.25 cm (Range- 2cm to 5 cm). Mean duration of hospital stay was 2.85 days. With this procedure the patients were able to resume his/her daily routines very early and a mean of 4.65 days was recorded among the 40 patients involved in the study. Also a mean of 11.6 days was recorded as the time taken to return to office works which was all within two weeks after the operation. Carolina's comfort scale measure quality of life score in pre-op and post-op period on sensation of mesh,pain sensation and limitation of movement . where the scores were added and the mean sensation of mesh at post-operative period was 0.30.
Conclusion
There was significant improvement in dimensions of body pain, physical function, vitality, emotional role, mental health and sensation of mesh in small and medium size hernia, with totally transfascial suture fixation of mesh.
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Affiliation(s)
- M K Agrawal
- General Surgery, King George's Medical University , Lucknow , India
| | - A Kumar
- General Surgery, King George's Medical University , Lucknow , India
| | - M H Fanai
- General Surgery, King George's Medical University , Lucknow , India
| | - A Pal
- General Surgery, King George's Medical University , Lucknow , India
| | - A Anand
- General Surgery, King George's Medical University , Lucknow , India
| | - H S Pahwa
- General Surgery, King George's Medical University , Lucknow , India
| | - A A Sonkar
- General Surgery, King George's Medical University , Lucknow , India
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Anand A, Soon RA, Ho ZX, Shenkin SD, MacLullich AMJ, Mills NL. Automated electronic health record frailty assessment for older cardiac patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Frailty is an established risk factor for poorer outcomes in older hospitalised patients, but most measures require additional clinical review. Such formal frailty assessments are rarely undertaken in acute cardiac patients. However, routine electronic health records increasingly record health and functional deficits that together may represent the frailty phenotype.
Purpose
To report the outcomes of acute cardiac patients in relation to an automated frailty measurement, derived from routine electronic health records.
Methods
This retrospective observational cohort study included consecutive patients aged ≥70 years old who were managed under the specialist care of a consultant cardiologist between April 2016 and August 2020 in three acute hospitals across Edinburgh, Scotland. The Continuous Dynamic Evaluation of Frailty (CODE-f) score was derived from national Care Assurance Standards data that is mandated for older patient hospital care. This includes measures of cognition, functional dependence, nutrition, falls risk, continence, skin health and mobility. A total of 31 data points were included in an unweighted frailty index with scores ranging between 0 (no markers present) and 1 (all present). No CODE-f score was generated if insufficient data was completed (>33% missing). The primary outcome was mortality at 1 year after hospital admission. Secondary outcomes were length of first (index) hospital stay and the number of days spent alive and out of hospital in the year after index admission (“home time”). In a nested cohort study of 318 consecutive patients at one hospital site, the Clinical Frailty Scale (CFS) was determined from manual electronic case note review for comparison with CODE-f scores.
Results
A total of 2,406 patients were included (mean age 79±6 years, 60% male). The CODE-f could be generated in 2,158 (90%) patients, with a mean score of 0.20±0.21. The primary outcome occurred in 352 (15%) patients. Those in the highest scoring CODE-f quartile (>0.35) had greater than 3-fold increased risk of death at 1 year compared to patients in the lowest quartile (<0.07), after adjustment for age and sex (27% versus 9%, adjusted odds ratio 3.44, 95% confidence intervals [CI] 2.47 to 4.82, p<0.001). Increasing median length of index hospital stay was observed at CODE-f scores above 0.3 (Figure A). In the highest CODE-f quartile, nearly one third of patients experienced less than 9 months home time in the following year, compared to fewer than 1 in 10 in the lowest two quartiles (Figure B). In the nested cohort study, CODE-f scores were well correlated with the CFS (r=0.50, 95% CI 0.41 to 0.58, p<0.001).
Conclusion
An automated electronic health record measure can identify frail older adults at risk of poorer recovery and death after acute cardiac illness. This could inform complex treatment decisions and future care planning for this patient group.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Chief Scientist Office
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Affiliation(s)
- A Anand
- University of Edinburgh, Centre for Cardiovascular Science , Edinburgh , United Kingdom
| | - R A Soon
- University of Edinburgh , Edinburgh , United Kingdom
| | - Z X Ho
- University of Edinburgh , Edinburgh , United Kingdom
| | - S D Shenkin
- University of Edinburgh, Ageing and Health Research Group , Edinburgh , United Kingdom
| | - A M J MacLullich
- University of Edinburgh, Ageing and Health Research Group , Edinburgh , United Kingdom
| | - N L Mills
- University of Edinburgh, Centre for Cardiovascular Science , Edinburgh , United Kingdom
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Ferry AV, Wereski R, Marshall L, Strachan FE, Schulberg SD, Bularga A, Chapman AR, Lee KK, Anand A, Mills NL. Exploring adherence to an early rule-out pathway for myocardial infarction in the emergency department using mixed-methods. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Incorporating a high-sensitivity cardiac troponin assay into a care pathway for the assessment of suspected acute coronary syndrome has enabled myocardial infarction to be ruled out earlier.
Purpose
Using mixed methods, we explored adherence to an early rule-out pathway in the HiSTORIC (High-Sensitivity Cardiac Troponin on Presentation to Rule Out Myocardial Infarction) randomised controlled trial.
Methods
In 16,972 consecutive patients we evaluated clinician adherence to an early rule-out pathway for the assessment of suspected acute coronary syndrome. Adherence was defined in patients with presentation cardiac troponin I concentrations <5ng/L and symptom onset >2 hours from presentation without serial troponin testing (type 1 adherence); presentation troponin <5ng/L and symptom onset ≤2 hours from presentation with serial testing (type 2 adherence); or presentation troponin between 5ng/L and sex-specific 99th centile with serial testing (type 3 adherence). Semi-structured interviews were conducted with 23 clinicians to aid interpretation of the quantitative analysis. Qualitative data were coded and organized into themes.
Results
In patients with troponin <5ng/L presenting >2hr from symptom onset, adherence was achieved in 81% of patients. In patients presenting ≤2hr from symptom onset, 35% of patients had a second troponin test. In patients with an initial troponin concentration between 5ng/L and the 99th centile, 65% of patients had a second troponin test. Compared to patients managed by clinicians who were adherent to the pathway, patients with troponin over-testing (type 1 non-adherence) were more likely to be older (mean age 52±16 years versus 58±14, P<0.001) and have a history of coronary disease (11% versus 27%, P<0.001). In contrast, patients with under testing (type 2 non-adherence) tended to be younger (mean age 49±16 versus 63±15, P<0.001), female (50% versus 37%, P<0.001) and have lower presentation troponin levels (median concentration 1.0ng/L IQR 1.0 to 2.0, versus 5.0ng/L IQR 2.0–10.0) compared to those in whom testing was performed according to pathway recommendations. Semi-structured interview data revealed how pathway adherence was influenced by five main themes: guideline characteristics, patient characteristics, the healthcare practitioner, the healthcare system and scientific evidence. Clear visual pathway layout was fundamental in achieving optimal adherence. Strong clinical suspicion of acute coronary syndrome promoted repeat troponin testing and deviation from the pathway was felt to be justifiable by more senior clinicians.
Conclusion
This analysis revealed successful implementation of the early rule-out pathway with interview data aiding interpretation of trial data. Younger patients with lower troponin concentrations were less likely to receive pathway recommended serial troponin testing. Clinical judgement is one of the main reasons for discontinuation of pathway recommendations.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation
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Affiliation(s)
- A V Ferry
- University of Edinburgh, Centre for Cardiovascular Science , Edinburgh , United Kingdom
| | - R Wereski
- University of Edinburgh, Centre for Cardiovascular Science , Edinburgh , United Kingdom
| | - L Marshall
- University of Edinburgh, Centre for Cardiovascular Science , Edinburgh , United Kingdom
| | - F E Strachan
- Usher Institute of Population Health Sciences and Informatics , Edinburgh , United Kingdom
| | - S D Schulberg
- University of Edinburgh, Centre for Cardiovascular Science , Edinburgh , United Kingdom
| | - A Bularga
- University of Edinburgh, Centre for Cardiovascular Science , Edinburgh , United Kingdom
| | - A R Chapman
- University of Edinburgh, Centre for Cardiovascular Science , Edinburgh , United Kingdom
| | - K K Lee
- University of Edinburgh, Centre for Cardiovascular Science , Edinburgh , United Kingdom
| | - A Anand
- University of Edinburgh, Centre for Cardiovascular Science , Edinburgh , United Kingdom
| | - N L Mills
- University of Edinburgh, Centre for Cardiovascular Science , Edinburgh , United Kingdom
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30
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Lowry M, Doudesis D, Kimenai D, Bularga A, Taggart C, Wereski R, Ferry A, Stewart S, Tuck C, Lee K, Chapman A, Shah A, Newby D, Anand A, Mills N. Impact of time from symptom onset on the diagnostic performance of high-sensitivity cardiac troponin for type 1 myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
High-sensitivity cardiac troponin has enabled the rapid rule-out and rule-in of myocardial infarction at presentation. However, increases in cardiac troponin may not be detectable early after symptom onset, and uncertainty remains as to how time of symptom onset influences diagnostic performance.
Purpose
To evaluate the impact of time from symptom onset on the diagnostic performance of high-sensitivity cardiac troponin for type 1 myocardial infarction.
Methods
In a secondary analysis of a prospective multicentre randomised controlled trial of consecutive patients with suspected acute coronary syndrome, we evaluated the diagnostic performance of high-sensitivity cardiac troponin I measurements at presentation stratified by time of symptom onset to blood sampling. Diagnostic performance was evaluated in four groups (≤3 hours, 4–6 hours, 7–12 hours and >12 hours from symptom onset) for recommended thresholds to rule-out (sex-specific 99th centile and optimised threshold [64 ng/L]) type 1 myocardial infarction.
Results
This analysis included 41,104 patients (median 60 [interquartile range 49–74] years, 46% female) of which 12,595 (31%), 10,298 (25%), 7,171 (17%) and 11,040 (27%) presented ≤3 hours, 4–6 hours, 7–12 hours and >12 hours, respectively. Type 1 myocardial infarction was the adjudicated diagnosis in 3,692 (9%) patients. For the rule-out of type 1 myocardial infarction, sensitivity was highest in those tested 7–12 hours from symptom onset and lowest in those tested ≤3 hours. In early presenters, a threshold of <2 ng/L had greater sensitivity and negative predictive value (99.4% [95% CI 98.9 to 99.7%] and 99.7% [95% CI 99.5 to 99.9%]) compared to <5 ng/L (96.7% [95% CI 95.7 to 97.6%] and 99.3% [95% CI 99.1 to 99.5%], respectively). In those tested >3 hrs from symptom onset, the sensitivity and negative predictive value for both thresholds were similar, but a threshold of <5 ng/L correctly ruled out more patients (60% [17,056/28,506] versus 29% [8,316/28,506]). For the rule-in of myocardial infarction, the sensitivity of the 99th centile and 64 ng/L was lowest in patients tested within 3 hours (71.7% [95% CI 69.3 to 74.1%] and 46.5% [95% CI 44.1 to 49.2%], respectively), and increased in those tested later from symptom onset. The specificity and positive predictive value were highest when testing was performed 7–12 hours from symptom onset for the sex-specific 99th centile (92.4% [95% CI 91.8 to 93.0%] and 51.3% [95% CI 48.2–54.5%]) and 64 ng/L (96.2% [95% CI 95.7 to 96.7%] and 61.2% [95% CI 57.3 to 65.2%]).
Conclusions
The diagnostic performance of cardiac troponin for myocardial infarction is strongly influenced by the time from symptom onset to testing. In early presenters the limit of detection may facilitate immediate rule-out of myocardial infarction, but otherwise testing at least 3 hours from symptom onset is needed with the optimal time to rule-in myocardial infarction being 7–12 hours from the onset of symptoms.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation (BHF)Medical Research council UK (MRC)
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Affiliation(s)
- M Lowry
- University of Edinburgh , Edinburgh , United Kingdom
| | - D Doudesis
- University of Edinburgh , Edinburgh , United Kingdom
| | - D Kimenai
- University of Edinburgh , Edinburgh , United Kingdom
| | - A Bularga
- University of Edinburgh , Edinburgh , United Kingdom
| | - C Taggart
- University of Edinburgh , Edinburgh , United Kingdom
| | - R Wereski
- University of Edinburgh , Edinburgh , United Kingdom
| | - A Ferry
- University of Edinburgh , Edinburgh , United Kingdom
| | - S Stewart
- University of Edinburgh , Edinburgh , United Kingdom
| | - C Tuck
- University of Edinburgh , Edinburgh , United Kingdom
| | - K Lee
- University of Edinburgh , Edinburgh , United Kingdom
| | - A Chapman
- University of Edinburgh , Edinburgh , United Kingdom
| | - A Shah
- University of Edinburgh , Edinburgh , United Kingdom
| | - D Newby
- University of Edinburgh , Edinburgh , United Kingdom
| | - A Anand
- University of Edinburgh , Edinburgh , United Kingdom
| | - N Mills
- University of Edinburgh , Edinburgh , United Kingdom
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31
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Lee K, Doudesis D, Bing R, Astengo F, Perez J, Anand A, McIntyre S, Bloor N, Sandler B, Lister S, Pollock K, Qureshi A, McAllister D, Shah A, Mills N. Sex-differences in oral anticoagulation therapy in patients hospitalised with atrial fibrillation: a nationwide cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Important disparities in the treatment and outcomes of women and men with atrial fibrillation are well recognized. Whether introduction of direct oral anticoagulants has reduced disparities in treatment is uncertain.
Methods
All patients who had an incident hospitalization from 2010 to 2019 with non-valvular atrial fibrillation in Scotland were included in this cohort study. Community drug dispensing data were used to determine prescribed oral anticoagulation therapy and comorbidity status. Logistic regression modelling was used to evaluate patient factors associated with treatment with vitamin K antagonists and direct oral anticoagulants.
Results
A total of 172,989 patients (48% women [82,833/172,989]) had an incident hospitalization with non-valvular atrial fibrillation in Scotland between 2010 and 2019. The proportion of patients with thromboembolic risk factors (CHA2DS2VASc score >0 in men and >1 in women) treated with oral anticoagulation therapy increased from 36.8% to 66.3% over this 10-year period. By 2019, factor Xa inhibitors accounted for 83.6% of all oral anticoagulants prescribed, while treatment with vitamin K antagonists and direct thrombin inhibitors declined to 15.9% and 0.6%, respectively. Women were less likely to be prescribed any oral anticoagulation therapy compared to men (adjusted odds ratio, aOR 0.68 [95% CI, CI 0.67–0.70]). This disparity was mainly attributed to vitamin K antagonists (aOR 0.68 [95% CI 0.66–0.70]), whilst there was less disparity in use of factor Xa inhibitors between women and men (aOR 0.92 [95% CI 0.90–0.95]). At 1 year following hospitalization with atrial fibrillation, patients not prescribed oral anticoagulation therapy were more likely to have subsequent major adverse cardiovascular events compared to those prescribed with oral anticoagulation therapy (38.8% [15,380/39,608] versus 17.0% [6,761/39,671] in women and 35.2% [12,977/36,868] versus 16.4% [7,395/45,093] in men).
Conclusions
Women with non-valvular atrial fibrillation were significantly less likely to be prescribed vitamin K antagonists compared to men. Most patients admitted to hospital in Scotland with incident non-valvular atrial fibrillation are now treated with factor Xa inhibitors and this is associated with less treatment disparities between women and men.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This study was supported by the British Heart Foundation through a Clinical Research Training Fellowship (FS/18/25/33454), Intermediate Clinical Research Fellowship (FS/19/17/34172), Senior Clinical Research Fellowship (FS/16/14/32023) and a Research Excellence Award (RE/18/5/34216), and a research grant to NHS Lothian from Bristol Myers Squibb Pharmaceuticals Ltd and Pfizer UK Ltd.
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Affiliation(s)
- K Lee
- University of Edinburgh , Edinburgh , United Kingdom
| | - D Doudesis
- University of Edinburgh , Edinburgh , United Kingdom
| | - R Bing
- University of Edinburgh , Edinburgh , United Kingdom
| | - F Astengo
- University of Edinburgh , Edinburgh , United Kingdom
| | - J Perez
- University of Glasgow , Glasgow , United Kingdom
| | - A Anand
- University of Edinburgh , Edinburgh , United Kingdom
| | - S McIntyre
- Bristol Myers Squibb Pharmaceuticals Ltd , London , United Kingdom
| | - N Bloor
- Pfizer Ltd , Tadworth , United Kingdom
| | - B Sandler
- Bristol Myers Squibb Pharmaceuticals Ltd , London , United Kingdom
| | - S Lister
- Bristol Myers Squibb Pharmaceuticals Ltd , London , United Kingdom
| | - K Pollock
- Bristol Myers Squibb Pharmaceuticals Ltd , London , United Kingdom
| | - A Qureshi
- Bristol Myers Squibb Pharmaceuticals Ltd , London , United Kingdom
| | - D McAllister
- University of Glasgow , Glasgow , United Kingdom
| | - A Shah
- London School of Hygiene and Tropical Medicine , London , United Kingdom
| | - N Mills
- University of Edinburgh , Edinburgh , United Kingdom
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Doudesis D, Lee KK, Bularga A, Ferry AV, Tuck C, Anand A, Boeddinghaus J, Mueller C, Greenslade JH, Pickering JW, Than MP, Cullen L, Mills NL. Machine learning to optimise use of cardiac troponin in the diagnosis of acute myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Guidelines recommend fixed cardiac troponin thresholds for the assessment of patients with suspected acute coronary syndrome, however, performance varies in important patient groups as concentrations are influenced by age, sex and comorbidities. This limitation can be addressed using machine learning algorithms.
Methods
Machine learning algorithms were developed that integrate cardiac troponin concentrations at presentation or on serial testing with age, sex and clinical features in 10,038 consecutive emergency patients with suspected acute coronary syndrome. The primary outcome was an adjudicated diagnosis of type 1, type 4b or type 4c myocardial infarction. The best performing algorithm was selected for the CoDE-ACS (Collaboration for the Diagnosis and Evaluation of Acute Coronary Syndrome) decision-support tool, and performance was externally validated in 3,035 patients pooled from three prospective studies.
Findings
CoDE-ACS had excellent discrimination and calibration using cardiac troponin at presentation (area under curve [AUC] 0.959, 95% confidence interval 0.948–0.971, Brier score 0.040), in the pooled external validation cohort. At presentation, the rule-out score identified 62.1% (1,885/3,035) of all patients as low-probability of myocardial infarction with a 99.5% (99.1–99.7%) negative predictive value and 97.0% (96.3–97.6%) sensitivity. The rule-in score identified 8.3% (252/3,035) of patients as high-probability with an 83.7% (82.4–85.0%) positive predictive value and 98.5% (98.0–98.9%) specificity. Performance of the rule-out and rule-in scores was consistent across patient subgroups (Figure 1 and Figure 2). CoDE-ACS incorporating a second cardiac troponin measurement also had excellent discrimination and calibration (AUC 0.971 [0.962–0.980], Brier score 0.039) and refined the individualised probabilities in the 29.5% (898/3,035) of patients neither ruled-out or ruled-in at presentation to guide further investigation.
Conclusions
We developed and externally validated the CoDE-ACS decision-support tool using machine learning to aid in the diagnosis of myocardial infarction. CoDE-ACS had excellent diagnostic performance to rule-out and rule-in myocardial infarction at presentation, performed consistently across patient subgroups, and provided individualised probabilities to guide further care in those who require serial troponin measurements.
Conclusions
We developed and externally validated the CoDE-ACS decision-support tool using machine learning to aid in the diagnosis of myocardial infarction. CoDE-ACS had excellent diagnostic performance to rule-out and rule-in myocardial infarction at presentation, performed consistently across patient subgroups, and provided individualised probabilities to guide further care in those who require serial troponin measurements.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National Institute for Health ResearchBritish Heart Foundation
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Affiliation(s)
- D Doudesis
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - K K Lee
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - A Bularga
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - A V Ferry
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - C Tuck
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - A Anand
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - J Boeddinghaus
- University of Basel, Cardiovascular Research Institute Basel and Department of Cardiology , Basel , Switzerland
| | - C Mueller
- University of Basel, Cardiovascular Research Institute Basel and Department of Cardiology , Basel , Switzerland
| | - J H Greenslade
- University of Queensland, School of Medicine , Brisbane , Australia
| | - J W Pickering
- University of Otago, Christchurch Heart Institute , Christchurch , New Zealand
| | - M P Than
- Christchurch Hospital , Christchurch , New Zealand
| | - L Cullen
- University of Queensland, School of Medicine , Brisbane , Australia
| | - N L Mills
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
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Lee K, Doudesis D, Ferry AV, Chapman AR, Kimenai D, Tuck C, Strachan FE, Newby DE, Anand A, Shah ASV, Mills NL. Implementation of high-sensitivity cardiac troponin and risk of myocardial infarction or death at 5 years: a stepped-wedge cluster-randomised controlled trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Implementation of a high-sensitivity cardiac troponin I assay with the sex-specific 99th centile as the diagnostic threshold identifies more patients with myocardial injury and infarction, but whether this impacts on long-term clinical outcomes is unknown.
Purpose
In a prespecified analysis of a stepped-wedge cluster-randomised controlled trial performed across ten hospitals in Scotland, we evaluated the impact of implementing a high-sensitivity cardiac troponin I assay on outcomes at 5 years in consecutive patients with suspected acute coronary syndrome.
Methods
Throughout the trial, all 48,282 patients had cardiac troponin I concentrations measured using both a contemporary (standard care) and high-sensitivity (implementation) assay. During standard care, results from the high-sensitivity assay were concealed and the contemporary assay was used to guide care. Hospitals were randomly allocated to early (n=5) or late (n=5) implementation of the high-sensitivity assay using the sex-specific 99th centile to guide care and results from the contemporary assay were concealed. Patients reclassified by the high-sensitivity assay were defined as those with cardiac troponin concentrations above the sex-specific 99th centile but below the contemporary assay diagnostic threshold. Subsequent myocardial infarction or all-cause death at 5 years was compared before and after implementation using an adjusted Cox proportional hazards model in those reclassified by the high-sensitivity assay and stratified by index diagnosis.
Results
Overall, 10,360 patients had cardiac troponin concentrations greater than the sex-specific 99th centile of whom 1,771 (17%) were reclassified by the high-sensitivity assay. Compared to those identified as having elevated cardiac troponin by the contemporary assay, patients reclassified by the high-sensitivity assay were more likely to have non-ischemic myocardial injury (54% versus 28%) and less likely to have type 1 myocardial infarction (33% versus 59%; P<0.001 for both). In those reclassified, the 5-year incidence of subsequent myocardial infarction or all-cause death was 63% (456/720) before and 54% (567/1051) after implementation of the high-sensitivity assay (adjusted hazard ratio [aHR] 0.75 [95% CI 0.57–0.98]) (Figure 1). Following implementation, subsequent myocardial infarction or all-cause death at 5 years was reduced in patients with non-ischemic myocardial injury (aHR 0.66 [0.51–0.86]) but not type 1 or type 2 myocardial infarction (aHR 0.90 [0.78–1.03] and 0.81 [0.55–1.20], respectively).
Conclusions
In patients with suspected acute coronary syndrome, implementation of a high-sensitivity cardiac troponin assay was associated with a lower risk of subsequent myocardial infarction or death at 5 years. Improvements in outcome were greater in those with a diagnosis of non-ischemic myocardial injury rather than infarction.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation
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Affiliation(s)
- K Lee
- University of Edinburgh , Edinburgh , United Kingdom
| | - D Doudesis
- University of Edinburgh , Edinburgh , United Kingdom
| | - A V Ferry
- University of Edinburgh , Edinburgh , United Kingdom
| | - A R Chapman
- University of Edinburgh , Edinburgh , United Kingdom
| | - D Kimenai
- University of Edinburgh , Edinburgh , United Kingdom
| | - C Tuck
- University of Edinburgh , Edinburgh , United Kingdom
| | - F E Strachan
- University of Edinburgh , Edinburgh , United Kingdom
| | - D E Newby
- University of Edinburgh , Edinburgh , United Kingdom
| | - A Anand
- University of Edinburgh , Edinburgh , United Kingdom
| | - A S V Shah
- London School of Hygiene and Tropical Medicine , London , United Kingdom
| | - N L Mills
- University of Edinburgh , Edinburgh , United Kingdom
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Bularga A, Kimenai DM, Taggart C, Lowry M, Wereski R, McCance K, Lee KK, Anand A, Strachan FE, Tuck C, Shah ASV, Chapman AR, Newby DE, Jenks S, Mills NL. Impact of patient selection on performance of an early rule-out pathway for myocardial infarction: from research to the real world. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Early rule-out pathways for myocardial infarction using high-sensitivity cardiac troponin are widely recommended in the assessment of patients with suspected acute coronary syndrome. Although developed in selected patients participating in research studies, these pathways are applied more widely in clinical practice where the diagnostic performance and effectiveness of these pathways may differ.
Purpose
To evaluate the performance of an early rule-out pathway for myocardial infarction using high-sensitivity cardiac troponin in selected and consecutive unselected patients with suspected acute coronary syndrome.
Methods
Presentation and serial high-sensitivity cardiac troponin I concentrations were measured in two cohorts of patients with suspected acute coronary syndrome presenting to the Emergency Departments across three acute care hospitals in Scotland. In the unselected cohort, electronic health record data were collected on consecutive patients in whom the usual care clinician measured cardiac troponin for suspected acute coronary syndrome. In the selected cohort, patients with suspected acute coronary syndrome were approached between 8am and 8pm by research staff and written informed consent obtained. In both cohorts, the performance of the High-STEACS early rule-out pathway was evaluated for an adjudicated diagnosis of myocardial infarction (type 1, type 4b or type 4c) during the index hospital admission.
Results
The unselected and selected patient cohorts comprised of 1,242 (median age 60 [interquartile range 47–75] years, 46% women) and 1,695 (median age 61 [52–73] years, 40% women) patients respectively. Myocardial infarction was diagnosed in 6% (74/1,242) and 14% (232/1,695) of patients in the unselected and selected patient cohorts respectively. More patients had myocardial infarction ruled-out in the unselected (74% [828/1,112] versus 66% [1,102/1,678]; P<0.001), with similar negative predictive value (99.9% [95% CI 99.7%-100%] versus 99.7% [95% CI 99.4%-99.0%) and sensitivity (99.3% [95% CI 97.4%-100%] versus 98.9% [95% CI 97.6%-99.9%]; Figure 1). In the selected cohort, more patients had intermediate troponin concentrations requiring serial testing (36% versus 29%) or had myocardial infarction diagnosed (34% versus 26%; P<0.001 for both). In contrast, the positive predictive value for myocardial infarction was lower in unselected patients (26.1% [95% CI 21.2%-31.4%] versus 39.9% [95% CI 35.9%-44.0%]).
Conclusion
The prevalence of myocardial infarction is lower in patients with suspected acute coronary syndrome evaluated in routine practice compared to those selected to participate in a research study. Whilst more patients have myocardial infarction accurately ruled out, the positive-predictive value in those ruled in is lower resulting in more hospital admissions with elevated cardiac troponin due to other conditions.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): British Heart FoundationMedical Research Council
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Affiliation(s)
- A Bularga
- University of Edinburgh , Edinburgh , United Kingdom
| | - D M Kimenai
- University of Edinburgh , Edinburgh , United Kingdom
| | - C Taggart
- University of Edinburgh , Edinburgh , United Kingdom
| | - M Lowry
- University of Edinburgh , Edinburgh , United Kingdom
| | - R Wereski
- University of Edinburgh , Edinburgh , United Kingdom
| | - K McCance
- University of Edinburgh, Department Clinical Biochemistry, , Edinburgh , United Kingdom
| | - K K Lee
- University of Edinburgh , Edinburgh , United Kingdom
| | - A Anand
- University of Edinburgh , Edinburgh , United Kingdom
| | - F E Strachan
- University of Edinburgh , Edinburgh , United Kingdom
| | - C Tuck
- University of Edinburgh , Edinburgh , United Kingdom
| | - A S V Shah
- London School of Hygiene and Tropical Medicine, Department of Cardiology , London , United Kingdom
| | - A R Chapman
- University of Edinburgh , Edinburgh , United Kingdom
| | - D E Newby
- University of Edinburgh , Edinburgh , United Kingdom
| | - S Jenks
- Royal Infirmary of Edinburgh, Department of Clinical Biochemistry , Edinburgh , United Kingdom
| | - N L Mills
- University of Edinburgh , Edinburgh , United Kingdom
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35
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Lier S, Rein I, Lund S, Lång A, Lång E, Meyer N, Dutta A, Anand S, Nesse G, Johansen R, Klungland A, Rinholm J, Bøe S, Anand A, Pollard S, Lerdrup M, Pandey D. P10.12.A CDK12/CDK13 inhibition disrupts a transcriptional program critical for glioblastoma survival. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Glioblastoma multiforme (GBM) is the most prevalent and aggressive malignant tumor of the central nervous system. With a median survival of only one year, GBM patients have a particularly poor prognosis, highlighting a clear need for novel therapeutic strategies to target this disease. Transcriptional cyclin-dependent kinases (CDK), which phosphorylate key residues of RNA polymerase II (RNAPII) C-terminal domain (CTD), play a major role in sustaining aberrant transcriptional programs that are key to development and maintenance of cancer cells.
Material and Methods
We used pharmacological inhibition and genetic ablation to study effects of CDK12/CDK13 depletion on the proliferatory and migratory capacity of GBM cells and mouse xenografts. SLAM-seq, CUT&RUN and cell cycle assays were used to study the mechanistic effects of CDK12/CDK13 depletion in GBM cells.
Results
CDK12/CDK13 depletion markedly reduced the proliferatory and migratory capacity of GBM cells, as well as in vivo growth. CDK12/CDK13 inhibition potentiated existing chemotherapeutic treatments. Mechanistically, inhibition of CDK12/CDK13 leads to a genome-wide abrogation of RNAPII CTD phosphorylation, which in turn disrupts transcription and cell cycle progression in GBM cells.
Conclusion
These results provide proof-of-concept for the potential of CDK12 and CDK13 as therapeutic targets for GBM.
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Affiliation(s)
- S Lier
- Institute of Basic Medical Sciences, University of Oslo , Oslo , Norway
- Dept. of Microbiology, Oslo University Hospital , Oslo , Norway
| | - I Rein
- Dept. of Radiation Biology, Oslo University Hospital , Oslo , Norway
| | - S Lund
- Dept. of Microbiology, Oslo University Hospital , Oslo , Norway
| | - A Lång
- Dept. of Microbiology, Oslo University Hospital , Oslo , Norway
| | - E Lång
- Dept. of Microbiology, Oslo University Hospital , Oslo , Norway
| | - N Meyer
- Institute of Basic Medical Sciences, University of Oslo , Oslo , Norway
- Dept. of Microbiology, Oslo University Hospital , Oslo , Norway
| | - A Dutta
- Dept. of Computer Science and Engineering, Indian Institute of Technology, Guwahati , Assam , India
| | - S Anand
- Department of Informatics, Systems and Communications, University of Milano-Bicocca , Milan , Italy
| | - G Nesse
- Dept. of Microbiology, Oslo University Hospital , Oslo , Norway
| | - R Johansen
- Dept. of Microbiology, Oslo University Hospital , Oslo , Norway
| | - A Klungland
- Dept. of Microbiology, Oslo University Hospital , Oslo , Norway
- Dept. of Biosciences, University of Oslo , Oslo , Norway
| | - J Rinholm
- Institute of Basic Medical Sciences, University of Oslo , Oslo , Norway
- Dept. of Microbiology, Oslo University Hospital , Oslo , Norway
| | - S Bøe
- Dept. of Microbiology, Oslo University Hospital , Oslo , Norway
| | - A Anand
- Dept. of Computer Science and Engineering, Indian Institute of Technology, Guwahati , Assam , India
| | - S Pollard
- MRC Centre for Regenerative Medicine, SCRM Building, University of Edinburgh , Edinburgh , United Kingdom
| | - M Lerdrup
- Center for Chromosome Stability (CCS), Department of Cellular and Molecular Medicine, University of Copenhagen , Copenhagen , Denmark
| | - D Pandey
- Dept. of Microbiology, Oslo University Hospital , Oslo , Norway
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36
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Anand A, Harwood DS, Bishop C, Todd K, Ellis R, Ellis R, Poulsen FR, Kristensen BW. P12.08.A Uncovering the glioblastoma tumor-microenvironment by high-end multiplexing with imaging mass cytometry. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Glioblastoma is one of the most aggressive cancers, and hypoxia plays an essential role in its tumor- microenvironment. Tumor-associated microglia and macrophages (TAMs) have been reported to constitute up to 30 % of the cells, a fraction that is even higher in hypoxic areas. Single-cell mRNA sequencing of glioblastoma tumors has revealed vast heterogeneity, but the spatial aspects are not entirely defined yet. The aim of this study was to uncover differences between the hypoxic and normoxic tumor-microenvironment of human glioblastoma by high-end multiplexing with imaging mass cytometry.
Material and Methods
A tissue microarray (TMA) with normoxic and hypoxic areas from 4 IDH-wildtype glioblastomas was prepared based on the hypoxia marker hypoxia-inducing factor 1 alpha (HIF1 alpha). The TMA was stained with 18 metal-tagged antibodies covering TAMs, lymphocytes, immune checkpoints, vessels, tumor cells and proliferation. The Hyperion-CYTOF technology was used to ablate the samples and the images were analyzed by MCD viewer, Visiopharm software, and customized R scripts.
Results
Single-cell analysis of 160 fields covering around 45,000 cells in the glioblastoma microenvironment revealed multiple cellular phenotypes. It was revealed that proliferating TAMs (IBA1+, Ki67+) were more frequent in hypoxia, whereas proliferating vessels (CD34+, Ki67+) were more frequent in normoxia. Additionally, proliferating stem-like tumor cells (OLIG-2+, Ki67+) were more frequent in normoxia regions.
Conclusion
Our study revealed multiple cellular phenotypes in the glioblastoma microenvironment. The TAMs, endothelial and tumor cell phenotypes revealed may play a critical role in glioblastoma biology however this needs to be elucidated in future studies.
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Affiliation(s)
- A Anand
- Department of Pathology, The Bartholin Institute, Rigshospitalet , Copenhagen , Denmark
- Department of Pathology, The Bartholin Institute, Rigshospitalet , Copenhagen , Denmark
| | - D S Harwood
- Department of Pathology, The Bartholin Institute, Rigshospitalet , Copenhagen , Denmark
| | - C Bishop
- NIHR Guy's and St Thomas' Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London , London , United Kingdom
| | - K Todd
- NIHR Guy's and St Thomas' Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London , London , United Kingdom
| | - R Ellis
- NIHR Guy's and St Thomas' Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London , London , United Kingdom
| | - R Ellis
- NIHR Guy's and St Thomas' Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London , London , United Kingdom
| | - F R Poulsen
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark, OUH , Odense , Denmark
| | - B W Kristensen
- Department of Pathology, The Bartholin Institute, Rigshospitalet , Copenhagen , Denmark
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Tryggestad E, Anand A, Beltran C, Brooks J, Cimmiyotti J, Grimaldi N, Hodge T, Hunzeker A, Lucido JJ, Laack NN, Momoh R, Moseley DJ, Patel SH, Ridgway A, Seetamsetty S, Shiraishi S, Undahl L, Foote RL. Scalable radiotherapy data curation infrastructure for deep-learning based autosegmentation of organs-at-risk: A case study in head and neck cancer. Front Oncol 2022; 12:936134. [PMID: 36106100 PMCID: PMC9464982 DOI: 10.3389/fonc.2022.936134] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/03/2022] [Indexed: 12/02/2022] Open
Abstract
In this era of patient-centered, outcomes-driven and adaptive radiotherapy, deep learning is now being successfully applied to tackle imaging-related workflow bottlenecks such as autosegmentation and dose planning. These applications typically require supervised learning approaches enabled by relatively large, curated radiotherapy datasets which are highly reflective of the contemporary standard of care. However, little has been previously published describing technical infrastructure, recommendations, methods or standards for radiotherapy dataset curation in a holistic fashion. Our radiation oncology department has recently embarked on a large-scale project in partnership with an external partner to develop deep-learning-based tools to assist with our radiotherapy workflow, beginning with autosegmentation of organs-at-risk. This project will require thousands of carefully curated radiotherapy datasets comprising all body sites we routinely treat with radiotherapy. Given such a large project scope, we have approached the need for dataset curation rigorously, with an aim towards building infrastructure that is compatible with efficiency, automation and scalability. Focusing on our first use-case pertaining to head and neck cancer, we describe our developed infrastructure and novel methods applied to radiotherapy dataset curation, inclusive of personnel and workflow organization, dataset selection, expert organ-at-risk segmentation, quality assurance, patient de-identification, data archival and transfer. Over the course of approximately 13 months, our expert multidisciplinary team generated 490 curated head and neck radiotherapy datasets. This task required approximately 6000 human-expert hours in total (not including planning and infrastructure development time). This infrastructure continues to evolve and will support ongoing and future project efforts.
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Affiliation(s)
- E. Tryggestad
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, United States
- *Correspondence: E. Tryggestad,
| | - A. Anand
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - C. Beltran
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, FL, United States
| | - J. Brooks
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, United States
| | - J. Cimmiyotti
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, United States
| | - N. Grimaldi
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, United States
| | - T. Hodge
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, United States
| | - A. Hunzeker
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, United States
| | - J. J. Lucido
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, United States
| | - N. N. Laack
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, United States
| | - R. Momoh
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, United States
| | - D. J. Moseley
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, United States
| | - S. H. Patel
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - A. Ridgway
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - S. Seetamsetty
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, United States
| | - S. Shiraishi
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, United States
| | - L. Undahl
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, United States
| | - R. L. Foote
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, United States
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Anand A, Hellings S, Garg S, Punnen J, Nagamalesh UM, Selvam S, Raghuraman B, Date O, Kumaran S, Narayan P, Udwadia A, Gordon DA, Zhao L, Gulia J. Abstract P1117: Transcriptional Changes In Failing Hearts In A South Asian Cohort Capture Molecular Pathophysiology Underlying Maladaptive Remodelling And Reflect A Consistent Disease Gene Signature. Circ Res 2022. [DOI: 10.1161/res.131.suppl_1.p1117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Heart failure (HF) is a leading cause of death worldwide and research focused on human cardiac tissue provides insights into underlying disease mechanisms. In this study, we performed transcriptome analyses on cardiac tissue from 21 South Asian (SA) HF patients and compared them with 21 controls without HF. The aim was to i) probe dysregulated genes and pathways in HF and ii) identify a core HF gene signature conserved across etiologies and ethnicities. Gene set enrichment analyses on dysregulated genes (DGs) showed positive enrichment of Gene Ontology terms for ECM remodelling, immune signalling and negative enrichment of terms like cardiac conduction, muscle contraction reflecting altered molecular signalling and cellular cross-talk in failing hearts. The immune cell signatures among the DGs suggest changes in immune milieu which correlates with altered immune signalling pathways. Although poor concordance in DGs across studies on HF transcriptome is well documented, evidence on stratification potential of select DGs is still preliminary. Using an independent component analysis and a machine learning based workflow, we identified gene signatures from two cohorts (SA, GSE116250) independently. We refined these into a core signature after cross validating their stratification potential and by removing the genes with low potential. The core signature effectively separated HF from control samples in SA, GSE116250 and other cohorts potentially reflecting central elements underlying end stage HF. In summary, the transcriptome analyses from SA HF cohort highlights the pathways reflecting HF pathophysiology and reiterates conserved themes across public HF cohorts.
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Affiliation(s)
| | | | | | - Julius Punnen
- Narayana Institute of Cardiac Sciences, Bengaluru, India
| | | | | | | | | | | | | | | | | | - Lei Zhao
- BRISTOL MYERS SQUIBB, Pennington, NJ
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Hohman JA, Martinez KA, Anand A, Rood M, Martyn T, Rose S, Rothberg MB. Use of Direct-to-Consumer Telemedicine to Access Mental Health Services. J Gen Intern Med 2022; 37:2759-2767. [PMID: 35091925 PMCID: PMC8799413 DOI: 10.1007/s11606-021-07326-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 12/14/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND The coronavirus disease 2019 pandemic has contributed to growing demand for mental health services, but patients face significant barriers to accessing care. Direct-to-consumer(DTC) telemedicine has been proposed as one way to increase access, yet little is known about its pre-pandemic use for mental healthcare. OBJECTIVE To characterize patients, providers, and their use of a large nationwide DTC telemedicine platform for mental healthcare. DESIGN Retrospective cross-sectional study. SETTING Mental health encounters conducted on the American Well DTC telemedicine platform from 2016 to 2018. PARTICIPANTS Patients and physicians. MAIN MEASURES Patient measures included demographics, insurance report, and number of visits. Provider characteristics included specialty, region, and number of encounters. Encounter measures included wait time, visit length and timing, out-of-pocket payment, coupon use, prescription outcome, referral receipt, where care otherwise would have been sought, and patient satisfaction. Factors associated with five-star physician ratings and prescription receipt were assessed using logistic regression. KEY RESULTS We analyzed 19,270 mental health encounters between 6708 patients and 1045 providers. Visits were most frequently for anxiety (39.1%) or depression (32.5%), with high satisfaction (4.9/5) across conditions. Patients had a median 2.0 visits for psychiatry (IQR 1.0-3.0) and therapy (IQR 1.0-5.0), compared to 1.0 visit (IQR 1.0-1.0) for urgent care. High satisfaction was positively correlated with prescription receipt (OR 1.89, 95% CI 1.54-2.32) and after-hours timing (aOR 1.18, 95% CI 1.02-1.36). Prescription rates ranged from 79.6% for depression to 32.2% for substance use disorders. Prescription receipt was associated with increased visit frequency (aOR 1.95, 95% CI 1.57-2.42 for ≥ 3 visits). CONCLUSIONS As the burden of psychiatric disease grows, DTC telemedicine offers one solution for extending access to mental healthcare. While most encounters were one-off, evidence of some continuity in psychiatry and therapy visits-as well as overall high patient satisfaction-suggests potential for broader DTC telemental health use.
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Affiliation(s)
- Jessica A Hohman
- Cleveland Clinic Center for Value-Based Care Research, Cleveland, OH, USA. .,Cleveland Clinic Community Care, Cleveland, OH, USA.
| | - Kathryn A Martinez
- Cleveland Clinic Center for Value-Based Care Research, Cleveland, OH, USA
| | - Amit Anand
- Cleveland Clinic Center for Behavioral Health, Cleveland, OH, USA
| | - Mark Rood
- Cleveland Clinic Community Care, Cleveland, OH, USA
| | - Trejeeve Martyn
- Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA
| | - Susannah Rose
- Office of Patient Experience, Cleveland Clinic, Cleveland, OH, USA
| | - Michael B Rothberg
- Cleveland Clinic Center for Value-Based Care Research, Cleveland, OH, USA.,Cleveland Clinic Community Care, Cleveland, OH, USA
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Federoff M, McCarthy MJ, Anand A, Berrettini WH, Bertram H, Bhattacharjee A, Calkin CV, Conroy C, Coryell WH, D'Arcangelo N, DeModena A, Fisher C, Feeder S, Frazier N, Frye MA, Gao K, Garnham J, Gershon ES, Alliey-Rodriguez N, Glazer K, Goes F, Karberg T, Harrington G, Jakobsen P, Kamali M, Kelly M, Leckband SG, Lohoff F, Maihofer AX, McInnis MG, Mondimore F, Morken G, Nurnberger JI, Oedegaard KJ, Ritchey M, Ryan K, Schinagle M, Schoeyen H, Schwebel C, Shaw M, Shilling PD, Slaney C, Stautland A, Tarwater B, Calabrese JR, Alda M, Nievergelt CM, Zandi PP, Kelsoe JR. Correction of depression-associated circadian rhythm abnormalities is associated with lithium response in bipolar disorder. Bipolar Disord 2022; 24:521-529. [PMID: 34825444 DOI: 10.1111/bdi.13162] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is characterized by episodes of depression and mania and disrupted circadian rhythms. Lithium is an effective therapy for BD, but only 30%-40% of patients are fully responsive. Preclinical models show that lithium alters circadian rhythms. However, it is unknown if the circadian rhythm effects of lithium are essential to its therapeutic properties. METHODS In secondary analyses of a multi-center, prospective, trial of lithium for BD, we examined the relationship between circadian rhythms and therapeutic response to lithium. Using standardized instruments, we measured morningness, diurnal changes in mood, sleep, and energy (circadian rhythm disturbances) in a cross-sectional study of 386 BD subjects with varying lithium exposure histories. Next, we tracked symptoms of depression and mania prospectively over 12 weeks in a subset of 88 BD patients initiating treatment with lithium. Total, circadian, and affective mood symptoms were scored separately and analyzed. RESULTS Subjects with no prior lithium exposure had the most circadian disruption, while patients stable on lithium monotherapy had the least. Patients who were stable on lithium with another drug or unstable on lithium showed intermediate levels of disruption. Treatment with lithium for 12 weeks yielded significant reductions in total and affective depression symptoms. Lithium responders (Li-Rs) showed improvement in circadian symptoms of depression, but non-responders did not. There was no difference between Li-Rs and nonresponders in affective, circadian, or total symptoms of mania. CONCLUSIONS Exposure to lithium is associated with reduced circadian disruption. Lithium response at 12 weeks was selectively associated with the reduction of circadian depressive symptoms. We conclude that stabilization of circadian rhythms may be an important feature of lithium's therapeutic effects. CLINICAL TRIALS REGISTRY NCT0127253.
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Affiliation(s)
- Monica Federoff
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Michael J McCarthy
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Department of Psychiatry, VA San Diego Healthcare System, La Jolla, California, USA
| | - Amit Anand
- Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio, USA
| | - Wade H Berrettini
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Abesh Bhattacharjee
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Department of Psychiatry, VA San Diego Healthcare System, La Jolla, California, USA
| | | | - Carla Conroy
- Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Nicole D'Arcangelo
- Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio, USA
| | - Anna DeModena
- Department of Psychiatry, VA San Diego Healthcare System, La Jolla, California, USA
| | - Carrie Fisher
- Departments of Psychiatry and Medical and Molecular Genetics, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | | | - Keming Gao
- Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | | | - Kara Glazer
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Fernando Goes
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Toyomi Karberg
- Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Petter Jakobsen
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Norway
| | | | - Marisa Kelly
- University of Michigan, Ann Arbor, Michigan, USA
| | - Susan G Leckband
- Department of Psychiatry, VA San Diego Healthcare System, La Jolla, California, USA
| | - Falk Lohoff
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Adam X Maihofer
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | | | - Francis Mondimore
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Gunnar Morken
- Division of Psychiatry, St. Olav University Hospital of Trondheim and Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - John I Nurnberger
- Departments of Psychiatry and Medical and Molecular Genetics, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ketil J Oedegaard
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Norway
| | - Megan Ritchey
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kelly Ryan
- University of Michigan, Ann Arbor, Michigan, USA
| | - Martha Schinagle
- Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio, USA
| | - Helle Schoeyen
- Department of Clinical Medicine, University of Bergen, Norway.,Clinic of Adult Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Candice Schwebel
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Martha Shaw
- University of Chicago, Chicago, Illinois, USA
| | - Paul D Shilling
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | | | | | | | - Joseph R Calabrese
- Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Caroline M Nievergelt
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Peter P Zandi
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - John R Kelsoe
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
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Spielberg JM, Sadeh N, Cha J, Matyi MA, Anand A. Affect Regulation-Related Emergent Brain Network Properties Differentiate Depressed Bipolar Disorder From Major Depression and Track Risk for Bipolar Disorder. Biol Psychiatry Cogn Neurosci Neuroimaging 2022; 7:765-773. [PMID: 34637954 PMCID: PMC8993939 DOI: 10.1016/j.bpsc.2021.09.007] [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] [Received: 05/07/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Individuals with or at risk for bipolar disorder (BD) often present initially for the treatment of depressive symptoms. Unfortunately, pharmacological treatments for major depressive disorder (MDD) can be iatrogenic, precipitating mania that may not have otherwise occurred. Current diagnostic procedures rely solely on self-reported/observable symptoms, and thus alternative data sources, such as brain network properties, are needed to supplement current self-report/observation-based indices of risk for mania. METHODS Brain connectivity during affect maintenance/regulation was examined in a large (N = 249), medication-free sample of currently depressed patients with BD (n = 50) and MDD (n = 116) and healthy control subjects (n = 83). BD risk was categorized in a subset of patients with MDD. We used graph theory to identify emergent network properties that differentiated between patients with BD and MDD and between patients with MDD at high and low risk for BD. RESULTS BD and MDD differed in the extent to which the rostral anterior cingulate cortex was embedded in the local network, amount of influence the hippocampus exerted over global network communication, and clarity of orbitofrontal cortex communication. Patients with MDD at high risk for BD showed a pattern of local network clustering around the right amygdala that was similar to the pattern observed in healthy control subjects, whereas patients with MDD at low risk for BD deviated from this pattern. CONCLUSIONS BD and MDD differed in emergent network mechanisms subserving affect regulation, and amygdala properties tracked BD risk in patients with MDD. If replicated, our findings may be combined with other markers to assess the presence of BD and/or BD risk in individuals presenting with depressive symptoms to prevent the use of iatrogenic treatments.
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Affiliation(s)
- Jeffrey M Spielberg
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware.
| | - Naomi Sadeh
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware
| | - Jungwon Cha
- Center for Behavioral Health, Cleveland Clinic, Cleveland, Ohio; Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Melanie A Matyi
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware
| | - Amit Anand
- Center for Behavioral Health, Cleveland Clinic, Cleveland, Ohio; Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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Anand A, Roche D, Wright SR, Tjong VK, Rana JK, Abouali J. A qualitative assessment of perceptions and attitudes toward postoperative pain and opioid use in patients undergoing elective knee arthroscopy. Can J Surg 2022; 65:E440-E446. [PMID: 35790242 PMCID: PMC9337868 DOI: 10.1503/cjs.004321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Orthopedic surgeons routinely prescribe opioids to manage post-operative pain. In the face of an opioid epidemic, a one-size-fits-all approach to pain management is no longer appropriate. Patient-centred prescribing practices should be used by surgeons; however, little is known about what influences patient attitudes toward postoperative pain and its management to inform such practices. We sought to explore patient attitudes toward postsurgical pain management, including opioids. Methods: We conducted qualitative, semistructured interviews of 11 opioid-naive patients (age 16–46 yr) who were scheduled to undergo arthroscopic knee surgery. Transcripts were analyzed thematically using a framework analysis that involved familiarization, developing a thematic framework, indexing, charting and mapping, and interpretation. Results: Participant attitudes toward postoperative pain and opioids were influenced by perceived tolerance to pain based on personal experience, perceived predisposition to addiction based on personal assumptions regarding addictive personality traits and risk factors, and perceptions of opioid use shaped by external influences, including family, friends and the media’s depiction of the opioid epidemic. Every patient expressed that preoperative counselling and education regarding postoperative pain management would be beneficial in improving their knowledge base, easing anxieties and clarifying misunderstandings. Conclusion: Surgeons can address the patient-reported factors identified in this study to help optimize a patient’s perioperative experience without relying solely on prescribed analgesia. By improving accessibility to education and promoting safe, patient-centred prescribing practices, we may reduce reliance on opioids in orthopedic surgery.
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Affiliation(s)
- Amit Anand
- From the Department of Orthopaedic Surgery (Anand, Abouali), University of Toronto, Toronto, Ont.; Royal College of Surgeons in Ireland (Roche), Dublin, Ireland; The Wilson Centre (Wright) and the Department of Family and Community Medicine (Wright), Michael Garron Hospital, Toronto East Health Network, Toronto, Ont.; Department of Orthopaedic Surgery (Tjong), Northwestern University Feinberg School of Medicine, Chicago, Ill.; Women's Health in Women's Hands Community Health Centre (Rana), Toronto, Ont.
| | - Donal Roche
- From the Department of Orthopaedic Surgery (Anand, Abouali), University of Toronto, Toronto, Ont.; Royal College of Surgeons in Ireland (Roche), Dublin, Ireland; The Wilson Centre (Wright) and the Department of Family and Community Medicine (Wright), Michael Garron Hospital, Toronto East Health Network, Toronto, Ont.; Department of Orthopaedic Surgery (Tjong), Northwestern University Feinberg School of Medicine, Chicago, Ill.; Women's Health in Women's Hands Community Health Centre (Rana), Toronto, Ont
| | - Sarah R Wright
- From the Department of Orthopaedic Surgery (Anand, Abouali), University of Toronto, Toronto, Ont.; Royal College of Surgeons in Ireland (Roche), Dublin, Ireland; The Wilson Centre (Wright) and the Department of Family and Community Medicine (Wright), Michael Garron Hospital, Toronto East Health Network, Toronto, Ont.; Department of Orthopaedic Surgery (Tjong), Northwestern University Feinberg School of Medicine, Chicago, Ill.; Women's Health in Women's Hands Community Health Centre (Rana), Toronto, Ont
| | - Vehniah K Tjong
- From the Department of Orthopaedic Surgery (Anand, Abouali), University of Toronto, Toronto, Ont.; Royal College of Surgeons in Ireland (Roche), Dublin, Ireland; The Wilson Centre (Wright) and the Department of Family and Community Medicine (Wright), Michael Garron Hospital, Toronto East Health Network, Toronto, Ont.; Department of Orthopaedic Surgery (Tjong), Northwestern University Feinberg School of Medicine, Chicago, Ill.; Women's Health in Women's Hands Community Health Centre (Rana), Toronto, Ont
| | - Jesleen K Rana
- From the Department of Orthopaedic Surgery (Anand, Abouali), University of Toronto, Toronto, Ont.; Royal College of Surgeons in Ireland (Roche), Dublin, Ireland; The Wilson Centre (Wright) and the Department of Family and Community Medicine (Wright), Michael Garron Hospital, Toronto East Health Network, Toronto, Ont.; Department of Orthopaedic Surgery (Tjong), Northwestern University Feinberg School of Medicine, Chicago, Ill.; Women's Health in Women's Hands Community Health Centre (Rana), Toronto, Ont
| | - Jihad Abouali
- From the Department of Orthopaedic Surgery (Anand, Abouali), University of Toronto, Toronto, Ont.; Royal College of Surgeons in Ireland (Roche), Dublin, Ireland; The Wilson Centre (Wright) and the Department of Family and Community Medicine (Wright), Michael Garron Hospital, Toronto East Health Network, Toronto, Ont.; Department of Orthopaedic Surgery (Tjong), Northwestern University Feinberg School of Medicine, Chicago, Ill.; Women's Health in Women's Hands Community Health Centre (Rana), Toronto, Ont
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Anand A, Singh SP, Sahu M, Hote MP, Singh U, Reddy PR. Postoperative Mortality in Surgically Treated Infective Endocarditis Patients and Its Correlation with EuroSCORE I. Journal of Cardiac Critical Care TSS 2022. [DOI: 10.1055/s-0042-1750194] [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: 10/18/2022] Open
Abstract
Abstract
Introduction Even after advances in medical and surgical treatment, infective endocarditis is associated with substantial morbidity and mortality. The aim of this study was to evaluate postoperative mortality in surgically treated infective endocarditis patients and its correlation with the European System for Cardiac Operative Risk Evaluation (EuroSCORE) I.
Methods This retrospective observational study included 43 patients treated surgically for infective endocarditis, between 2014 and 2019, at a tertiary care center. Mortality in surgically treated infective endocarditis patients was determined in terms of frequency (%). Patients were divided into two groups—survivors and nonsurvivors (died within 30 days of surgery). Mean EuroSCORE I of survivors and nonsurvivors was compared using the unpaired t-test with equal variance. A correlation was sought between mortality and EuroSCORE I as well. The prediction ability of EuroSCORE I for mortality was determined by the area under receiver operating characteristic curve.
Results Out of 43 patients who underwent surgery for infective endocarditis,11 patients (25.58%) died. Mean EuroSCORE I was 15.90 ± 2.02 in nonsurvivors and 7.84 ± 3.19 in survivors. EuroSCORE I was significantly higher in nonsurvivors (p < 0.05). The area under curve value was 0.9744 (p < 0.001), thus showing that EuroSCORE I predicts mortality in surgically treated infective endocarditis patients.
Conclusion The 30-day mortality in patients who underwent surgery for infective endocarditis was 25.58%. There is a significant correlation between EuroSCORE I and mortality. A EuroSCORE I value >14 predicts mortality in surgically treated infective endocarditis patients with sensitivity and specificity of 90.91 and 90.63%, respectively.
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Affiliation(s)
- Amit Anand
- Department of Cardiothoracic and Vascular Surgery, Cadio-Thoracic Centre, All India Institute of Medical Sciences, New Delhi
| | - Sarvesh Pal Singh
- Department of Cardiothoracic and Vascular Surgery, Cadio-Thoracic Centre, All India Institute of Medical Sciences, New Delhi
| | - Manoj Sahu
- Department of Cardiothoracic and Vascular Surgery, Cadio-Thoracic Centre, All India Institute of Medical Sciences, New Delhi
| | - Milind Padmakar Hote
- Department of Cardiothoracic and Vascular Surgery, Cadio-Thoracic Centre, All India Institute of Medical Sciences, New Delhi
| | - Ummed Singh
- Department of Cardiothoracic and Vascular Surgery, Cadio-Thoracic Centre, All India Institute of Medical Sciences, New Delhi
| | - Pradeep Ramakrishnan Reddy
- Department of Cardiothoracic and Vascular Surgery, Cadio-Thoracic Centre, All India Institute of Medical Sciences, New Delhi
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44
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Daud A, Perlus R, Anand A, Safir OA, Gross AE, Kuzyk PR. Mid-term outcomes of the Wagner Cone Prosthesis™ stem for developmental dysplasia of the hip: minimum two year follow-up. Int Orthop 2022; 46:1733-1740. [PMID: 35593929 DOI: 10.1007/s00264-022-05437-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/06/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Treatment of symptomatic developmental dysplasia of the hip (DDH) requires a technically demanding total hip arthroplasty (THA) reconstruction. In patients with DDH, prostheses can be difficult to implant and often face the risk of fracture, mismatch, and loosening. The Wagner Cone Prosthesis™ is a tapered, conical stem which can improve treatment success in this population. We look at midterm survivorship and outcomes of THA for DDH using the Wagner Cone Prosthesis™. METHODS We retrospectively analyzed 28 patients (33 hips) with DDH undergoing THA using the Wagner Cone Prosthesis™ between January 2008 and January 2020. Ten, nine, and fourteen included patients were classified as Hartofilakidis A, B, and C, respectively. Survivorship according to Kaplan-Meier analysis was the primary outcome, with re-operation and revision as endpoints. The Oxford hip score (OHS) was used to assess clinical outcome. We used multivariate analysis to determine predictors of poor outcomes. The average follow-up was 4.6 years, with a minimum of two years. RESULTS Kaplan-Meier survivorship over the 13-year study period was 93.9 ± 4.2% for all-cause revision as an endpoint and 96.9 ± 3.1% for stem revisions only. The overall reoperation rate was 6.1%, with periprosthetic fracture and dislocation being reasons for re-operation. No patients were revised for aseptic loosening, and no patients were revised for subsidence. OHS improved from 19.3 ± 9.6 (4-39) pre-operatively to 37.6 ± 8.4 (19-48) at latest follow-up (p < 0.05). CONCLUSION In patients with DDH, THA with the Wagner Cone Prosthesis™ demonstrates excellent clinical, radiographic, and patient-reported functional outcomes at midterm follow-up.
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Affiliation(s)
- Anser Daud
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada. .,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, M5G 1X5, Canada.
| | - Ryan Perlus
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, M5G 1X5, Canada
| | - Amit Anand
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, M5G 1X5, Canada
| | - Oleg A Safir
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, M5G 1X5, Canada
| | - Allan E Gross
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, M5G 1X5, Canada
| | - Paul R Kuzyk
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, M5G 1X5, Canada
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45
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Murthy V, Chilukuri S, Mallick I, Maitre P, Agarwal A, Moses A, James F, Narang K, Kataria T, Anand A, Dutta D, Mitra S, Pavamani S, Mallick S, Mahale N, Chandra M, Narayan A, Shahid T, Sairam M, Kannan V, Mohanty S, Basu T, Hotwani C, G B. OC-0606 Multi-institutional outcomes of Gleason grade group 5 prostate cancers treated with EBRT and ADT. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02628-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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46
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Cha J, Spielberg JM, Hu B, Altinay M, Anand A. Differences in network properties of the structural connectome in bipolar and unipolar depression. Psychiatry Res Neuroimaging 2022; 321:111442. [PMID: 35152051 PMCID: PMC10577577 DOI: 10.1016/j.pscychresns.2022.111442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Differentiation between Bipolar Disorder Depression (BDD) and Unipolar Major Depressive Disorder (MDD) is critical to clinical practice. This study investigated machine learning classification of BDD and MDD using graph properties of Diffusion-weighted Imaging (DWI)-based structural connectome. METHODS This study included a large number of medication-free (N =229) subjects: 60 BDD, 95 MDD, and 74 Healthy Control (HC) subjects. DWI probabilistic tractography was performed to create Fractional Anisotropy (FA) and Total Streamline (TS)-based structural connectivity matrices. Global and nodal graph properties were computed from these matrices and tested for group differences. Next, using identified graph properties, machine learning classification (MLC) between BDD, MDD, MDD with risk factors for developing BD (MDD+), and MDD without risk factors for developing BD (MDD-) was conducted. RESULTS Communicability Efficiency of the left superior frontal gyrus (SFG) was significantly higher in BDD vs. MDD. In particular, Communicability Efficiency using TS-based connectivity in the left SFG as well as FA-based connectivity in the right middle anterior cingulate area was higher in the BDD vs. MDD- group. There were no significant differences in graph properties between BDD and MDD+. Direct comparison between MDD+ and MDD- showed differences in Eigenvector Centrality (TS-based connectivity) of the left middle frontal sulcus. Acceptable Area Under Curve (AUC) for classification were seen between the BDD and MDD- groups, and between the MDD+ and MDD- groups, using the differing graph properties. CONCLUSION Graph properties of DWI-based connectivity can discriminate between BDD and MDD subjects without risk factors for BD.
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Affiliation(s)
- Jungwon Cha
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, USA; Center for Behavioral Health, Cleveland Clinic, USA
| | | | - Bo Hu
- Center for Quantitative Health Sciences, Cleveland Clinic, USA
| | | | - Amit Anand
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, USA; Center for Behavioral Health, Cleveland Clinic, USA
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47
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Cha J, Spielberg JM, Hu B, Altinay M, Anand A. Resting-state functional connectivity graph-properties correlate with bipolar disorder-risk in young medication-free depressed subjects: Bipolar-risk Resting State Functional Connectivity in Major Depression. J Affect Disord 2022; 301:52-59. [PMID: 35007643 DOI: 10.1016/j.jad.2022.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/28/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Major Depressive Disorder (MDD) is frequently associated with risk factors for the development of Bipolar Disorder (BD). Using graph theory, we investigated brain network properties associated with BD risk factors in young MDD subjects. METHODS Resting-state fMRI was acquired from a large cohort (N= 104) of medication-free currently depressed participants (25 BD depression (BDD), 79 MDD). Lifetime mania symptom count (LMSC), current Young Mania Rating Scale (YMRS) score, and family history of mood disorders (FHMD) were examined as BD risk factors. Functional connectivity matrices from 280 regions of interests (ROIs) were first entered into the Network Based Statistic (NBS) toolbox to identify connections that varied with each risk factor. Next, within the correlated network for each risk factor, global and nodal graph properties for the top five linked nodes were calculated. Last, using identified graph properties, machine learning classification (MLC) between BDD, MDD with BD risk factors (MDD+), and without BD risk factors (MDD-) was conducted. RESULTS LMSC positively correlated with left lateral orbitofrontal cortex (LOFC) Communication Efficiency and with left middle temporal Eigenvector Centrality. Current YMRS score positively correlated with right amygdala Communication Efficiency and Closeness Centrality. FHMD positively correlated with right insula Eigenvector Centrality. Acceptable MLC accuracy was seen between BDD and MDD- using middle temporal Eigenvector Centrality, whereas moderate accuracy was seen between MDD+ and MDD- using OFC Communication Efficiency. LIMITATION Although participants were medication-free, they were not medication-naïve. CONCLUSION Functional connectome graph properties may serve as BD vulnerability biomarkers in young individuals with MDD.
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Affiliation(s)
- Jungwon Cha
- Department of Psychiatry, Mass General Brigham, Harvard Medical School, United States
| | - Jeffrey M Spielberg
- Department of Psychological and Brain Sciences, University of Delaware, United States
| | - Bo Hu
- Center for Quantitative Health Sciences, Cleveland Clinic, United States
| | - Murat Altinay
- Center for Behavioral Health, Cleveland Clinic, United States
| | - Amit Anand
- Department of Psychiatry, Mass General Brigham, Harvard Medical School, United States.
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48
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Jones HE, Morrison I, Hurding S, Wild S, Anand A, Shenkin SD. 709 IMPACT ON HEALTHCARE UTILISATION OF A GENERAL PRACTITIONER-LED MODEL OF CARE FOR PATIENTS WITH FRAILTY. Age Ageing 2022. [DOI: 10.1093/ageing/afac035.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Primary care has a significant role to play in the identification and management of frailty. MidMed is a new dedicated GP-led service developed by a large practice in Midlothian for patients living at home with moderate or severe frailty. MidMed comprises a full-time GP performing a comprehensive geriatric assessment (CGA) adapted for primary care. Patients receive direct access to all appointments with the named GP. The aim of this study was to assess the impact of MidMed on healthcare utilisation in this patient group.
Methods
Patients with moderate or severe frailty at the MidMed practice were identified by the electronic Frailty Index (>0.24). After 16 months, patients who had been accepted into MidMed (MidMed group) were compared with those yet to be enrolled and who continued to receive usual care (non-MidMed group). Routinely collected data were used to identify outcomes including unscheduled hospital admissions, primary care consultations, continuity of care, outpatient attendances and mortality. Adjusted rate ratios were estimated using regression models.
Results
510 patients with moderate or severe frailty were identified (290 in MidMed, 220 in non-MidMed). Patients in each group were just as likely to have at least one hospital admission per year but those in MidMed had a reduced risk of further hospital admission compared to the non-MidMed group (adjusted RR 0.46 [95%CI 0.30–0.71]). MidMed was also associated with statistically significant higher usage of primary care (adjusted RR 1.52, [95%CI, 1.30–1.75]) and better continuity of care. There was no difference in mortality or the number of outpatient appointments when adjusted for co-variates.
Conclusion
A GP-led service for frailty is associated with lower risk of hospital readmission and improved continuity of care. Further studies are now required to better understand why use of such primary care services increase and whether this changes over time.
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Affiliation(s)
| | | | | | - S Wild
- The Usher Institute, University of Edinburgh
| | - A Anand
- The Centre for Cardiovascular Science, University of Edinburgh
| | - S D Shenkin
- The Usher Institute, University of Edinburgh
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49
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Vardy ERLC, Anand A, Cheng M, Ibitoye T, MacLullich AMJ. 795 A POSITIVE 4AT DELIRIUM ASSESSMENT TOOL SCORE ON HOSPITAL ADMISSION IS LINKED TO MORTALITY, LENGTH OF STAY AND ‘HOME TIME’: A STUDY OF 82,770 HOSPITAL ADMISSIONS IN EDINBURGH AND SALFORD. Age Ageing 2022. [DOI: 10.1093/ageing/afac037.795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Delirium is linked with poor outcomes but studies using large-scale routine data are scarce. The 4AT (www.the4AT.com) is a brief (~2 minutes), well-validated tool for detection of delirium and cognitive impairment. We performed a two-centre study (Edinburgh and Salford) of Electronic Health Record (EHR) 4AT scores and outcomes in 82,770 non-elective hospital admissions in patients aged ≥65. We determined relationships between 4AT scores 0 (no impairment), 1–3 (cognitive impairment but no delirium) and ≥ 4 (delirium), in relation to 30-day inpatient mortality, length of stay, and time at home (‘home time’) in the year following index admission.
Methods
We analysed EHR 4AT scores recorded within 24 hours of admission, and outcomes data were also derived from the EHR. The study period was between April 2016 (Edinburgh)/September 2017 (Salford) and April 2020 (both centres).
Results
4AT scores suggestive of delirium (≥4) were present in 25% in Salford, and 18% in Edinburgh. After adjustment for age and sex, 30-day inpatient mortality with 4AT ≥4 was 5.5-fold greater than the 4AT 0 group in Edinburgh (aOR 5.53, 95% confidence interval [CI] 4.99–6.13) and 3.4-fold greater in Salford (aOR 3.39, 95% CI 2.98–3.87). Length of stay was more than double in patients with any abnormal 4AT score compared to a 4AT score of 0. The median ‘home time’ at 1 year was reduced by 112 days (Edinburgh) and 61 days (Salford) in the 4AT ≥4 compared to 4AT 0 days.
Conclusions
This large study using routine clinical data confirms the relationships between delirium and poor outcomes previously reported in smaller research studies. Further, the results demonstrate the feasibility and value of using a brief clinical tool to identify delirium as a strong marker of adverse outcomes, and will be helpful in guiding policy development around patient safety including better treatment of delirium.
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Affiliation(s)
- E R L C Vardy
- Salford Royal NHS Foundation trust, Northern Care Alliance, Stott Lane, Salford
| | - A Anand
- Cardiovascular sciences, University of Edinburgh
| | - M Cheng
- Salford Royal NHS Foundation trust, Northern Care Alliance, Stott Lane, Salford
| | - T Ibitoye
- Edinburgh Delirium Research Group, Geriatric Medicine, Usher Institute, University of Edinburgh
| | - A M J MacLullich
- Edinburgh Delirium Research Group, Geriatric Medicine, Usher Institute, University of Edinburgh
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50
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Tamman AJF, Anand A, Mathew SJ. A comparison of the safety, feasibility, and tolerability of ECT and ketamine for treatment-resistant depression. Expert Opin Drug Saf 2022; 21:745-759. [PMID: 35253555 DOI: 10.1080/14740338.2022.2049754] [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: 11/04/2022]
Abstract
INTRODUCTION Treatment-resistant depression (TRD) is a problematic and prevalent public health and societal concern. Although electroconvulsive therapy (ECT) is the gold standard TRD intervention, the treatment evokes apprehension due to public perceptions, feasibility, and tolerability. Despite significant medical advancements, few medications have been approved by the U.S. Food and Drug Administration for TRD. In 2019, intranasal esketamine, the S-isomer of racemic ketamine, was approved for TRD, garnering significant excitement about the potential for the drug to act as an alternative treatment to ECT. AREAS COVERED The goal of this narrative review is to compare the safety, efficacy, and tolerability of ketamine and ECT; clarify whether ketamine is a reasonable alternative to ECT; and to facilitate improved treatment assignment for TRD. Empirical quantitative and qualitative studies and national and international guidelines these treatments are reviewed. EXPERT OPINION : The field awaits the results of two ongoing large comparative effectiveness trials of ECT and IV ketamine for TRD, which should help guide clinicians and patients as to the relative risk and benefit of these interventions. Over the next five years we anticipate further innovations in neuromodulation and in drug development which broadly aim to develop more tolerable versions of ECT and ketamine, respectively.
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Affiliation(s)
- Amanda J F Tamman
- Department of Psychology, St. John's University, Queens, NY, USA.,Mood and Anxiety Disorders Program, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Amit Anand
- Department of Psychiatry, Mass General Brigham, Harvard Medical School, Boston, MA, USA
| | - Sanjay J Mathew
- Michael E. Debakey VA Medical Center, Houston, TX, USA.,Mood and Anxiety Disorders Program, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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