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Elliott A, Wright G, Pendleton A, Rooney M. Effects of TNF-α inhibition versus secukinumab on active ultrasound-confirmed enthesitis in psoriatic arthritis. Ther Adv Musculoskelet Dis 2023; 15:1759720X231179524. [PMID: 38024204 PMCID: PMC10655675 DOI: 10.1177/1759720x231179524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/15/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Enthesitis is a hallmark of psoriatic disease, but its clinical assessment is problematic in terms of diagnostic sensitivity and overlap with other comorbid conditions. Ultrasound is a useful tool that can give a more detailed assessment of enthesitis. Research demonstrates that those with persistent ultrasound entheseal disease are at risk of progressive articular damage. With limited data to guide choice between biologic therapy for psoriatic arthritis (PsA) patients, we wanted to assess the response of ultrasound-confirmed enthesitis to different forms of biologic therapies and study its utility in making more informed decisions. Methods This was an open label observational study including patients aged ⩾18 years, who fulfil the classification criteria for PSA (CASPAR) and were due to commence on their first biologic therapy. The primary outcome was the change in MAdrid Sonographic Enthesitis Index (MASEI) score at 16 weeks of treatment. The MASEI score was also modified to assess the active elementary lesions (ActiveMASEI). Results In all, 80 PsA patients were enrolled with 75 patients completing the study [secukinumab n = 23 and tumour necrosis factor inhibitor (TNFi) n = 52]. The mean reduction in MASEI score after 16 weeks of treatment was 3.42 with TNFi versus 1.74 with secukinumab (p = 0.097). There was a significant difference in the change in the MASEIActive score for TNFi versus secukinumab (4.37 versus 2.26; p = 0.030) and this difference was more pronounced when only power Doppler signal within 2 mm of the enthesis insertion was included (4.37 versus 2.00; p = 0.007). Clinical outcomes were similar for both classes of biologic apart from a significant reduction in regards to the Dermatology Life Quality Index and Psoriasis Area and Severity Index score with secukinumab versus TNFi. Conclusions We have for the first time compared the effect of ultrasound-confirmed enthesitis between different forms of biologic therapies for PsA. We have seen an overall improvement in entheseal scores for both classes of medications and demonstrated a larger reduction in active entheseal disease for TNFi versus secukinumab that merits further exploration.
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Affiliation(s)
- Ashley Elliott
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | | | | | - Madeleine Rooney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
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Potts C, Bond RR, Jordan JA, Mulvenna MD, Dyer K, Moorhead A, Elliott A. Process mining to discover patterns in patient outcomes in a Psychological Therapies Service. Health Care Manag Sci 2023; 26:461-476. [PMID: 37191758 PMCID: PMC10186289 DOI: 10.1007/s10729-023-09641-8] [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: 03/11/2021] [Accepted: 04/21/2023] [Indexed: 05/17/2023]
Abstract
In the mental health sector, Psychological Therapies face numerous challenges including ambiguities over the client and service factors that are linked to unfavourable outcomes. Better understanding of these factors can contribute to effective and efficient use of resources within the Service. In this study, process mining was applied to data from the Northern Health and Social Care Trust Psychological Therapies Service (NHSCT PTS). The aim was to explore how psychological distress severity pre-therapy and attendance factors relate to outcomes and how clinicians can use that information to improve the service. Data included therapy episodes (N = 2,933) from the NHSCT PTS for adults with a range of mental health difficulties. Data were analysed using Define-Measure-Analyse model with process mining. Results found that around 11% of clients had pre-therapy psychological distress scores below the clinical cut-off and thus these individuals were unlikely to significantly improve. Clients with fewer cancelled or missed appointments were more likely to significantly improve post-therapy. Pre-therapy psychological distress scores could be a useful factor to consider at assessment for estimating therapy duration, as those with higher scores typically require more sessions. This study concludes that process mining is useful in health services such as NHSCT PTS to provide information to inform caseload planning, service management and resource allocation, with the potential to improve client's health outcomes.
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Affiliation(s)
- C Potts
- School of Psychology, Faculty of Life and Health Sciences, Ulster University, Coleraine, Northern Ireland.
| | - R R Bond
- School of Computing, Faculty of Computing Engineering & the Built Environment, Ulster University, Belfast, Northern Ireland
| | - J-A Jordan
- IMPACT Research Centre, Northern Health and Social Care Trust, Antrim, Northern Ireland
| | - M D Mulvenna
- School of Computing, Faculty of Computing Engineering & the Built Environment, Ulster University, Belfast, Northern Ireland
| | - K Dyer
- IMPACT Research Centre, Northern Health and Social Care Trust, Antrim, Northern Ireland
- Psychological Therapies Service, Northern Health and Social Care Trust, Antrim, Northern Ireland
| | - A Moorhead
- School of Communication and Media, Institute of Nursing and Health Research, Ulster University, Belfast, Northern Ireland
| | - A Elliott
- IMPACT Research Centre, Northern Health and Social Care Trust, Antrim, Northern Ireland
- Psychological Therapies Service, Northern Health and Social Care Trust, Antrim, Northern Ireland
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Elliott A, Walters RK, Pirinen M, Kurki M, Junna N, Goldstein J, Reeve M, Siirtola H, Lemmelä S, Turley P, Palotie A, Daly M, Widén E. Distinct and shared genetic architectures of Gestational diabetes mellitus and Type 2 Diabetes Mellitus. medRxiv 2023:2023.02.16.23286014. [PMID: 36865330 PMCID: PMC9980250 DOI: 10.1101/2023.02.16.23286014] [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: 02/25/2023]
Abstract
Gestational diabetes mellitus (GDM) affects more than 16 million pregnancies annually worldwide and is related to an increased lifetime risk of Type 2 diabetes (T2D). The diseases are hypothesized to share a genetic predisposition, but there are few GWAS studies of GDM and none of them is sufficiently powered to assess whether any variants or biological pathways are specific to GDM. We conducted the largest genome-wide association study of GDM to date in 12,332 cases and 131,109 parous female controls in the FinnGen Study and identified 13 GDM-associated loci including 8 novel loci. Genetic features distinct from T2D were identified both at the locus and genomic scale. Our results suggest that the genetics of GDM risk falls into two distinct categories - one part conventional T2D polygenic risk and one part predominantly influencing mechanisms disrupted in pregnancy. Loci with GDM-predominant effects map to genes related to islet cells, central glucose homeostasis, steroidogenesis, and placental expression. These results pave the way for an improved biological understanding of GDM pathophysiology and its role in the development and course of T2D.
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Affiliation(s)
- A. Elliott
- Analytic and Translational Genetics Unit, Massachusetts Gen. Hosp., Boston, MA
- Stanley Ctr. for Psychiatric Res., Broad Inst. of Harvard and MIT, Cambridge, MA
- Harvard Med. Sch., Boston, MA
| | - R. K. Walters
- Analytic and Translational Genetics Unit, Massachusetts Gen. Hosp., Boston, MA
- Stanley Ctr. for Psychiatric Res., Broad Inst. of Harvard and MIT, Cambridge, MA
- Harvard Med. Sch., Boston, MA
| | - M. Pirinen
- Institute for Molecular Med. Finland, Helsinki Institute of Life Sciences., University of Helsinki, Helsinki, Finland
- Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - M. Kurki
- Analytic and Translational Genetics Unit, Massachusetts Gen. Hosp., Boston, MA
- Stanley Ctr. for Psychiatric Res., Broad Inst. of Harvard and MIT, Cambridge, MA
| | - N. Junna
- Institute for Molecular Med. Finland, Helsinki Institute of Life Sciences., University of Helsinki, Helsinki, Finland
| | - J. Goldstein
- Stanley Ctr. for Psychiatric Res., Broad Inst. of Harvard and MIT, Cambridge, MA
| | - M.P. Reeve
- Institute for Molecular Med. Finland, Helsinki Institute of Life Sciences., University of Helsinki, Helsinki, Finland
| | - H. Siirtola
- TAUCHI Research Center, Faculty of Information Technology and Communication Sciences (ITC), Tampere University, Tampere, Finland
| | - S. Lemmelä
- Institute for Molecular Med. Finland, Helsinki Institute of Life Sciences., University of Helsinki, Helsinki, Finland
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - P. Turley
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
- Department of Economics, University of Southern California, Los Angeles, CA, USA
| | | | - A. Palotie
- Analytic and Translational Genetics Unit, Massachusetts Gen. Hosp., Boston, MA
- Stanley Ctr. for Psychiatric Res., Broad Inst. of Harvard and MIT, Cambridge, MA
- Harvard Med. Sch., Boston, MA
- Institute for Molecular Med. Finland, Helsinki Institute of Life Sciences., University of Helsinki, Helsinki, Finland
| | - M. Daly
- Analytic and Translational Genetics Unit, Massachusetts Gen. Hosp., Boston, MA
- Stanley Ctr. for Psychiatric Res., Broad Inst. of Harvard and MIT, Cambridge, MA
- Harvard Med. Sch., Boston, MA
- Institute for Molecular Med. Finland, Helsinki Institute of Life Sciences., University of Helsinki, Helsinki, Finland
| | - E. Widén
- Institute for Molecular Med. Finland, Helsinki Institute of Life Sciences., University of Helsinki, Helsinki, Finland
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Eder L, Mathew AJ, Carron P, Bertheussen H, Cañete JD, Azem M, Delle Sedie A, Salvarani C, Ranza R, Elliott A, Turkiewicz A, de Toledo RA, Bukulmez H, Stoenoiu MS, Mandelin AM, Koehm M, Lindsay CA, Siegel E, Mease PJ. Management of Enthesitis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations. J Rheumatol 2023; 50:258-264. [PMID: 36319005 DOI: 10.3899/jrheum.220312] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Enthesitis is a key pathological and clinical feature of psoriatic arthritis (PsA) in children and adults. Enthesitis is typically assessed clinically using several validated enthesitis scoring systems that have been used in clinical trials. Enthesitis treatment response has been reported as change in the total enthesitis score or the proportion of patients who achieved complete resolution. The majority of trials in PsA did not require patients to have enthesitis at study entry since enthesitis was evaluated only as a secondary outcome. Despite the inherent limitations of the clinical assessment of enthesitis, imaging of the entheses using ultrasound or magnetic resonance imaging has rarely been used in clinical trials to assess response to treatment of enthesitis. This systematic review summarizes existing evidence regarding pharmaceutical and nonpharmaceutical interventions for enthesitis in patients with PsA to facilitate an evidence-based update of the Group for Research and Assessment in Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for PsA. METHODS We performed a systematic literature review to identify 41 randomized clinical trials that reported enthesitis treatment response in patients with PsA. For each intervention, the response effect size was summarized and the quality of evidence was graded. Recommendations were then formulated for the various pharmacological and nonpharmacological therapies. RESULTS We included 41 randomized clinical trials in our review and graded each intervention. CONCLUSION Several classes of systemic conventional and advanced therapies and local measures were recommended for active enthesitis in patients with PsA.
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Affiliation(s)
- Lihi Eder
- L. Eder, MD, PhD, Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada;
| | - Ashish J Mathew
- A.J. Mathew, MBBS, DNB, DM, The Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Philippe Carron
- P. Carron, MD, PhD, Department of Internal Medicine and Pediatrics, Ghent University, Ghent University Hospital, and VIB Center for Inflammation Research, Ghent, Belgium
| | | | - Juan D Cañete
- J.D. Cañete, DMD, PhD, Department of Rheumatology, Hospital Clinic and IDIBAPS, Barcelona, Spain
| | - May Azem
- M. Azem, MD, Solo Private Practice, and Department of Internal Medicine, Lake Hospital, University Hospital Systems, Cleveland, Ohio, USA
| | - Andrea Delle Sedie
- A. Delle Sedie, MD, Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Carlo Salvarani
- C. Salvarani, MD, Dipartimento Specialità Mediche, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia and Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con interesse Trapiantologico, Oncologico e di Medicina Rigenerativa, Università di Modena e Reggio Emilia, Modena, Italy
| | - Roberto Ranza
- R. Ranza, MD, PhD, Rheumatology Unit, Hospital de Clinicas, EBSERH, Universidade Federal de Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Ashley Elliott
- A. Elliott, MB Bch BAO, MSc, MRCP, Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | | | - Ricardo Acayaba de Toledo
- R.A. de Toledo, MD, MSc, Regional School of Medicine Foundation of São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Hulya Bukulmez
- H. Bukulmez, MD, Department of Pediatrics, Division of Pediatric Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Maria S Stoenoiu
- M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Arthur M Mandelin
- A.M. Mandelin II, MD, PhD, Northwestern University, Department of Medicine, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michaela Koehm
- M. Koehm, MD, Rheumatology Division, University Hospital Frankfurt and Fraunhofer-Institute for Translational Medicine and Pharmacology ITMP, Frankfurt, Germany
| | - Chris A Lindsay
- C.A. Lindsay, PharmD, GRAPPA Patient Research Partner, Aurinia Pharmaceuticals Inc., Rockville, Maryland, USA
| | - Evan Siegel
- E. Siegel, MD, Arthritis and Rheumatism Associates, Rockville, Maryland, and Georgetown University School of Medicine, Washington, DC, USA
| | - Philip J Mease
- P.J. Mease MD, MACR, Rheumatology Research, Swedish Medical Center/Providence St. Joseph Health and University of Washington School of Medicine, Seattle, Washington, USA
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Di Matteo A, Moscioni E, Lommano MG, Cipolletta E, Smerilli G, Farah S, Airoldi C, Aydin SZ, Becciolini A, Bonfiglioli K, Carotti M, Carrara G, Cazenave T, Corradini D, Cosatti MA, de Agustin JJ, Destro Castaniti GM, Di Carlo M, Di Donato E, Di Geso L, Elliott A, Fodor D, Francioso F, Gabba A, Hernández-Díaz C, Horvath R, Hurnakova J, Jesus D, Marin J, Martire MV, Mashadi Mirza R, Massarotti M, Musca AA, Nair J, Okano T, Papalopoulos I, Rosa J, Rosemffet M, Rovisco J, Rozza D, Salaffi F, Scioscia C, Scirè CA, Tamas MM, Tanimura S, Ventura-Rios L, Villota-Eraso C, Villota O, Voulgari PV, Vreju FA, Vukatana G, Hereter JZ, Zanetti A, Grassi W, Filippucci E. Reliability assessment of ultrasound muscle echogenicity in patients with rheumatic diseases: Results of a multicenter international web-based study. Front Med (Lausanne) 2023; 9:1090468. [PMID: 36733934 PMCID: PMC9886677 DOI: 10.3389/fmed.2022.1090468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/29/2022] [Indexed: 01/18/2023] Open
Abstract
Objectives To investigate the inter/intra-reliability of ultrasound (US) muscle echogenicity in patients with rheumatic diseases. Methods Forty-two rheumatologists and 2 radiologists from 13 countries were asked to assess US muscle echogenicity of quadriceps muscle in 80 static images and 20 clips from 64 patients with different rheumatic diseases and 8 healthy subjects. Two visual scales were evaluated, a visual semi-quantitative scale (0-3) and a continuous quantitative measurement ("VAS echogenicity," 0-100). The same assessment was repeated to calculate intra-observer reliability. US muscle echogenicity was also calculated by an independent research assistant using a software for the analysis of scientific images (ImageJ). Inter and intra reliabilities were assessed by means of prevalence-adjusted bias-adjusted Kappa (PABAK), intraclass correlation coefficient (ICC) and correlations through Kendall's Tau and Pearson's Rho coefficients. Results The semi-quantitative scale showed a moderate inter-reliability [PABAK = 0.58 (0.57-0.59)] and a substantial intra-reliability [PABAK = 0.71 (0.68-0.73)]. The lowest inter and intra-reliability results were obtained for the intermediate grades (i.e., grade 1 and 2) of the semi-quantitative scale. "VAS echogenicity" showed a high reliability both in the inter-observer [ICC = 0.80 (0.75-0.85)] and intra-observer [ICC = 0.88 (0.88-0.89)] evaluations. A substantial association was found between the participants assessment of the semi-quantitative scale and "VAS echogenicity" [ICC = 0.52 (0.50-0.54)]. The correlation between these two visual scales and ImageJ analysis was high (tau = 0.76 and rho = 0.89, respectively). Conclusion The results of this large, multicenter study highlighted the overall good inter and intra-reliability of the US assessment of muscle echogenicity in patients with different rheumatic diseases.
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Affiliation(s)
- Andrea Di Matteo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom,*Correspondence: Andrea Di Matteo,
| | - Erica Moscioni
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Maria Giovanna Lommano
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Gianluca Smerilli
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Sonia Farah
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Carla Airoldi
- Hospital Provincial, Rheumatology, Rosario, Argentina
| | - Sibel Zehra Aydin
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Andrea Becciolini
- Internal Medicine and Rheumatology Unit, Department of Medicine, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Karina Bonfiglioli
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marina Carotti
- Department of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Greta Carrara
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy
| | - Tomas Cazenave
- Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Davide Corradini
- Rheumatology Unit, University Clinic AOU Cagliari, Monserrato, CA, Italy
| | - Micaela Ana Cosatti
- CEMIC, Centro de Educación Médica e Investigaciones Médicas “Norberto Quirno”, Buenos Aires, Argentina
| | - Juan Josè de Agustin
- Rheumatology Unit, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Giulia Maria Destro Castaniti
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Section, University of Palermo, Palermo, Italy
| | - Marco Di Carlo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Eleonora Di Donato
- Internal Medicine and Rheumatology Unit, Department of Medicine, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Luca Di Geso
- Department of Internal Medicine, Ospedale Madonna del Soccorso, San Benedetto del Tronto, Marche, Italy
| | - Ashley Elliott
- Centre for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Daniela Fodor
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Francesca Francioso
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Alessandra Gabba
- Local Health Unit (ASL), Samugheo, OR, Italy,Local Health Unit (ASL), Orosei, NU, Italy
| | - Cristina Hernández-Díaz
- División de Reumatología, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City, Mexico
| | - Rudolf Horvath
- Department of Paediatric and Adult Rheumatology, University Hospital Motol, Prague, Czechia
| | - Jana Hurnakova
- Department of Paediatric and Adult Rheumatology, University Hospital Motol, Prague, Czechia
| | - Diogo Jesus
- Department of Rheumatology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Josefina Marin
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Marco Massarotti
- Department of Rheumatology, University Hospitals Dorset NHS Foundation Trust, Christchurch Hospital, Christchurch, United Kingdom
| | | | - Jagdish Nair
- Department of Rheumatology, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom
| | - Tadashi Okano
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ioannis Papalopoulos
- Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Heraklion, Greece
| | - Javier Rosa
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marcos Rosemffet
- Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - João Rovisco
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Davide Rozza
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy
| | - Fausto Salaffi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Crescenzio Scioscia
- Rheumatology Unit, Department of Emergency and Organ Transplants (DETO), University of Bari, Bari, Italy
| | | | - Maria-Magdalena Tamas
- Department of Rheumatology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Shun Tanimura
- Department of Rheumatology, Hokkaido Medical Center for Rheumatic Diseases, Sapporo, Japan
| | - Lucio Ventura-Rios
- División de Reumatología, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City, Mexico
| | - Catalina Villota-Eraso
- IPS Servicio Integral de Reumatología e Inmunología Doctor Orlando Villota, Pasto, Colombia
| | - Orlando Villota
- Division of Rheumatology, Fundación Hospital San Pedro, Pasto, Colombia
| | - Paraskevi V. Voulgari
- Department of Rheumatology, School of Health Science, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Florentin Ananu Vreju
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Gentiana Vukatana
- Rheumatology Unit, IRCCS Policlinico S. Orsola-Malpighi, Bologna, Italy
| | | | - Anna Zanetti
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy
| | - Walter Grassi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
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Di Matteo A, Cipolletta E, Destro Castaniti GM, Smerilli G, Airoldi C, Aydin SZ, Becciolini A, Bonfiglioli K, Bruns A, Carrara G, Cazenave T, Ciapetti A, Cosatti MA, de Agustín JJ, Di Carlo M, Di Donato E, Di Geso L, Duran E, Elliott A, Estrach C, Farisogulları B, Fiorenza A, Fodor D, Gabba A, Hernández-Díaz C, Huang F, Hurnakova J, Li L, Jesus D, Karadag O, Martire MV, Massarotti M, Michelena X, Musca AA, Nair J, Okano T, Papalopoulos I, Rosemffet M, Rovisco J, Rozza D, Salaffi F, Satulu I, Scioscia C, Scirè CA, Sun F, Tamas MM, Tanimura S, Ventura-Rios L, Voulgari PV, Vreju FA, Vukatana G, Wong E, Yang J, Zacariaz Hereter J, Zanetti A, Grassi W, Filippucci E. Reliability assessment of the definition of ultrasound enthesitis in SpA: results of a large, multicentre, international, web-based study. Rheumatology (Oxford) 2022; 61:4863-4874. [PMID: 35293988 DOI: 10.1093/rheumatology/keac162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/07/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To investigate the reliability of the OMERACT US Task Force definition of US enthesitis in SpA. METHODS In this web exercise, based on the evaluation of 101 images and 39 clips of the main entheses of the lower limbs, the elementary components included in the OMERACT definition of US enthesitis in SpA (hypoechoic areas, entheseal thickening, power Doppler signal at the enthesis, enthesophytes/calcifications, bone erosions) were assessed by 47 rheumatologists from 37 rheumatology centres in 15 countries. Inter- and intra-observer reliability of the US components of enthesitis was calculated using Light's kappa, Cohen's kappa, Prevalence And Bias Adjusted Kappa (PABAK) and their 95% CIs. RESULTS Bone erosions and power Doppler signal at the enthesis showed the highest overall inter-reliability [Light's kappa: 0.77 (0.76-0.78), 0.72 (0.71-0.73), respectively; PABAK: 0.86 (0.86-0.87), 0.73 (0.73-0.74), respectively], followed by enthesophytes/calcifications [Light's kappa: 0.65 (0.64-0.65), PABAK: 0.67 (0.67-0.68)]. This was moderate for entheseal thickening [Light's kappa: 0.41 (0.41-0.42), PABAK: 0.41 (0.40-0.42)], and fair for hypoechoic areas [Light's kappa: 0.37 (0.36-0.38); PABAK: 0.37 (0.37-0.38)]. A similar trend was observed in the intra-reliability exercise, although this was characterized by an overall higher degree of reliability for all US elementary components compared with the inter-observer evaluation. CONCLUSIONS The results of this multicentre, international, web-based study show a good reliability of the OMERACT US definition of bone erosions, power Doppler signal at the enthesis and enthesophytes/calcifications. The low reliability of entheseal thickening and hypoechoic areas raises questions about the opportunity to revise the definition of these two major components for the US diagnosis of enthesitis.
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Affiliation(s)
- Andrea Di Matteo
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Edoardo Cipolletta
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Giulia Maria Destro Castaniti
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology section, University of Palermo, Palermo, Italy
| | - Gianluca Smerilli
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Carla Airoldi
- Rheumatology, Hospital Provincial, Rosario, Argentina
| | - Sibel Zehra Aydin
- University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Andrea Becciolini
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | - Karina Bonfiglioli
- Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alessandra Bruns
- Division of Rheumatology, Sherbrooke University, Sherbrooke, Canada
| | - Greta Carrara
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy
| | - Tomas Cazenave
- Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Alessandro Ciapetti
- Rheumatology Department, Betsi Cadwaladr University Health Board, Glan Clwyd Hospital, Bodelwyddan, Denbighshire, UK
| | - Micaela Ana Cosatti
- CEMIC, Centro de investigaciones médicas Norberto Quirno, Buenos Aires, Argentina
| | - Juan José de Agustín
- Rheumatology Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Marco Di Carlo
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Eleonora Di Donato
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | - Luca Di Geso
- Department of Internal Medicine, Ospedale Madonna del Soccorso, San Benedetto del Tronto, Marche, Italy
| | - Emine Duran
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ashley Elliott
- Centre for Experimental Medicine, Queen's University, Belfast
| | - Cristina Estrach
- Rheumatology, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Bayram Farisogulları
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Alessia Fiorenza
- SSD Reumatologia, Ospedale Sant'Andrea di Vercelli, Vercelli, Italy
| | - Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alessandra Gabba
- Rheumatology Clinic, ATS Sardegna, Medicina Specialistica Ambulatoriale, Oristano, Nuoro
| | - Cristina Hernández-Díaz
- Division de Reumatologia, Instituto Nacional de Rehabilitacion "Luis Guillermo Ibarra Ibarra", Mexico City, Mexico
| | - Feng Huang
- Department of Rheumatology and Immunology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jana Hurnakova
- Department of Paediatric and Adult Rheumatology, University Hospital Motol, Prague, Czech Republic
| | - Ling Li
- Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Diogo Jesus
- Rheumatology Department, Centro Hospitalar de Leiria, Leiria.,Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Marco Massarotti
- Department of Rheumatology, University Hospitals Dorset NHS Foundation Trust, Christchurch Hospital, Christchurch, UK
| | - Xabier Michelena
- Rheumatology Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Alice Andreea Musca
- Internal Medicine and Rheumatology Department, Dr. I. Cantacuzino Clinical Hospital, Bucharest, Romania
| | - Jagdish Nair
- Rheumatology, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Tadashi Okano
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ioannis Papalopoulos
- Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Greece
| | - Marcos Rosemffet
- Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - João Rovisco
- Faculdade de Medicina, Coimbra University, Coimbra, Portugal
| | - Davide Rozza
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy
| | - Fausto Salaffi
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Iulia Satulu
- Rheumatology Department, Internal Medicine Clinic, Kalmar County Hospital, Kalmar, Sweden
| | - Crescenzio Scioscia
- Department of Emergency and Organ Transplants (DETO), Rheumatology Unit, Bari
| | | | - Fei Sun
- Department of Rheumatology and Immunology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Maria-Magdalena Tamas
- Department of Rheumatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Shun Tanimura
- Rheumatology Department, Hokkaido Medical Center for Rheumatic Diseases, Sapporo, Japan
| | - Lucio Ventura-Rios
- Division de Reumatologia, Instituto Nacional de Rehabilitacion "Luis Guillermo Ibarra Ibarra", Mexico City, Mexico
| | - Paraksevi V Voulgari
- Department of Rheumatology, School of Health Science, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Florentin Ananu Vreju
- Rheumatology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | | | - Ernest Wong
- Rheumatology Department, Queen Alexandra Hospital, Portsmouth, UK
| | - Jinshui Yang
- Department of Rheumatology and Immunology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | | | - Anna Zanetti
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy.,Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Walter Grassi
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Emilio Filippucci
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
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Willey-Courand D, Bui T, Dudley E, Coburn L, Flores D, Dorsett S, Vavrina K, Elliott A, Nieto A. 95 Increasing vitamin D levels and dual energy X-ray absorptiometry screening using a microsystems approach. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00786-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Daza JF, Cuthbertson BH, Myles PS, Shulman MA, Wijeysundera DN, Wijeysundera DN, Pearse RM, Myles PS, Abbott TEF, Shulman MA, Torres E, Ambosta A, Melo M, Mamdani M, Thorpe KE, Wallace S, Farrington C, Croal BL, Granton JT, Oh P, Thompson B, Hillis G, Beattie WS, Wijeysundera HC, Ellis M, Borg B, Kerridge RK, Douglas J, Brannan J, Pretto J, Godsall MG, Beauchamp N, Allen S, Kennedy A, Wright E, Malherbe J, Ismail H, Riedel B, Melville A, Sivakumar H, Murmane A, Kenchington K, Kirabiyik Y, Gurunathan U, Stonell C, Brunello K, Steele K, Tronstad O, Masel P, Dent A, Smith E, Bodger A, Abolfathi M, Sivalingam P, Hall A, Painter TW, Macklin S, Elliott A, Carrera AM, Terblanche NCS, Pitt S, Samuels J, Wilde C, Leslie K, MacCormick A, Bramley D, Southcott AM, Grant J, Taylor H, Bates S, Towns M, Tippett A, Marshall F, McCartney CJL, Choi S, Somascanthan P, Flores K, Karkouti K, Clarke HA, Jerath A, McCluskey SA, Wasowicz M, Day L, Pazmino-Canizares J, Belliard R, Lee L, Dobson K, Stanbrook M, Hagen K, Campbell D, Short T, Van Der Westhuizen J, Higgie K, Lindsay H, Jang R, Wong C, McAllister D, Ali M, Kumar J, Waymouth E, Kim C, Dimech J, Lorimer M, Tai J, Miller R, Sara R, Collingwood A, Olliff S, Gabriel S, Houston H, Dalley P, Hurford S, Hunt A, Andrews L, Navarra L, Jason-Smith A, Thompson H, McMillan N, Back G. Measurement properties of the WHO Disability Assessment Schedule 2.0 for evaluating functional status after inpatient surgery. Br J Surg 2022; 109:968-976. [PMID: 35929065 DOI: 10.1093/bjs/znac263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/17/2022] [Accepted: 07/08/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Expert recommendations propose the WHO Disability Assessment Schedule (WHODAS) 2.0 as a core outcome measure in surgical studies, yet data on its long-term measurement properties remain limited. These were evaluated in a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) prospective cohort. METHODS Participants were adults (40 years of age or older) who underwent inpatient non-cardiac surgery. The 12-item WHODAS and EQ-5DTM-3L questionnaires were administered preoperatively (in person) and 1 year postoperatively (by telephone). Responsiveness was characterized using standardized response means (SRMs) and correlation coefficients between change scores. Construct validity was evaluated using correlation coefficients between 1-year scores and comparisons of WHODAS scores across clinically relevant subgroups. RESULTS The analysis included 546 patients. There was moderate correlation between changes in WHODAS and various EQ-5DTM subscales. The strongest correlation was between changes in WHODAS and changes in the functional domains of the EQ-5D-3L-for example, mobility (Spearman's rho 0.40, 95 per cent confidence interval [c.i.] 0.32 to 0.48) and usual activities (rho 0.45, 95 per cent c.i. 0.30 to 0.52). When compared across quartiles of EQ-5D index change, median WHODAS scores followed expected patterns of change. In subgroups with expected functional status changes, the WHODAS SRMs ranged from 'small' to 'large' in the expected directions of change. At 1 year, the WHODAS demonstrated convergence with the EQ-5D-3L functional domains, and good discrimination between patients with expected differences in functional status. CONCLUSION The WHODAS questionnaire has construct validity and responsiveness as a measure of functional status at 1 year after major surgery.
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Affiliation(s)
- Julian F Daza
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Brian H Cuthbertson
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Paul S Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Mark A Shulman
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Duminda N Wijeysundera
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada
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Puri S, Elliott A, Soares H, Lou E, Halmos B, Langer C, Uprety D, Darabi S, Walker P, El-Deiry W, VanderWalde A, Owonikoko T, Liu S. 889MO Comparative expression of driver transcription factors in extra-pulmonary small cell carcinoma. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, Allsop L, Almeida P, Altmann D, Alvarez Corral M, Amoils S, Anderson D, Antoniades C, Arbane G, Arias A, Armour C, Armstrong L, Armstrong N, Arnold D, Arnold H, Ashish A, Ashworth A, Ashworth M, Aslani S, Assefa-Kebede H, Atkin C, Atkin P, Aung H, Austin L, Avram C, Ayoub A, Babores M, Baggott R, Bagshaw J, Baguley D, Bailey L, Baillie JK, Bain S, Bakali M, Bakau M, Baldry E, Baldwin D, Ballard C, Banerjee A, Bang B, Barker RE, Barman L, Barratt S, Barrett F, Basire D, Basu N, Bates M, Bates A, Batterham R, Baxendale H, Bayes H, Beadsworth M, Beckett P, Beggs M, Begum M, Bell D, Bell R, Bennett K, Beranova E, Bermperi A, Berridge A, Berry C, Betts S, Bevan E, Bhui K, Bingham M, Birchall K, Bishop L, Bisnauthsing K, Blaikely J, Bloss A, Bolger A, Bonnington J, Botkai A, Bourne C, Bourne M, Bramham K, Brear L, Breen G, Breeze J, Bright E, Brill S, Brindle K, Broad L, Broadley A, Brookes C, Broome M, Brown A, Brown A, Brown J, Brown J, Brown M, Brown M, Brown V, Brugha T, Brunskill N, Buch M, Buckley P, Bularga A, Bullmore E, Burden L, Burdett T, Burn D, Burns G, Burns A, Busby J, Butcher R, Butt A, Byrne S, Cairns P, Calder PC, Calvelo E, Carborn H, Card B, Carr C, Carr L, Carson G, Carter P, Casey A, Cassar M, Cavanagh J, Chablani M, Chambers RC, Chan F, Channon KM, Chapman K, Charalambou A, Chaudhuri N, Checkley A, Chen J, Cheng Y, Chetham L, Childs C, Chilvers ER, Chinoy H, Chiribiri A, Chong-James K, Choudhury N, Chowienczyk P, Christie C, Chrystal M, Clark D, Clark C, Clarke J, Clohisey S, Coakley G, Coburn Z, Coetzee S, Cole J, Coleman C, Conneh F, Connell D, Connolly B, Connor L, Cook A, Cooper B, Cooper J, Cooper S, Copeland D, Cosier T, Coulding M, Coupland C, Cox E, Craig T, Crisp P, Cristiano D, Crooks MG, Cross A, Cruz I, Cullinan P, Cuthbertson D, Daines L, Dalton M, Daly P, Daniels A, Dark P, Dasgin J, David A, David C, Davies E, Davies F, Davies G, Davies GA, Davies K, Dawson J, Daynes E, Deakin B, Deans A, Deas C, Deery J, Defres S, Dell A, Dempsey K, Denneny E, Dennis J, Dewar A, Dharmagunawardena R, Dickens C, Dipper A, Diver S, Diwanji SN, Dixon M, Djukanovic R, Dobson H, Dobson SL, Donaldson A, Dong T, Dormand N, Dougherty A, Dowling R, Drain S, Draxlbauer K, Drury K, Dulawan P, Dunleavy A, Dunn S, Earley J, Edwards S, Edwardson C, El-Taweel H, Elliott A, Elliott K, Ellis Y, Elmer A, Evans D, Evans H, Evans J, Evans R, Evans RI, Evans T, Evenden C, Evison L, Fabbri L, Fairbairn S, Fairman A, Fallon K, Faluyi D, Favager C, Fayzan T, Featherstone J, Felton T, Finch J, Finney S, Finnigan J, Finnigan L, Fisher H, Fletcher S, Flockton R, Flynn M, Foot H, Foote D, Ford A, Forton D, Fraile E, Francis C, Francis R, Francis S, Frankel A, Fraser E, Free R, French N, Fu X, Furniss J, Garner L, Gautam N, George J, George P, Gibbons M, Gill M, Gilmour L, Gleeson F, Glossop J, Glover S, Goodman N, Goodwin C, Gooptu B, Gordon H, Gorsuch T, Greatorex M, Greenhaff PL, Greenhalgh A, Greenwood J, Gregory H, Gregory R, Grieve D, Griffin D, Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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11
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Aguilar-Arevalo AA, Alves DSM, Biedron S, Boissevain J, Borrego M, Chavez-Estrada M, Chavez A, Conrad JM, Cooper RL, Diaz A, Distel JR, D'Olivo JC, Dunton E, Dutta B, Elliott A, Evans D, Fields D, Greenwood J, Gold M, Gordon J, Guarincerri E, Huang EC, Kamp N, Kelsey C, Knickerbocker K, Lake R, Louis WC, Mahapatra R, Maludze S, Mirabal J, Moreno R, Neog H, deNiverville P, Pandey V, Plata-Salas J, Poulson D, Ray H, Renner E, Schaub TJ, Shaevitz MH, Smith D, Sondheim W, Szelc AM, Taylor C, Thompson WH, Thornton RT, Tripathi M, Van Berg R, Van de Water RG, Verma S, Walker K. First Leptophobic Dark Matter Search from the Coherent-CAPTAIN-Mills Liquid Argon Detector. Phys Rev Lett 2022; 129:021801. [PMID: 35867467 DOI: 10.1103/physrevlett.129.021801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
We report the first results of a search for leptophobic dark matter (DM) from the Coherent-CAPTAIN-Mills (CCM) liquid argon (LAr) detector. An engineering run with 120 photomultiplier tubes (PMTs) and 17.9×10^{20} protons on target (POT) was performed in fall 2019 to study the characteristics of the CCM detector. The operation of this 10-ton detector was strictly light based with a threshold of 50 keV and used coherent elastic scattering off argon nuclei to detect DM. Despite only 1.5 months of accumulated luminosity, contaminated LAr, and nonoptimized shielding, CCM's first engineering run has already achieved sensitivity to previously unexplored parameter space of light dark matter models with a baryonic vector portal. With an expected background of 115 005 events, we observe 115 005+16.5 events which is compatible with background expectations. For a benchmark mediator-to-DM mass ratio of m_{V_{B}}/m_{χ}=2.1, DM masses within the range 9 MeV≲m_{χ}≲50 MeV are excluded at 90% C. L. in the leptophobic model after applying the Feldman-Cousins test statistic. CCM's upgraded run with 200 PMTs, filtered LAr, improved shielding, and 10 times more POT will be able to exclude the remaining thermal relic density parameter space of this model, as well as probe new parameter space of other leptophobic DM models.
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Affiliation(s)
| | - D S M Alves
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S Biedron
- University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - J Boissevain
- Bartoszek Engineering, Aurora, Illinois 60506, USA
| | - M Borrego
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | | | - A Chavez
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - J M Conrad
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - R L Cooper
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
- New Mexico State University, Las Cruces, New Mexico 88003, USA
| | - A Diaz
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - J R Distel
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - J C D'Olivo
- Universidad Nacional Autónoma de México, CDMX 04510, México
| | - E Dunton
- Columbia University, New York, New York 10027, USA
| | - B Dutta
- Texas A&M University, College Station, Texas 77843, USA
| | - A Elliott
- Embry-Riddle Aeronautical University, Prescott, Arizona 86301, USA
| | - D Evans
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - D Fields
- University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - J Greenwood
- Embry-Riddle Aeronautical University, Prescott, Arizona 86301, USA
| | - M Gold
- University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - J Gordon
- Embry-Riddle Aeronautical University, Prescott, Arizona 86301, USA
| | - E Guarincerri
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - E C Huang
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - N Kamp
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - C Kelsey
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - K Knickerbocker
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - R Lake
- Embry-Riddle Aeronautical University, Prescott, Arizona 86301, USA
| | - W C Louis
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - R Mahapatra
- Texas A&M University, College Station, Texas 77843, USA
| | - S Maludze
- Texas A&M University, College Station, Texas 77843, USA
| | - J Mirabal
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - R Moreno
- Embry-Riddle Aeronautical University, Prescott, Arizona 86301, USA
| | - H Neog
- Texas A&M University, College Station, Texas 77843, USA
| | - P deNiverville
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - V Pandey
- University of Florida, Gainesville, Florida 32611, USA
| | - J Plata-Salas
- Universidad Nacional Autónoma de México, CDMX 04510, México
| | - D Poulson
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - H Ray
- University of Florida, Gainesville, Florida 32611, USA
| | - E Renner
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - T J Schaub
- University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - M H Shaevitz
- Columbia University, New York, New York 10027, USA
| | - D Smith
- Embry-Riddle Aeronautical University, Prescott, Arizona 86301, USA
| | - W Sondheim
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A M Szelc
- University of Edinburgh, Edinburgh EH9 3FD, United Kingdom
| | - C Taylor
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - W H Thompson
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - R T Thornton
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - M Tripathi
- University of Florida, Gainesville, Florida 32611, USA
| | - R Van Berg
- Bartoszek Engineering, Aurora, Illinois 60506, USA
| | - R G Van de Water
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S Verma
- Texas A&M University, College Station, Texas 77843, USA
| | - K Walker
- Embry-Riddle Aeronautical University, Prescott, Arizona 86301, USA
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Elliott A, Miras HN. Recent advances in polyoxothiometalate chemistry. J COORD CHEM 2022. [DOI: 10.1080/00958972.2022.2086049] [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: 10/18/2022]
Affiliation(s)
- A. Elliott
- School of Chemistry, The University of Glasgow, Glasgow, UK
| | - H. N. Miras
- School of Chemistry, The University of Glasgow, Glasgow, UK
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Castillo RL, Yan D, Ashhurst AS, Elliott A, Angioni MM, Scher JU, Naik S, Neimann A, Byrne SN, Payne RJ, FitzGerald O, Pennington SR, Cauli A, Chandran V. GRAPPA 2020 Research Award Recipients. J Rheumatol 2022; 49:55-56. [PMID: 35293338 DOI: 10.3899/jrheum.211335] [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] [Accepted: 12/07/2021] [Indexed: 10/18/2022]
Abstract
At the 2021 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) annual meeting, a summary of the research conducted by the recipients of the 2020 GRAPPA Research Awards was presented by the awardees. The summary of the 4 presentations is provided here.
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Affiliation(s)
- Rochelle L Castillo
- R.L. Castillo, MD, MS, Postdoctoral Fellow, J.U. Scher, MD, Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Di Yan
- D. Yan, MD, MS, Chief Resident, A. Neimann, MD, MS, Assistant Professor, Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Anneliese S Ashhurst
- A.S. Ashhurst, PhD, School of Medical Sciences, Faculty of Medicine and Health, and School of Chemistry, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Ashley Elliott
- A. Elliott, MB Bch, MSc, MRCP, Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Maria Maddalena Angioni
- M.M. Agnioni, MSc, PhD, A. Cauli, MD, PhD, Rheumatology Unit, Department of Medical Sciences and Public Health, Azienda Ospedaliera Universitaria and University of Cagliari, Monserrato, Cagliari, Italy
| | - Jose U Scher
- R.L. Castillo, MD, MS, Postdoctoral Fellow, J.U. Scher, MD, Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Shruti Naik
- S. Naik, PhD, Assistant Professor, Departments of Pathology, Medicine, and Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Andrea Neimann
- D. Yan, MD, MS, Chief Resident, A. Neimann, MD, MS, Assistant Professor, Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Scott N Byrne
- S.N. Byrne, PhD, Professor of Immunology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, and The Westmead Institute for Medical Research, Westmead, Australia
| | - Richard J Payne
- R.J. Payne, PhD, Professor of Chemistry, School of Chemistry, Faculty of Science, The University of Sydney, Sydney, and Australian Research Council Centre of Excellence for Innovations in Peptide and Protein Science, The University of Sydney, Sydney, Australia
| | - Oliver FitzGerald
- O. FitzGerald, MD, FRCPI, FRCP, Consultant Rheumatologist and Newman Clinical Research Professor, S.R. Pennington, PhD, School of Medicine, Conway Institute for Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Stephen R Pennington
- O. FitzGerald, MD, FRCPI, FRCP, Consultant Rheumatologist and Newman Clinical Research Professor, S.R. Pennington, PhD, School of Medicine, Conway Institute for Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Alberto Cauli
- M.M. Agnioni, MSc, PhD, A. Cauli, MD, PhD, Rheumatology Unit, Department of Medical Sciences and Public Health, Azienda Ospedaliera Universitaria and University of Cagliari, Monserrato, Cagliari, Italy
| | - Vinod Chandran
- V. Chandran, MBBS, MD, DM, PhD, FRCPC, Associate Professor, University of Toronto, Department of Medicine, Division of Rheumatology, Toronto Western Hospital, Toronto, Ontario, Canada.
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14
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De Bosscher R, Janssens K, Dausin C, Goetschalckx K, Bogaert J, Ghekiere O, Van De Heyning C, Elliott A, Sanders P, Kalman J, Herbots L, Willems R, Heidbuchel H, La Gerche A, Claessen G. The prevalence and clinical significance of a reduced ventricular ejection fraction in asymptomatic young elite endurance athletes. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Health and Medical Research Council of Australia
Background
Ventricular ejection fraction (EF) is the most widely used parameter to evaluate ventricular systolic function. Endurance athletes presenting with a reduced ventricular EF often raise the question of an underlying dilated or arrhythmogenic cardiomyopathy. The clinical significance of a reduced EF in athletes remains to be elucidated.
Purpose
To investigate the prevalence and clinical significance of a reduced EF in asymptomatic endurance athletes.
Methods
Two hundred eighteen asymptomatic young elite endurance athletes were evaluated at baseline. Cardiac magnetic resonance imaging (CMR) was performed to assess cardiac volumes, left ventricular and right ventricular EF (LVEF and RVEF), mass and fibrosis. Athletes with reduced EF (ATrEF) were defined as those having LVEF<50% and/or RVEF<45%. Ventricular systolic and diastolic function were assessed by trans-thoracic echocardiography. A 12-lead ECG and 24-hour holtermonitoring assessed electrical alterations and arrhythmias. In 145 athletes, LV and RV contractile reserve was evaluated by exercise CMR. Cardiopulmonary testing was performed in all athletes to measure maximal oxygen uptake (VO2max).
Results
Thirty-one ATrEF (14.2%) were compared to 187 athletes with a preserved EF (ATpEF). ATrEF were more frequently males (93 vs 77% male, p=0.033) but did not differ from ATpEF with regard to age (18.8±2.1 vs 18.3±2.1 years, p=0.25). Ten athletes had an isolated reduced LVEF, 10 had an isolated reduced RVEF and 11 had both a reduced LVEF and RVEF. ATrEF had similar end-diastolic volumes and cardiac mass but differed by higher end-systolic volumes.
Peak exercise LVEF and RVEF determined by exercise CMR remained lower in ATrEF (68±3 vs 73±4% and 62±6 vs 69±5%, p<0.001) but contractile reserve was greater (ΔLVEF 18±5 vs 14±4% and ΔRVEF 19±5 vs 15±5%, p<0.01).
A reduced EF was not associated with lower exercise capacity, in fact VO2max was higher in ATrEF than in ATpEF (65±6 vs 62±9mL/kg/min, p=0.020) and the percentage of predicted VO2max by the Wasserman equation were similar (151±14 vs 149±21%, p=0.533).
Fibrosis was present in 3 ATrEF and 18 ATpEF (9.7 vs 9.6%, p=0.993) and was isolated to the RV hinge-points in all but 3 ATpEF who had midmyocardial LV lateral wall fibrosis. LV systolic strain (-17.5±2.0 vs -19±2.1%, p<0.001) was lower in ATrEF whereas RV free wall systolic strain (-24.9±3.7 vs -25.1±3.5%, p=0.776) was similar. Diastolic function was normal in all ATrEF and ATpEF. Pathologic T-wave inversions were present in 2 ATrEF and 13 ATpEF (6.5 vs 7%, p=0.999). Ventricular premature beats (VPB) were infrequent but more prevalent in ATrEF than in ATpEF (2[0-18] vs 1[0-2]/24h, p=0.025; 16.1 vs 2.7% >100/24h, p=0.006).
Conclusion
A reduced ventricular EF is common in asymptomatic young elite endurance athletes, is more frequent in males but is not associated with structural, functional or electrical abnormalities apart from a minor excess in VPB.
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Affiliation(s)
- R De Bosscher
- University Hospitals (UZ) Leuven, Cardiology, Leuven, Belgium
| | - K Janssens
- Baker Heart and Diabetes Institute, Cardiology, Melbourne, Australia
| | - C Dausin
- University of Leuven, Movement Sciences, Leuven, Belgium
| | - K Goetschalckx
- University Hospitals (UZ) Leuven, Cardiology, Leuven, Belgium
| | - J Bogaert
- University Hospitals (UZ) Leuven, Radiology, Leuven, Belgium
| | - O Ghekiere
- Virga Jesse Hospital, Radiology, Hasselt, Belgium
| | | | - A Elliott
- Royal Adelaide Hospital, Cardiology, Adelaide, Australia
| | - P Sanders
- Royal Melbourne Hospital, Cardiology, Melbourne, Australia
| | - J Kalman
- Royal Melbourne Hospital, Cardiology, Melbourne, Australia
| | - L Herbots
- Virga Jesse Hospital, Cardiology, Hasselt, Belgium
| | - R Willems
- University Hospitals (UZ) Leuven, Cardiology, Leuven, Belgium
| | - H Heidbuchel
- University Hospital Antwerp, Cardiology, Antwerp, Belgium
| | - A La Gerche
- Baker Heart and Diabetes Institute, Cardiology, Melbourne, Australia
| | - G Claessen
- University Hospitals (UZ) Leuven, Cardiology, Leuven, Belgium
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Elliott A, McGonagle D, Rooney M. Integrating imaging and biomarker assessment to better define psoriatic arthritis and predict response to biologic therapy. Rheumatology (Oxford) 2021; 60:vi38-vi52. [PMID: 34951926 PMCID: PMC8709569 DOI: 10.1093/rheumatology/keab504] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/08/2021] [Indexed: 12/13/2022] Open
Abstract
The treatment options for PsA have substantially expanded over the last decade. Approximately 40% of patients will not respond to first-line anti-TNF-α therapies. There is limited data to help clinicians select the most appropriate biologic therapy for PsA patients, including guidance for decisions on biologic therapy switching. In this review we will examine the current understanding of predictors of response to treatment. Imaging technology has evolved to allow us to better study psoriatic disease and define disease activity, including synovitis and enthesitis. Enthesitis is implicated in the pathogenesis, diagnosis and prognosis of PsA. It appears to be a common thread among all of the various PsA clinical presentations. Enthesitis mainly manifests as tenderness, which is difficult to distinguish from FM, chronic pain and mechanically associated enthesopathy, and it might be relevant for understanding the apparent 40% failure of existing therapy. Excess adipose tissue makes if more difficult to detect joint swelling clinically, as many PsA patients have very high BMIs. Integrating imaging and clinical assessment with biomarker analysis could help to deliver stratified medicine in PsA and allow better treatment decision making. This could include which patients require ongoing biologic therapy, which class of biologic therapy that should be, and who alternatively requires management of non-inflammatory disease.
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Affiliation(s)
- Ashley Elliott
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Madeleine Rooney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
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Elliott A, Pendleton A, Wright G, Rooney M. The relationship between the nail and systemic enthesitis in psoriatic arthritis. Rheumatol Adv Pract 2021; 5:rkab088. [PMID: 34888436 PMCID: PMC8651221 DOI: 10.1093/rap/rkab088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/27/2021] [Indexed: 01/02/2023] Open
Abstract
Objective Psoriatic nail disease is more common in PsA than in isolated skin psoriasis (PsO). The nail is closely integrated to the DIP joint entheses. US data have shown that those patients with nail disease in PsO are more likely to have systemic enthesitis. We examined whether there was a relationship between nail disease, DIP enthesitis and systemic enthesitis in established PsA. Methods Forty-six PsA participants with nail disease underwent US scanning of the nail unit and the DIP entheses along with peripheral entheseal sites according to the Madrid sonographic enthesitis index (MASEI). Results At the finger level, there was a mild to moderate correlation between nail US changes and both clinical nail disease and DIP enthesis changes (DIP US) [Spearman correlation (rS) = 0.30, P < 0.001 and rS = 0.16, P < 0.001, respectively]. At the patient level, there was a moderate correlation between the nail US score and nail psoriasis severity index score and DIP US (rS = 0.33, P = 0.024 and rS = 0.43, P = 0.003, respectively). At the patient level, there was also a positive correlation between a higher nail US score and the active peripheral enthesitis score (MASEI-active) (rS = 0.35, P = 0.018). When power Doppler was part of nail US score, similar results were demonstrated at both the finger and patient levels. Conclusion This study has demonstrated the utility of nail US imaging and the close relationship, on scanning, between the DIP entheses and the nail unit. In PsA, we have seen a correlation between active US changes at the nail and peripheral enthesitis, which requires further analysis. Trial registration ClinicalTrials.gov, https://clinicaltrials.gov, NCT03955861.
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Affiliation(s)
- Ashley Elliott
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast
| | | | - Gary Wright
- Rheumatology Department, Musgrave Park Hospital, Belfast, UK
| | - Madeleine Rooney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast
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Verdicchio C, Elliott A, Mahajan R, Linz D, Lau D, Sanders P. Greater cardiorespiratory fitness reduces incidence of atrial fibrillation: a meta-analysis. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.200] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia affecting 1-2% of the global population, with the prevalence of AF increasing dramatically over the past two decades. Although low levels of cardiorespiratory fitness (CRF) and physical activity are predictive of cardiovascular disease onset and mortality, only recently has this emerged as a potential risk factor for AF.
Purpose
The aim of this meta-analysis was therefore to quantify the relationship between CRF, measured by a symptom limited exercise stress test, and incident AF. We hypothesised that there would be an inverse relationship between CRF and the incidence of AF.
Methods
The systematic literature review was conducted using PUBMED, MEDLINE and EMBASE databases, with seven studies meeting the inclusion criteria. A random-effects meta-analysis was then used to compare the multivariate risk estimates of the lowest CRF group from each cohort with the group of the highest CRF.
Results
Data from 206,925 individuals (55.8% males) was used for analysis with a mean age of 55 ± 2.5 years and a mean follow-up period of 10.3 ± 5 years. The total number of AF events across the studies was 19,913. The overall pooled risk of AF in the high-CRF group versus the low-CRF group showed a significant lower risk of incident AF in those with high-CRF (OR: 0.52, 95% CI, 0.44-0.605, p < 0.001). There was evidence of statistical heterogeneity between the studies (I2 = 81%, p < 0.001). AF incidence rates demonstrated an overall decline in rates across the CRF quartiles from low to high. The mean incidence rate for low-CRF was 21 ± 13.4 compared to 6.9 ± 0.7 per 1000 person-years for the high CRF group (p = 0.03).
Conclusion
There is an inverse association between a lower CRF and an increased risk of AF, with a higher level of CRF protective against AF. This study highlights that low-CRF may be an additional risk factor for AF along with already other established lifestyle-based risk factors such as obesity and hypertension. Exercise interventions should be promoted as a primary prevention strategy in those at risk of developing AF with known risk factors. Future studies are warranted to identify the mechanism(s) through which improved CRF confers a reduction in AF incidence.
Abstract Figure. AF risk between high and low-CRF
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Affiliation(s)
- C Verdicchio
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - A Elliott
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - R Mahajan
- University of Adelaide, Adelaide, Australia
| | - D Linz
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D Lau
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - P Sanders
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
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Nath L, Kapusniak A, Elliott A, Hebart M, Stent A, Franklin S. Sudden Cardiac Death in Thoroughbred Horses. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tu S, Gallagher C, Elliott A, Linz D, Pitman B, Hendriks J, Lau D, Sanders P, Wong C. Alcohol Intake and Bradyarrhythmia Risk: A Cohort Study of 385,670 Individuals. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.125] [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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20
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Malik V, Elliott A, Thomas G, Arnolda L, Lau D, Sanders P. Catheter Ablation of Atrial Fibrillation is Not Associated With Cardiac Volume-regulating Afferent Nerve Disruption. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Griffin A, Thiyagarajah A, Elliott A, Lau D, Sanders P. Incidence of New-Onset Atrial Fibrillation After Cavotricuspid Isthmus Ablation for Isolated Atrial Flutter: A Systematic Review and Meta-analysis. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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De Bosscher R, Claeys M, Dausin C, Goetschalckx K, Bogaert J, Van De Heyning C, Ghekiere O, Herbots L, Claus P, Kalman J, Sanders P, Elliott A, Heidbuchel H, La Gerche A, Claessen G. Hinge point fibrosis in athletes is not associated with structural, functional or electrical consequences: a comparison between young and middle-aged elite endurance athletes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3126] [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
The health benefits of extensive endurance training have been debated due to the report of myocardial fibrosis (MF), arrhythmias and temporary post-race cardiac impairment in middle-aged and veteran athletes. The extent of these changes is unknown in elite young athletes.
Purpose
To assess the prevalence of MF and its structural, functional and electrical impact in highly trained young endurance athletes (YA, 15–23 years) as compared to middle-aged athletes (MA, 30–50 years). We hypothesised that MF would be more frequent in MA and associated with more structural, functional and electrical abnormalities.
Methods
We prospectively assessed 197 YA and 34 MA. All had ECG, maximal oxygen consumption (VO2max) testing, cardiac magnetic resonance imaging (CMR), echocardiography and 24h-holter. Indexed left ventricular and right ventricular end diastolic volume (LVEDVi, RVEDVi), ejection fraction (LVEF, RVEF), left ventricular mass (LVMi), and MF defined as delayed gadolinium enhancement were assessed by CMR. LV and RV free wall strain (LVSL, RVfwSL) were assessed by 2D speckle tracking echocardiography. Ventricular premature beats (VPB) and non-sustained ventricular tachycardia (nsVT) were assessed by 24h-holter.
Results
YA and MA (18±2 vs 38±5 years [p<0.01]; 78% vs 80% male [p=0.99]) with an elite level of fitness (VO2max 61±8 vs 54±10 mL/min/kg [p<0.01]; % predicted VO2max 150±20 vs 158±30 [p=0.02]) had a large variance in LV and RV remodelling (Figure 1). MF was seen in 28 athletes (12.5%) and more prevalent in MA than in YA (23.5 vs 10.5%, p=0.048). MF was limited to the hinge points in all 8 MA with MF and 17 YA. 3 YA had LV lateral wall subepicardial MF. 27 of 187 (14.4%) male athletes had MF compared to 1 of 50 (2%) female athletes (p=0.01).
MF+ MA(A) and YA(B) as well as MF− MA(C) and YA(D) had similar structural remodelling (LVEDVi 110±14 vs 118±14 vs 113±19 vs 110±16 mL/m2; RVEDVi 120±14 vs 128±17 vs 117±19 vs 125±23mL/m2; LVMi 77±11 vs 83±14 vs 81±14 vs 77±15g/m2, p>0.05). LVEF, LVSL and RVSL were similar (59±3 vs 58±5 vs 61±6 vs 58±6%; −18.8±2 vs −18.8±2 vs −19.8±2 vs −19.3±2%; −26.3±2.4 vs −24.4±2.4; −26.3±3 vs −25.8±3.5% respectively, p>0.05). LVEF <50% was seen in 19 (8.2%) athletes (0 [0%] vs [5%] 1 vs 1 [3.8%] vs 17 [9.6%]; p=0.51). RVEF was higher in D compared to C without further differences between groups (54±4 vs 54±6 vs 53±6 vs 57±5, p=0.005). RVEF<45% was seen 21 (9.1%) athletes (0 [0%] vs 1 [5%] vs 0 [0%] vs 20 [11.3%]; p=0.14). Abnormal T-wave inversion was similar (12.5 vs 5 vs 7.4 vs 6.2%, p=0.93) as was the prevalence of >100VPB/24h (12.5 vs 5 vs 11.1 vs 5.1%, p=0.42). 2 athletes had nsVT, both in D. All had similar exercise capacity (% predicted VO2max 157±26 vs 152±15 vs 147±24 vs 158±32%; p=0.11).
Conclusion
Hinge-point fibrosis was more prevalent in MA, possibly due to repeated hemodynamic stress during exercise, but is not associated with structural, functional or electrical consequences.
Figure 1. Cardiac remodelling in elite athletes
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Fonds voor Wetenschappelijk Onderzoek (FWO)
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Affiliation(s)
- R De Bosscher
- University Hospitals (UZ) Leuven, Cardiology, Leuven, Belgium
| | - M Claeys
- University Hospitals (UZ) Leuven, Cardiology, Leuven, Belgium
| | | | - K Goetschalckx
- University Hospitals (UZ) Leuven, Cardiology, Leuven, Belgium
| | - J Bogaert
- University Hospitals (UZ) Leuven, Radiology, Leuven, Belgium
| | | | - O Ghekiere
- Virga Jesse Hospital, Radiology, Hasselt, Belgium
| | - L Herbots
- Virga Jesse Hospital, Cardiology, Hasselt, Belgium
| | | | - J Kalman
- Baker Heart and Diabetes Institute, Cardiology, Melbourne, Australia
| | - P Sanders
- Baker Heart and Diabetes Institute, Cardiology, Melbourne, Australia
| | - A Elliott
- Royal Adelaide Hospital, Cardiology, Adelaide, Australia
| | - H Heidbuchel
- University Hospital Antwerp, Cardiology, Antwerp, Belgium
| | - A La Gerche
- Baker Heart and Diabetes Institute, Cardiology, Melbourne, Australia
| | - G Claessen
- University Hospitals (UZ) Leuven, Cardiology, Leuven, Belgium
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McDermott R, Graff J, Antonarakis E, Hoimes C, Tagawa S, Hwang C, Kilari D, Tije A, Omlin A, Vaishampayan U, Elliott A, Wu H, Kim J, Schloss C, De Bono J. KEYNOTE-199 cohorts 4 and 5: Pembrolizumab (pembro) plus enzalutamide (enza) for enza-resistant metastatic castration-resistant prostate cancer (mCRPC). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33171-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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24
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Malik V, Mishima R, Elliott A, Emami M, Roberts-Thompson K, Mahajan R, Arnolda LF, Lau DH, Sanders P. 70Autonomic dysfunction in atrial fibrillation (AF) patients: absent vasomotor reflex to decreased cardiac venous return during af in comparison to sinus rhythm; implications for earlier rhythm control. Europace 2020. [DOI: 10.1093/europace/euaa162.274] [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
Funding Acknowledgements
Dr Malik is supported by an Australian Postgraduate Award Scholarship from the University of Adelaide.
OnBehalf
Centre for Heart Rhythm Disorders, University of Adelaide & Royal Adelaide Hospital
Background
A bi-directional relationship exists between AF and the autonomic nervous system (ANS). Patients with AF studied in sinus rhythm (SR) have impaired vasomotor responses to decreased cardiac volume. Whether autonomic dysfunction worsens during AF itself, is unknown.
Purpose
We examined haemodynamic responses to lower body negative pressure (LBNP) in patients with persistent AF compared to AF studied in SR. LBNP decreases cardiac volume, deactivates atrial stretch receptors and induces a reflex to maintain blood pressure by increasing systemic vascular resistance (SVR).
Methods
21 consecutive patients with paroxysmal or persistent AF were studied; during AF (n = 8) or SR (n = 13). Anti-arrhythmic and anti-hypertensives were withheld for 5 half-lives. Patients underwent LBNP using a custom-made chamber sealing both lower limbs. Negative pressure at sham (-0 mmHg), low (-20 mmHg) and high level (-40 mmHg) was applied for 5 minutes each. Finger photo plethysmography was used for beat-beat-blood pressure. Computation of SVR during AF is not feasible with this method. Therefore, the right forearm was used to perform venous occlusion plethysmography (VOP); non-invasive, well validated with LBNP and impervious to AF: to estimate forearm blood flow (FBF) and SVR (inversely proportional).
Results
Baseline characteristics and responses to LBNP are presented in Table 1. MAP was maintained, and HR rose slightly, in the SR group. MAP and HR decreased in the AF group. VOP demonstrates a reduction in FBF in the SR group (vasoconstriction); whereas the vasomotor response to LBNP was absent during AF. Figure 1 (Panels A-C).
Conclusion
The presence of AF is associated with autonomic dysfunction from impaired cardiac volume regulation. This novel finding may contribute to the known risk of falls and syncope due to AF. Further studies are needed to evaluate whether abnormal cardiac reflexes are involved in atrial remodelling and AF progression.
Table 1 Baseline Characteristics During AF During SR P Value Age 65 ± 5 59 ± 3 0.4 AAD & Anti-HTN medications withheld (%) 75 85 0.6 Resting mean arterial pressure (MAP) 109 ± 9 93 ± 6 0.1 Resting heart rate (HR) 94 ± 6 60 ± 4 0.0001* Haemodynamic response to LBNP % Δ MAP due to LBNP -9 ± 5 +0.5 ± 3 0.2 % Δ HR due to LBNP -6 ± 3 +5 ± 3 0.03* % Δ FBF due to LBNP +75 ± 59 -27 ± 8 0.02* AAD Anti-arrhthmic. HTN: Hypertension. Mean +/- SEM.
Abstract Figure. Vasomotor response to LBNP: in AF vs SR
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Affiliation(s)
- V Malik
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - R Mishima
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - A Elliott
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - M Emami
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - K Roberts-Thompson
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - R Mahajan
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - L F Arnolda
- University of Wollongong, Wollongong, Australia
| | - D H Lau
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - P Sanders
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
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Benz C, Harvey A, Middleton A, Elliott A. WS07.3 Managing exacerbations in young people with cystic fibrosis through Hospital in the Home physiotherapy via Telehealth. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30202-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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27
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McLauchlin J, Aird H, Elliott A, Forester E, Jørgensen F, Willis C. Microbiological quality of raw drinking milk and unpasteurised dairy products: results from England 2013-2019. Epidemiol Infect 2020; 148:e135. [PMID: 32406346 PMCID: PMC7374804 DOI: 10.1017/s0950268820001016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 03/21/2020] [Accepted: 05/11/2020] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to review microbiology results from testing >2500 raw drinking milk and dairy products made with unpasteurised milk examined in England between 2013 and 2019. Samples were collected as part of incidents of contamination, investigation of infections or as part of routine monitoring and were tested using standard methods for a range of both pathogens and hygiene indicators. Results from testing samples of raw cow's milk or cheese made from unpasteurised milk for routine monitoring purposes were overall of better microbiological quality than those collected during incident or investigations of infections. Results from routine monitoring were satisfactory for 62% of milks, 82% of cream, 100% of ice-cream, 51% of butter, 63% of kefir and 79% of cheeses, with 5% of all samples being considered potentially hazardous. Analysis of data from cheese demonstrated a significant association between increasing levels of indicator Escherichia coli with elevated levels of coagulase positive staphylococci and decreased probability of isolation of Shiga toxin-producing E. coli. These data highlight the public health risk associated with these products and provide further justification for controls applied to raw drinking milk and dairy products made with unpasteurised milk.
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Affiliation(s)
- J. McLauchlin
- Public Health England, National Infection Service, Food Water and Environmental Microbiology Services, Colindale, London, UK
| | - H. Aird
- Public Health England, National Infection Service, Food Water and Environmental Microbiology Laboratory York, National Agri-Food Innovation Campus, York, UK
| | - A. Elliott
- Public Health England, National Infection Service, Food Water and Environmental Microbiology Laboratory Porton, Porton Down, Salisbury, UK
- Public Health England, National Infection Service, Field Services, South West, Bristol, UK
| | - E. Forester
- Public Health England, National Infection Service, Food Water and Environmental Microbiology Laboratory York, National Agri-Food Innovation Campus, York, UK
- Public Health England, National Infection Service, Field Services, North West Office, Liverpool, UK
| | - F. Jørgensen
- Public Health England, National Infection Service, Food Water and Environmental Microbiology Laboratory Porton, Porton Down, Salisbury, UK
| | - C. Willis
- Public Health England, National Infection Service, Food Water and Environmental Microbiology Laboratory Porton, Porton Down, Salisbury, UK
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28
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Kadhim K, Elliott A, Middeldorp M, Hendriks J, Gallagher C, Mahajan R, McEvoy RD, Lau D, Sanders P, Linz D. P3794MOODS: a novel risk score to identify patients with atrial fibrillation and sleep apnoea. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Sleep-disordered breathing (SDB) is an important risk factor for developing atrial fibrillation (AF), and treatment of concomitant SDB can improve AF rhythm outcomes. Diagnosis of SDB requires sleep studies which can pose a significant time and resource burden. We sought to develop a prediction score based on clinical characteristics that can help identify AF patients who require further assessment for SDB.
Methods
Prospectively-collected data for 442 consecutive patients treated for AF from 2009 to 2017 were analysed. All patients were considered candidates for rhythm-control and therefore referred for sleep studies. The diagnosis of SDB was confirmed using in-lab polysomnography and classified using the apnoea-hypopnoea-index (AHI), with cut-offs of ≥15/hr and ≥30/hr indicating moderate-to-severe and severe SDB respectively. Patients treated up to 2015 formed the derivation cohort (n=311) and the remainder (n=113) formed the validation cohort. Multivariate logistic regression analysis was used to identify clinical variables predictive of moderate-to-severe SDB. A risk score model was developed based on regression coefficients and tested using receiver-operating-characteristics analyses on the validation cohort.
Results
Overall, mean age was 60±11 years, mean body mass index (BMI) was 30±5 kg/m2 and 69% were men. The prevalence of moderate-to-severe SDB was 33.7%. There were no significant differences in baseline characteristics between the derivation and validation cohorts. Male gender (score=1), overweight (BMI: 25–29 kg/m2, score=2), obesity (BMI≥30 kg/m2, score=3), diabetes (score=1), and stroke (score=2) were significantly independently predictive of moderate-to-severe SDB and formulated the score. The score performed well to predict moderate-to-severe SDB with a C-statistic of 0.73 (95% CI: 0.67–0.79, P<0.001) in the derivation cohort, and 0.67 (95% CI: 0.57–0.77, P<0.001) in the validation cohort. As a rule-out test, a score of ≤3 had a negative predictive value of 77% for moderate-to-severe SDB (91% for severe SDB). A score of ≥4 had an intermediate positive likelihood ratio (PLR) of 2 for moderate-to-severe SDB (2.2 for severe SDB), while a score of ≥5 had a high PLR of 6.5 and 6.8 for moderate-to-severe SDB and severe SDB respectively.
Sensitivity and specificity table
Conclusion
A novel risk score comprising clinical characteristics can identify patients with AF likely to benefit from further assessment for SDB. Application of this model may aid optimise resource utilisation and facilitate timely patient care.
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Affiliation(s)
- K Kadhim
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - A Elliott
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - M Middeldorp
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - J Hendriks
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - C Gallagher
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - R Mahajan
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - R D McEvoy
- Flinders Medical Centre and Flinders University, Adelaide Institute for Sleep Health (AISH), Adelaide, Australia
| | - D Lau
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - P Sanders
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D Linz
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
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Agbaedeng TA, Emami M, Munawar DA, Rattanakosit T, Khadim KI, Elliott A, Linz D, Mahajan R, Lau DH, Sanders P. P5657Fibrosis detected by late-gadolinium enhancement cardiac MRI is associated with atrial fibrillation and poorer ablation outcome: A meta-analysis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0600] [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
Fibrosis is a hallmark of atrial fibrillation (AF) substrate. Recent data suggests that fibrosis detected by late-gadolinium enhancement (LGE) cardiac MRI (CMR) can predict AF. However, this relationship is not well described.
Objective
To delineate the association of cardiac fibrosis detected by LGE CMR with AF prevalence, AF recurrence after catheter ablation.
Methods
PubMed, Embase, Web of Science and Ovid MEDLINE were searched through November 2018, using the keywords: LGE AND Fibrosis AND CMR AND AF. Inclusion criteria: 1. LGE CMR of left atrial (LA LGE), ventricular wall (LV LGE) or right ventricular wall (RV LGE); 2. Studies reporting AF or recurrent arrhythmia after ablation; 3. Patient ≥18 years; and 4. ≥50 participants. Included studies were pooled in a random effects meta-analysis and reported as: mean difference (MD); unadjusted risk ratios (RR); adjusted hazard ratios (HR); and 95% confidence intervals (95% CI).
Results
After exclusions, we identified 9 studies (2,307 patients [65.9% males, 34.1% females]) conducted between 2003 and 2015 for LGE and AF. Fibrosis was present in 666 (35.1%) and detected by LV LGE in 7 (78%) and RV LGE in 2 (22%). The presence of AF was higher in patients positive for ventricular LGE than those negative, trending towards significance (RR: 1.51, 95% CI: 0.94–2.45, p=0.09). Pooled LV fibrosis associated with AF progression (RR [NPAF vs. PAF]: 2.2, 95% CI: 1.22–3.94, p=0.009). We identified 8 studies (2,041 patients [65.8% males, 34.2% females]) conducted between 2006 and 2016 reporting LGE and AF recurrence after catheter ablation, with fibrosis detected in 644 (31.6%) by LA LGE in 8 (88.9%, biased towards one centre). After 17.8±14.2 follow-up years, atrial fibrosis was significantly greater in recurrent AF than controls (MD: 4.97%, 95% CI: 1.23–8.7, p<0.01), and predicted 16% increased risk of AF recurrence (RR: 1.16, 95% CI: 1.07–1.26, p<0.05).
Conclusion
Myocardial fibrosis detected by LGE associates with prevalence and progress of AF and is predictive of AF recurrence post ablation. This further supports the proarrhythmic role of fibrosis and selection of patients for ablation therapy based on LGE.
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Affiliation(s)
- T A Agbaedeng
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - M Emami
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D A Munawar
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - T Rattanakosit
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - K I Khadim
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - A Elliott
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D Linz
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - R Mahajan
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D H Lau
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - P Sanders
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
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Linz D, Nalliah C, Baumert M, Kadhim K, Middeldorp M, Elliott A, Lau D, McEvoy D, Kalman J, Sanders P. P661Nocturnal hypoxemic burden in ambulatory patients with atrial fibrillation: a disease-orientated assessment of sleep-disordered breathing severity. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0267] [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
Studies investigating the relationship between sleep-disordered breathing (SDB) and atrial fibrillation (AF) have largely assessed SDB-severity by the apnea–hypopnea index (AHI). However, the AHI does not incorporate nocturnal hypoxemic burden, which may increase the risk of non-paroxysmal AF (nPAF) as the clinical manifestation of more progressed AF substrates. This investigation sought to systematically characterize and compare the composition of AHI and hypoxemic burden with the aim to defining a disease-orientated metric for SDB-severity best associated with prevalent nPAF.
Methods
Polysomnography including overnight oximetry data were obtained in 435 consecutive ambulatory AF patients to determine the composition of AHI (apneas vs. hypopneas), the number of acute episodic desaturations per hour (oxygen desaturation index, ODI) and the composition of total time spent below 90% oxygen saturation (T90Total) attributed to acute desaturations (T90Desaturation). Logistic regression analysis was used to characterize the association with prevalent nPAF.
Results
One hundred sixty-nine AF patients (38%) had nPAF and one third (n=149, 34%) had moderate-to-severe SDB (AHI>15). 82% of the median total AHI (9.4 [3.6–20.1]) could be attributed to hypopneas. Only 29% of events were associated with episodic desaturations, which contributed to 96% (T90Desaturation) of the variation in T90Total. The high variability in durations and nadirs of distinct desaturation events can expose patients to long T90Total, even if the AHI is low. Not AHI, but T90Total and ODI were associated with nPAF independent of gender and age. However, diabetes, hypertension and body mass index contributed more significantly to the overall risk of nPAF.
Conclusions
In AF patients, hypopneas constitute a majority of respiratory events during sleep. Patients with low AHI can still be exposed to high nocturnal hypoxemic burden, which is mainly a cumulative consequence of episodic desaturations. T90Total and ODI, but not AHI, were associated with nPAF independent of gender and age, but concomitant modifiable risk factors made a more significant contribution to the overall risk of nPAF versus PAF.
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Affiliation(s)
- D Linz
- University of Adelaide, Adelaide, Australia
| | - C Nalliah
- Royal Melbourne Hospital, Royal Melbourne Hospital, Melbourne, Australia
| | - M Baumert
- University of Adelaide, Adelaide, Australia
| | - K Kadhim
- University of Adelaide, Adelaide, Australia
| | | | - A Elliott
- University of Adelaide, Adelaide, Australia
| | - D Lau
- University of Adelaide, Adelaide, Australia
| | - D McEvoy
- University of Adelaide, Adelaide, Australia
| | - J Kalman
- Royal Melbourne Hospital, Royal Melbourne Hospital, Melbourne, Australia
| | - P Sanders
- Royal Melbourne Hospital, Royal Melbourne Hospital, Melbourne, Australia
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Affiliation(s)
- Ashley Elliott
- Musgrave Park Hospital, Stockmans Lane Belfast, Belfast BT9 7JB, UK
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32
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Elliott A, Torrens SD, Pendleton A. THE NAIL-BED AS A WINDOW TO DISEASE: THE DEVELOPMENT OF A NURSE LED CAPILLAROSCOPY SERVICE. Ulster Med J 2019; 88:87. [PMID: 31061553 PMCID: PMC6500414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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33
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Nath L, Curl P, Elliott A, La Gerche A, Franklin S. Cardiac Arrhythmia has a High Rate of Recurrence in the Thoroughbred Racehorse, a Naturally Occurring Animal Model for the Athlete's Heart. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.162] [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: 11/29/2022]
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34
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Malik V, Thiyagarajah A, Munawar D, Linz D, Elliott A, Emami M, Mishima R, Mahajan R, Sanders P, Lau D. Abnormal Cardiac Electrical Remodelling in POTS: Mechanistic Insights on Potential Autonomic Dysregulation. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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35
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Gallagher C, Wong C, Hendriks J, Bednarz J, Elliott A, Linz D, Middeldorp M, Mahajan R, Lau D, Sanders P. Predictors of Health Care Resource Utilisation in AF: The REVIEW AF Study. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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36
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Nath L, Agbaedeng T, Franklin S, Saljic A, Stent A, La Gerche A, Elliott A. Myocardial Fibrosis is Present in Thoroughbred Racehorses with Sudden Cardiac Death. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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37
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Shulman M, Cuthbertson B, Wijeysundera D, Pearse R, Thompson B, Torres E, Ambosta A, Wallace S, Farrington C, Myles P, Wallace S, Thompson B, Ellis M, Borg B, Kerridge R, Douglas J, Brannan J, Pretto J, Godsall M, Beauchamp N, Allen S, Kennedy A, Wright E, Malherbe J, Ismail H, Riedel B, Melville A, Sivakumar H, Murmane A, Kenchington K, Gurunathan U, Stonell C, Brunello K, Steele K, Tronstad O, Masel P, Dent A, Smith E, Bodger A, Abolfathi M, Sivalingam P, Hall A, Painter T, Macklin S, Elliott A, Carrera A, Terblanche N, Pitt S, Samuels J, Wilde C, MacCormick A, Leslie K, Bramley D, Southcott A, Grant J, Taylor H, Bates S, Towns M, Tippett A, Marshall F, McCartney C, Choi S, Somascanthan P, Flores K, Beattie W, Karkouti K, Clarke H, Jerath A, McCluskey S, Wasowicz M, Granton J, Day L, Pazmino-Canizares J, Hagen K, Campbell D, Short T, Van Der Westhuizen J, Higgie K, Lindsay H, Jang R, Wong C, Mcallister D, Ali M, Kumar J, Waymouth E, Kim C, Dimech J, Lorimer M, Tai J, Miller R, Sara R, Collingwood A, Olliff S, Gabriel S, Houston H, Dalley P, Hurford S, Hunt A, Andrews L, Navarra L, Jason-Smith A, Thompson H, McMillan N, Back G, Melo M, Mamdani M, Hillis G, Wijeysundera H. Using the 6-minute walk test to predict disability-free survival after major surgery. Br J Anaesth 2019; 122:111-119. [DOI: 10.1016/j.bja.2018.08.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/13/2018] [Accepted: 08/29/2018] [Indexed: 11/16/2022] Open
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38
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Nalliah C, Baumert M, Kadhim K, Middeldorp M, Elliott A, Lau D, Mahajan R, Wong C, McEvoy D, Kalman J, Sanders P, Linz D. Nocturnal Hypoxemic Burden in Ambulatory Patients with Atrial Fibrillation: a Disease-Orientated Assessment of Sleep-Disordered Breathing Severity. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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39
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Elliott A, Heskett M, McGwin Jr G, Owsley C. LOWER RATES OF EYE CARE UTILIZATION AMONG VISUALLY IMPAIRED SUBSIDIZED SENIOR HOUSING RESIDENTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1853] [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: 11/14/2022] Open
Affiliation(s)
| | | | | | - C Owsley
- University of Alabama at Birmingham
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40
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Khokhar KB, Lau D, Elliott A, Mahajan R, Thiyagarajah A, Munawar DA, Stiles M, Linz DA, Agbaedeng TA, Emami M, Kadhim KB, Mishimi R, Harrington J, Sanders P. P1941Association of aortic stiffness and new onset AF- A meta-analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K B Khokhar
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders (CHRD), Adelaide, Australia
| | - D Lau
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders (CHRD), Adelaide, Australia
| | - A Elliott
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders (CHRD), Adelaide, Australia
| | - R Mahajan
- Waikato District Hospital, Cardiology, Waikato, New Zealand
| | - A Thiyagarajah
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders (CHRD), Adelaide, Australia
| | - D A Munawar
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders (CHRD), Adelaide, Australia
| | - M Stiles
- Waikato District Hospital, Cardiology, Waikato, New Zealand
| | - D A Linz
- Waikato District Hospital, Cardiology, Waikato, New Zealand
| | - T A Agbaedeng
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders (CHRD), Adelaide, Australia
| | - M Emami
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders (CHRD), Adelaide, Australia
| | - K B Kadhim
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders (CHRD), Adelaide, Australia
| | - R Mishimi
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders (CHRD), Adelaide, Australia
| | - J Harrington
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders (CHRD), Adelaide, Australia
| | - P Sanders
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders (CHRD), Adelaide, Australia
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41
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Elliott A, Verdicchio CV, Linz D, Stokes M, Gallagher C, Mahajan R, Hendriks JML, Lau DH, Sanders P. P983Mechanisms contributing to exercise intolerance in patients with atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Elliott
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - C V Verdicchio
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D Linz
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - M Stokes
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - C Gallagher
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - R Mahajan
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - J M L Hendriks
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D H Lau
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - P Sanders
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
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42
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Donaghy C, Elliott A, Cairns A. 030 A crystal clear case of seropositive rheumatoid arthritis. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cathy Donaghy
- Rheumatology, Musgrave Park Hospital, Belfast, UNITED KINGDOM
| | - Ashley Elliott
- Rheumatology, Musgrave Park Hospital, Belfast, UNITED KINGDOM
| | - Andrew Cairns
- Rheumatology, Musgrave Park Hospital, Belfast, UNITED KINGDOM
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43
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Elliott A, Donaghy C, Wright G. e40 An audit on the use and response to secukinumab within the Belfast Trust. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.581] [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: 11/13/2022] Open
Affiliation(s)
- Ashley Elliott
- Rheumatology Belfast Trust, Musgrave Park Hospital, Belfast, UNITED KINGDOM
| | - Cathy Donaghy
- Rheumatology Belfast Trust, Musgrave Park Hospital, Belfast, UNITED KINGDOM
| | - Gary Wright
- Rheumatology Belfast Trust, Musgrave Park Hospital, Belfast, UNITED KINGDOM
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44
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Elliott A, Wright G, Quinn A, Torrens D, Pendleton A, Mchenry M. e33 An experience of tight control in psoriatic arthritis management within the Belfast Trust. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.574] [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: 11/13/2022] Open
Affiliation(s)
- Ashley Elliott
- Rheumatology Belfast Trust, Musgrave Park Hospital, Belfast, UNITED KINGDOM
| | - Gary Wright
- Rheumatology Belfast Trust, Musgrave Park Hospital, Belfast, UNITED KINGDOM
| | - Anne Quinn
- Rheumatology Belfast Trust, Royal Victoria Hospital, Belfast, UNITED KINGDOM
| | - Donna Torrens
- Rheumatology Belfast Trust, Royal Victoria Hospital, Belfast, UNITED KINGDOM
| | - Adrian Pendleton
- Rheumatology Belfast Trust, Musgrave Park Hospital, Belfast, UNITED KINGDOM
| | - Michelle Mchenry
- Rheumatology Belfast Trust, Musgrave Park Hospital, Belfast, UNITED KINGDOM
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45
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Clarke C, Taggart P, Monaghan J, McKnight J, Cairns A, Elliott A. 284 A physiotherapy-led in-patient intensive rehabilitation programme for ankylosing spondylitis: follow-up outcomes. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.508] [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: 11/13/2022] Open
Affiliation(s)
- Caroline Clarke
- Physiotherapy, Musgrave Park Hospital, Belfast, UNITED KINGDOM
| | - Pauline Taggart
- Physiotherapy, Musgrave Park Hospital, Belfast, UNITED KINGDOM
| | - Julie Monaghan
- Physiotherapy, Musgrave Park Hospital, Belfast, UNITED KINGDOM
| | | | - Andrew Cairns
- Rheumatology, Musgrave Park Hospital, Belfast, UNITED KINGDOM
| | - Ashley Elliott
- Rheumatology, Musgrave Park Hospital, Belfast, UNITED KINGDOM
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46
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Elliott A, Verdicchio CV, Gallagher C, Munawar DA, Linz D, Stokes MB, Middeldorp ME, Mahajan R, Lau DH, Sanders P. P1188Exercise Intolerance in AF Patients: A consequence of rhythm status or myocardial impairment? Europace 2018. [DOI: 10.1093/europace/euy015.672] [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: 11/14/2022] Open
Affiliation(s)
- A Elliott
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - C V Verdicchio
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - C Gallagher
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D A Munawar
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D Linz
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - M B Stokes
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - M E Middeldorp
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - R Mahajan
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D H Lau
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - P Sanders
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
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47
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Linz D, Kadhim K, Elliott A, Brooks A, Hendriks JMLH, Lau DH, Mcevoy DH, Hohl M, Baumert M, Sanders P. 1007Diagnostic accuracy of overnight oximetry for the diagnosis of sleep-disordered breathing in atrial fibrillation patients. Europace 2018. [DOI: 10.1093/europace/euy015.556] [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: 11/14/2022] Open
Affiliation(s)
- D Linz
- South Australian Health and Medical Research Institute, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - K Kadhim
- South Australian Health and Medical Research Institute, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - A Elliott
- South Australian Health and Medical Research Institute, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - A Brooks
- South Australian Health and Medical Research Institute, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - JMLH Hendriks
- South Australian Health and Medical Research Institute, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D H Lau
- South Australian Health and Medical Research Institute, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D H Mcevoy
- South Australian Health and Medical Research Institute, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - M Hohl
- Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany
| | - M Baumert
- South Australian Health and Medical Research Institute, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - P Sanders
- South Australian Health and Medical Research Institute, Centre for Heart Rhythm Disorders, Adelaide, Australia
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48
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Agbaedeng TA, Mahajan R, Thanigaimani S, Elliott A, Mclennan E, Lau DH, Sanders P. 589Ventricular structural remodelling in an ovine sheep model of sustained weight gain: Potential role of desmoglein-2 in fibro-fatty replacement and arrhythmogenicity. Europace 2018. [DOI: 10.1093/europace/euy015.316] [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: 11/13/2022] Open
Affiliation(s)
- T A Agbaedeng
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - R Mahajan
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - S Thanigaimani
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - A Elliott
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - E Mclennan
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D H Lau
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - P Sanders
- University of Adelaide, Department of Medicine, Centre for Heart Rhythm Disorders, Adelaide, Australia
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49
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Verdicchio C, Elliott A, Mahajan R, Gallagher C, Middeldorp M, Linz D, Lau D, Sanders P. P1189Use of heart rate to guide exercise training intensity in patients with atrial fibrillation. Europace 2018. [DOI: 10.1093/europace/euy015.673] [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: 11/13/2022] Open
Affiliation(s)
- C Verdicchio
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - A Elliott
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - R Mahajan
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - C Gallagher
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - M Middeldorp
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D Linz
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D Lau
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - P Sanders
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
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50
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Verdicchio C, Elliott A, Wijaithum P, Lau D, Sanders P, Mahajan R. 50Restoration of sinus rhythm improves exercise capacity in patients with persistent atrial fibrillation: a meta-analysis. Europace 2018. [DOI: 10.1093/europace/euy015.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Verdicchio
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - A Elliott
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - P Wijaithum
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D Lau
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - P Sanders
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - R Mahajan
- University of Adelaide, Centre for Heart Rhythm Disorders, Adelaide, Australia
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