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Staudacher HM, Mahoney S, Canale K, Opie RS, Loughman A, So D, Beswick L, Hair C, Jacka FN. Clinical trial: A Mediterranean diet is feasible and improves gastrointestinal and psychological symptoms in irritable bowel syndrome. Aliment Pharmacol Ther 2024; 59:492-503. [PMID: 37969059 DOI: 10.1111/apt.17791] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/17/2023] [Accepted: 10/20/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Diet is fundamental to the care of irritable bowel syndrome (IBS). However, some approaches are not appropriate for individuals experiencing psychological symptoms. AIMS To assess feasibility of a Mediterranean diet in IBS and its impact on gastrointestinal and psychological symptoms. METHODS We recruited adults with Rome IV IBS and mild or moderate anxiety and/or depressive symptoms to an unblinded 6-week randomised controlled trial. Patients were randomised to Mediterranean diet counselling or habitual diet. We collected gastrointestinal and psychological symptom data, dietary data and stool samples for metagenomic sequencing. RESULTS We randomised 59 individuals (29 Mediterranean diet, 30 control); 48 completed the study. The Mediterranean Diet Adherence Screener score was higher in the Mediterranean diet group than controls at week 6 (7.5 [95% CI: 6.9-8.0] vs. 5.7 [5.2-6.3], p < 0.001), and there was a greater score increase than controls (2.1 [95% CI: 1.3-2.9] vs. 0.5 [95% CI: 0.1-1.0], p = 0.004), demonstrating Mediterranean diet feasibility. There was a greater proportion of gastrointestinal symptom responders in the Mediterranean diet group than controls (24/29, 83% vs. 11/30, 37%, p < 0.001) and depression responders (15/29, 52% vs. 6/30 20%, p = 0.015). There was no difference in FODMAP intake at week 6 (p = 0.51). Gastrointestinal adverse events were similar (p = 0.588). There were no differences in change in microbiome parameters between groups. CONCLUSIONS A Mediterranean diet is feasible in IBS and leads to improvement in gastrointestinal and psychological symptoms. Although this study was unblinded, these findings together with the broader benefits of the Mediterranean diet, provide strong impetus for future research in IBS. Australia New Zealand Clinical Trials Registry: ACTRN12620001362987.
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Affiliation(s)
- Heidi M Staudacher
- Food & Mood Centre, The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine and Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Sophie Mahoney
- Food & Mood Centre, The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine and Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Kim Canale
- Food & Mood Centre, The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine and Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Rachelle S Opie
- Food & Mood Centre, The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine and Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Amy Loughman
- Food & Mood Centre, The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine and Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Daniel So
- Food & Mood Centre, The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine and Barwon Health, Deakin University, Geelong, Victoria, Australia
- Department of Nutritional Sciences, King's College London, London, UK
| | - Lauren Beswick
- Department of Gastroenterology, Barwon Health, Geelong, Victoria, Australia
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Chris Hair
- Department of Gastroenterology, Barwon Health, Geelong, Victoria, Australia
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Felice N Jacka
- Food & Mood Centre, The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine and Barwon Health, Deakin University, Geelong, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Ng PY, Chan VWS, Ip A, Ling L, Chan KM, Leung AKH, Chan KKC, So D, Shum HP, Ngai CW, Chan WM, Sin WC. Ten-year territory-wide trends in the utilisation and clinical outcomes of extracorporeal membrane oxygenation in Hong Kong. Hong Kong Med J 2023; 29:514-523. [PMID: 37968897 DOI: 10.12809/hkmj2210025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION The utilisation of extracorporeal membrane oxygenation (ECMO) has been rapidly increasing in Hong Kong. This study examined 10-year trends in the utilisation and clinical outcomes of ECMO in Hong Kong. METHODS We retrospectively reviewed the records of all adult patients receiving ECMO who were admitted to the intensive care units (ICUs) of public hospitals in Hong Kong between 2010 and 2019. Temporal trends across years were assessed using the Mann-Kendall test. Observed hospital mortality was compared with the Acute Physiology and Chronic Health Evaluation (APACHE) IV-predicted mortality. RESULTS The annual number of patients receiving ECMO increased from 18 to 171 over 10 years. In total, 911 patients received ECMO during the study period: 297 (32.6%) received veno-arterial ECMO, 450 (49.4%) received veno-venous ECMO, and 164 (18.0%) received extracorporeal cardiopulmonary resuscitation. The annual number of patients aged ≥65 years increased from 0 to 47 (27.5%) [P for trend=0.001]. The median (interquartile range) Charlson Comorbidity Index increased from 1 (0-1) to 2 (1-3) [P for trend<0.001] while the median (interquartile range) APACHE IV score increased from 90 (57-112) to 105 (77-137) [P for trend=0.003]. The overall standardised mortality ratio comparing hospital mortality with APACHE IV-predicted mortality was 1.11 (95% confidence interval=1.01-1.22). Hospital and ICU length of stay both significantly decreased (P for trend=0.011 and <0.001, respectively). CONCLUSION As ECMO utilisation increased in Hong Kong, patients put on ECMO were older, more critically ill, and had more co-morbidities. It is important to combine service expansion with adequate resource allocation and training to maintain quality of care.
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Affiliation(s)
- P Y Ng
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong SAR, China
| | - V W S Chan
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - A Ip
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - L Ling
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - K M Chan
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - A K H Leung
- Department of Intensive Care, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - K K C Chan
- Department of Intensive Care, Tuen Mun Hospital, Hong Kong SAR, China
| | - D So
- Department of Intensive Care, Princess Margaret Hospital, Hong Kong SAR, China
| | - H P Shum
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - C W Ngai
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong SAR, China
| | - W M Chan
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong SAR, China
| | - W C Sin
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong SAR, China
- Department of Anaesthesiology, The University of Hong Kong, Hong Kong SAR, China
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Aslam H, Lotfaliany M, So D, Berding K, Berk M, Rocks T, Hockey M, Jacka FN, Marx W, Cryan JF, Staudacher HM. Fiber intake and fiber intervention in depression and anxiety: a systematic review and meta-analysis of observational studies and randomized controlled trials. Nutr Rev 2023:nuad143. [PMID: 38007616 DOI: 10.1093/nutrit/nuad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023] Open
Abstract
CONTEXT Dietary fibers hold potential to influence depressive and anxiety outcomes by modulating the microbiota-gut-brain axis, which is increasingly recognized as an underlying factor in mental health maintenance. OBJECTIVE Evidence for the effects of fibers on depressive and anxiety outcomes remains unclear. To this end, a systematic literature review and a meta-analysis were conducted that included observational studies and randomized controlled trials (RCTs). DATA SOURCES The PubMed, Embase, CENTRAL, CINAHL, and PsychINFO databases were searched for eligible studies. DATA EXTRACTION Study screening and risk-of-bias assessment were conducted by 2 independent reviewers. DATA ANALYSIS Meta-analyses via random effects models were performed to examine the (1) association between fiber intake and depressive and anxiety outcomes in observational studies, and (2) effect of fiber intervention on depressive and anxiety outcomes compared with placebo in RCTs. A total of 181 405 participants were included in 23 observational studies. In cross-sectional studies, an inverse association was observed between fiber intake and depressive (Cohen's d effect size [d]: -0.11; 95% confidence interval [CI]: -0.16, -0.05) and anxiety (d = -0.25; 95%CI, -0.38, -0.12) outcomes. In longitudinal studies, there was an inverse association between fiber intake and depressive outcomes (d = -0.07; 95%CI, -0.11, -0.04). In total, 740 participants were included in 10 RCTs, all of whom used fiber supplements. Of note, only 1 RCT included individuals with a clinical diagnosis of depression. No difference was found between fiber supplementation and placebo for depressive (d = -0.47; 95%CI, -1.26, 0.31) or anxiety (d = -0.30; 95%CI, -0.67, 0.07) outcomes. CONCLUSION Although observational data suggest a potential benefit for higher fiber intake for depressive and anxiety outcomes, evidence from current RCTs does not support fiber supplementation for improving depressive or anxiety outcomes. More research, including RCTs in clinical populations and using a broad range of fibers, is needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42021274898.
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Affiliation(s)
- Hajara Aslam
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine and Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Mojtaba Lotfaliany
- IMPACT, School of Medicine and Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Daniel So
- Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Kirsten Berding
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine and Barwon Health, Deakin University, Geelong, Victoria, Australia
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - Tetyana Rocks
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine and Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Meghan Hockey
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine and Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Felice N Jacka
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine and Barwon Health, Deakin University, Geelong, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- College of Public Health, Medical & Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Wolfgang Marx
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine and Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - John F Cryan
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Heidi M Staudacher
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine and Barwon Health, Deakin University, Geelong, Victoria, Australia
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So D, Thwaites PA, Gibson PR. Editorial: Interaction between fibre and colonic fermentation assessed with a novel gas-sensing capsule-Authors' reply. Aliment Pharmacol Ther 2023; 58:830-831. [PMID: 37768291 DOI: 10.1111/apt.17704] [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: 09/29/2023]
Abstract
LINKED CONTENTThis article is linked to So et al papers. To view these articles, visit https://doi.org/10.1111/apt.17629 and https://doi.org/10.1111/apt.17687
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Affiliation(s)
- Daniel So
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Phoebe A Thwaites
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Peter R Gibson
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia
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So D, Yao CK, Gill PA, Thwaites PA, Ardalan ZS, McSweeney CS, Denman SE, Chrimes AF, Muir JG, Berean KJ, Kalantar‐Zadeh K, Gibson PR. Detection of changes in regional colonic fermentation in response to supplementing a low FODMAP diet with dietary fibres by hydrogen concentrations, but not by luminal pH. Aliment Pharmacol Ther 2023; 58:417-428. [PMID: 37386938 PMCID: PMC10946934 DOI: 10.1111/apt.17629] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/04/2023] [Accepted: 06/15/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Carbohydrate fermentation plays a pivotal role in maintaining colonic health with excessive proximal and deficient distal fermentation being detrimental. AIMS To utilise telemetric gas- and pH-sensing capsule technologies for defining patterns of regional fermentation following dietary manipulations, alongside conventional techniques of measuring fermentation. METHODS In a double-blind crossover trial, 20 patients with irritable bowel syndrome were fed low FODMAP diets that included no extra fibre (total fibre content 24 g/day), or additional poorly fermented fibre, alone (33 g/day) or with fermentable fibre (45 g/day) for 2 weeks. Plasma and faecal biochemistry, luminal profiles defined by tandem gas- and pH-sensing capsules, and faecal microbiota were assessed. RESULTS Plasma short-chain fatty acid (SCFA) concentrations (μmol/L) were median (IQR) 121 (100-222) with fibre combination compared with 66 (44-120) with poorly fermented fibre alone (p = 0.028) and 74 (55-125) control (p = 0.069), but no differences in faecal content were observed. Luminal hydrogen concentrations (%), but not pH, were higher in distal colon (mean 4.9 [95% CI: 2.2-7.5]) with fibre combination compared with 1.8 (0.8-2.8) with poorly fermented fibre alone (p = 0.003) and 1.9 (0.7-3.1) control (p = 0.003). Relative abundances of saccharolytic fermentative bacteria were generally higher in association with supplementation with the fibre combination. CONCLUSIONS A modest increase in fermentable plus poorly fermented fibres had minor effects on faecal measures of fermentation, despite increases in plasma SCFA and abundance of fermentative bacteria, but the gas-sensing capsule, not pH-sensing capsule, detected the anticipated propagation of fermentation distally in the colon. The gas-sensing capsule technology provides unique insights into localisation of colonic fermentation. TRIAL REGISTRATION ACTRN12619000691145.
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Affiliation(s)
- Daniel So
- Department of GastroenterologyCentral Clinical School, Monash University and Alfred HealthMelbourneAustralia
| | - Chu K. Yao
- Department of GastroenterologyCentral Clinical School, Monash University and Alfred HealthMelbourneAustralia
| | - Paul A. Gill
- Department of GastroenterologyCentral Clinical School, Monash University and Alfred HealthMelbourneAustralia
| | - Phoebe A. Thwaites
- Department of GastroenterologyCentral Clinical School, Monash University and Alfred HealthMelbourneAustralia
| | - Zaid S. Ardalan
- Department of GastroenterologyCentral Clinical School, Monash University and Alfred HealthMelbourneAustralia
| | - Chris S. McSweeney
- Agriculture and FoodCommonwealth Scientific and Industrial Research OrganisationSt. LuciaAustralia
| | - Stuart E. Denman
- Agriculture and FoodCommonwealth Scientific and Industrial Research OrganisationSt. LuciaAustralia
| | - Adam F. Chrimes
- Atmo BiosciencesMelbourneAustralia
- School of Engineering, RMIT UniversityMelbourneAustralia
| | - Jane G. Muir
- Department of GastroenterologyCentral Clinical School, Monash University and Alfred HealthMelbourneAustralia
| | - Kyle J. Berean
- Atmo BiosciencesMelbourneAustralia
- School of Engineering, RMIT UniversityMelbourneAustralia
| | - Kourosh Kalantar‐Zadeh
- School of Chemical Engineering, University of New South WalesSydneyAustralia
- Faculty of EngineeringSchool of Chemical and Biomolecular Engineering, The University of SydneySydneyAustralia
| | - Peter R. Gibson
- Department of GastroenterologyCentral Clinical School, Monash University and Alfred HealthMelbourneAustralia
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Thwaites PA, Yao CK, Maggo J, John J, Chrimes AF, Burgell RE, Muir JG, Parker FC, So D, Kalantar‐Zadeh K, Gearry RB, Berean KJ, Gibson PR. Comparison of gastrointestinal landmarks using the gas-sensing capsule and wireless motility capsule. Aliment Pharmacol Ther 2022; 56:1337-1348. [PMID: 36082475 PMCID: PMC9826325 DOI: 10.1111/apt.17216] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 07/29/2022] [Accepted: 08/25/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND Accurate definition of the gastroduodenal and ileocaecal junctions (GDJ, ICJ) is essential for the measurement of regional transit times. AIMS To compare the assessment of these landmarks using the novel gas-sensing capsule and validated wireless motility capsule (WMC), and to evaluate intra-subject variance in transit times METHODS: Healthy subjects ingested the gas-sensing capsule and WMC tandemly in random order. Inter-observer agreement was evaluated by intra-class correlation coefficient (ICC). Agreement between the paired devices' transit times was assessed using Bland-Altman analysis; coefficient of variation was performed to express intra-individual variance in transit times. Similar analyses were completed with tandemly ingested gas-sensing capsules. RESULTS The inter-observer agreement for landmarks for both capsules was excellent (mean ICC ≥0.97) in 50 studies. The GDJ was identifiable in 92% of the gas-sensing capsule studies versus 82% of the WMC studies (p = 0.27); the ICJ in 96% versus 84%, respectively (p = 0.11). In the primary cohort (n = 26), median regional transit times differed by less than 6 min between paired capsules. Bland-Altman revealed a bias of -0.12 (95% limits of agreement, -0.94 to 0.70) hours for GDJ and - 0.446 (-2.86 to 2.0) hours for ICJ. Similar results were found in a demographically distinct validation cohort (n = 24). For tandemly ingested gas-sensing capsules, coefficients of variation of transit times were 11%-35%, which were similar to variance between the paired gas-sensing capsule and WMC, as were the biases. The capsules were well tolerated. CONCLUSIONS Key anatomical landmarks are accurately identified with the gas-sensing capsule in healthy individuals. Intra-individual differences in transit times between capsules are probably due to physiological factors. Studies in populations with gastrointestinal diseases are now required.
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Affiliation(s)
- Phoebe A. Thwaites
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Chu K. Yao
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | | | - James John
- Atmo BiosciencesMelbourneVictoriaAustralia
| | - Adam F. Chrimes
- Atmo BiosciencesMelbourneVictoriaAustralia,School of EngineeringRMIT UniversityMelbourneVictoriaAustralia
| | - Rebecca E. Burgell
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Jane G. Muir
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Francis C. Parker
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Daniel So
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia
| | - Kourosh Kalantar‐Zadeh
- School of Chemical EngineeringUniversity of New South WalesSydneyNew South WalesAustralia
| | | | - Kyle J. Berean
- Atmo BiosciencesMelbourneVictoriaAustralia,School of EngineeringRMIT UniversityMelbourneVictoriaAustralia
| | - Peter R. Gibson
- Department of Gastroenterology, Central Clinical SchoolMonash University and Alfred HealthMelbourneVictoriaAustralia,School of EngineeringRMIT UniversityMelbourneVictoriaAustralia
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Malhotra N, Wu W, So D, Boodhwani M, McDonald B, Wilson B, Toeg H, Chong A, Mielniczuk L, Stadnick E, Lamacie M, McGuinty C, Rubens F, LeMay M, Labinaz M, Chih S. SINGLE CENTRE COMPARISON OF PATIENTS MANAGED BY A CODE SHOCK TEAM VERSUS STANDARD OF CARE. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.123] [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: 11/02/2022] Open
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So D, Yao CK, Ardalan ZS, Thwaites PA, Kalantar-Zadeh K, Gibson PR, Muir JG. Supplementing Dietary Fibers With a Low FODMAP Diet in Irritable Bowel Syndrome: A Randomized Controlled Crossover Trial. Clin Gastroenterol Hepatol 2022; 20:2112-2120.e7. [PMID: 34929392 DOI: 10.1016/j.cgh.2021.12.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Institution of a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) in patients with irritable bowel syndrome (IBS) may lead to inadequate fiber intake. This trial aimed to investigate the effects of supplementing specific fibers concomitantly with a low FODMAP diet on relevant clinical and physiological indices in symptomatic patients with IBS. METHODS A double-blind crossover trial was conducted in which 26 patients with IBS were randomly assigned to 1 of 3 low FODMAP diets differing only in total fiber content: control, 23 g/d; sugarcane bagasse, 33 g/d; or fiber combination (sugarcane bagasse with resistant starch), 45 g/d. Each diet lasted 14 days with most food provided and ≥21 days' washout between. Endpoints were assessed during baseline and dietary interventions. RESULTS From a median IBS Severity Scoring System total score at baseline of 305, all diets reduced median scores by >50 with no differences in rates of symptom response between the diets: control (57%), sugarcane bagasse (67%), fiber combination (48%) (P = .459). Stool output was ∼50% higher during the fiber-supplemented vs control diets (P < .001 for both). While there were no overall differences overall in stool characteristics, descriptors, and water content, or in gastrointestinal transit times, supplementation with sugarcane bagasse normalized both low stool water content and slow colonic transit from during the control diet. CONCLUSIONS Concomitant supplementation of fibers during initiation of a low FODMAP diet did not alter symptomatic response in patients with IBS but augmented stool bulk and normalized low stool water content and slow transit. Resistant starch did not exert additional symptomatic benefits over sugarcane bagasse alone. (Australia and New Zealand Clinical Trial Registry; Number, ACTRN12619000691145).
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Affiliation(s)
- Daniel So
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia.
| | - Chu K Yao
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Zaid S Ardalan
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Phoebe A Thwaites
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Kourosh Kalantar-Zadeh
- Chemical Engineering (Food Science and Technology), University of New South Wales, Sydney, New South Wales, Australia
| | - Peter R Gibson
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Jane G Muir
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia
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So D, Loughman A, Staudacher HM. Effects of a low FODMAP diet on the colonic microbiome in irritable bowel syndrome: a systematic review with meta-analysis. Am J Clin Nutr 2022; 116:943-952. [PMID: 35728042 PMCID: PMC9535515 DOI: 10.1093/ajcn/nqac176] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/11/2022] [Accepted: 06/13/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND A low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet is increasingly used to manage symptoms in irritable bowel syndrome (IBS). Although this approach may alter the colonic microbiome, the nature of these changes has not been comprehensively synthesized. OBJECTIVES The aim of this study was to conduct a systematic review with meta-analysis of randomized controlled trials examining the impact of a low FODMAP diet on the composition and function of the microbiome in patients with IBS. METHODS A systematic search was conducted for randomized controlled trials evaluating the effects of a low FODMAP diet on the colonic microbiome in patients with IBS in MEDLINE, EMBASE, CENTRAL, and Web of Science from inception to April 2022. Outcomes included diversity of the microbiome, specific bacterial abundances, fecal SCFA concentration, and fecal pH. For fecal SCFA concentrations and pH, meta-analyses were performed via a random-effects model. RESULTS Nine trials involving 403 patients were included. There were no clear effects of the low FODMAP diet on diversity of the microbiome. A low FODMAP diet consistently led to lower abundance of Bifidobacteria, but there were no clear effects on diversity of the microbiome or abundances of other specific taxa. There were no differences in total fecal SCFA concentration between the low FODMAP diet and control diets (standardized mean difference: -0.25; 95% CI: -0.63, 0.13; P = 0.20), nor were there differences for fecal concentrations of specific SCFAs or fecal pH. CONCLUSIONS In patients with IBS, the effects of a low FODMAP diet on the colonic microbiome appear to be specific to Bifidobacteria with no consistent impacts on other microbiome metrics, including diversity, fecal SCFA concentrations, and fecal pH. Further, adequately powered trials are needed to confirm these findings.This review was registered at https://www.crd.york.ac.uk/prospero/ as CRD42020192243.
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Affiliation(s)
- Daniel So
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Amy Loughman
- Food & Mood Centre, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, Victoria, Australia
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Gibson PR, Halmos EP, So D, Yao CK, Varney JE, Muir JG. Diet as a therapeutic tool in chronic gastrointestinal disorders: Lessons from the FODMAP journey. J Gastroenterol Hepatol 2022; 37:644-652. [PMID: 34994019 DOI: 10.1111/jgh.15772] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/12/2021] [Accepted: 12/24/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM Diet is a powerful tool in the management of gastrointestinal disorders, but developing diet therapies is fraught with challenge. This review discusses key lessons from the FODMAP diet journey. METHODS Published literature and clinical experience were reviewed. RESULTS Key to designing a varied, nutritionally adequate low-FODMAP diet was our accurate and comprehensive database of FODMAP composition, made universally accessible via our user-friendly, digital application. Our discovery that FODMAPs coexist with gluten in cereal products and subsequent gluten/fructan challenge studies in nonceliac gluten-sensitive populations highlighted issues of collinearity in the nutrient composition of food and confirmation bias in the interpretation of dietary studies. Despite numerous challenges in designing, funding, and executing dietary randomized controlled trials, efficacy of the low-FODMAP diet has been repeatedly demonstrated, and confirmed by real-world experience, giving this therapy credibility in the eyes of clinicians and researchers. Furthermore, real-world application of this diet saw the evolution of a safe and effective three-phased approach. Specialist dietitians must deliver this diet to optimize outcomes as they can target and tailor the therapy and to mitigate the key risks of compromising nutritional adequacy and precipitating disordered eating behaviors, skills outside the gastroenterologist's standard tool kit. While concurrent probiotics are ineffective, specific fiber supplements may improve short-term and long-term outcomes. CONCLUSIONS The FODMAP diet is highly effective, but optimal outcomes are contingent on the involvement of a gastroenterological dietitian who can assess, educate, and monitor patients and manage risks associated with implementation of this restrictive diet.
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Affiliation(s)
- Peter R Gibson
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Emma P Halmos
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Daniel So
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Chu K Yao
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Jane E Varney
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Jane G Muir
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, Victoria, Australia
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11
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So D, Gibson PR, Muir JG, Yao CK. Dietary fibres and IBS: translating functional characteristics to clinical value in the era of personalised medicine. Gut 2021; 70:2383-2394. [PMID: 34417199 DOI: 10.1136/gutjnl-2021-324891] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/04/2021] [Indexed: 12/16/2022]
Abstract
Clinical guidelines in the use of fibre supplementation for patients with IBS provide one-size-fits-all advice, which has limited value. This narrative review addresses data and concepts around the functional characteristics of fibre and subsequent physiological responses induced in patients with IBS with a view to exploring the application of such knowledge to the precision use of fibre supplements. The key findings are that first, individual fibres elicit highly distinct physiological responses that are associated with their functional characteristics rather than solubility. Second, the current evidence has focused on the use of fibres as a monotherapy for IBS symptoms overall without attempting to exploit these functional characteristics to elicit specific, symptom-targeted effects, or to use fibre types as adjunctive therapies. Personalisation of fibre therapies can therefore target several therapeutic goals. Proposed goals include achieving normalisation of bowel habit, modulation of gut microbiota function towards health and correction of microbial effects of other dietary therapies. To put into perspective, bulking fibres that are minimally fermented can offer utility in modulating indices of bowel habit; slowly fermented fibres may enhance the activities of the gut microbiota; and the combination of both fibres may potentially offer both benefits while optimising the activities of the microbiota throughout the different regions of the colon. In conclusion, understanding the GI responses to specific fibres, particularly in relation to the physiology of the individual, will be the future for personalising fibre therapy for enhancing the personalised management of patients with IBS.
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Affiliation(s)
- Daniel So
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Peter R Gibson
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Jane G Muir
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Chu K Yao
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
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12
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So D, Tuck CJ. Plant-based diets in gastrointestinal disorders: something, nothing, or everything? Lancet Gastroenterol Hepatol 2021; 6:992. [PMID: 34774163 DOI: 10.1016/s2468-1253(21)00380-0] [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: 10/19/2022]
Affiliation(s)
- Daniel So
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Health, Melbourne, VIC, Australia
| | - Caroline J Tuck
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
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13
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Fu A, Barry Q, Boudreau R, Clifford C, Chow A, Simard T, Chong AY, Dick A, Froeschl M, Glover C, Hibbert B, Labinaz M, Le May M, Russo J, So D. Outcomes of patients with high bleeding risks characteristics presenting with acute coronary syndrome undergoing percutaneous coronary intervention. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with high bleeding risk characteristics (HBR) presenting with acute coronary syndrome (ACS) pose a clinical challenge to balance risk for recurrent ischemic events versus incurring bleeding with dual antiplatelet therapy.
Purpose
We seek to determine the incidence and predictors of short and long term ischemic and bleeding outcomes in patients with HBR factors presenting with ACS after percutaneous coronary intervention (PCI).
Method
Consecutive patients over a 1-year period, who underwent PCI for ACS were categorized as having HBR based on: age ≥75, anemia (hemoglobin<110g/L), thrombocytopenia (platelet<100x109/L), renal failure (eGFR<30umol/L) or concurrent use of oral anticoagulation. Primary outcome was major adverse cardiovascular event (MACE) defined as composite of cardiovascular death, myocardial infarction, and stroke at 1 year. Key secondary outcomes include significant bleeding defined as Bleeding Academic Research Consortium (BARC) type 3 or 5, and net adverse cardiovascular event (NACE), as a composite of MACE and significant bleeding.
Results
Of 1351 patients presented with ACS, 389 (28.8%) had at least one HBR criteria. At 1 year, patients with HBR, compared to those without, had increased MACE (11.1% vs 4.2%, p<0.001) and cardiovascular death (5.7% vs 1.7%, p<0.001). Patients with HBR had increased significant bleeding (3.6% vs 2.3%, p=0.011) and NACE (14.4% vs 5.4%, p<0.001). Multivariate analysis showed the presence of HBR and prior history of myocardial infarction were predictors for 1-year MACE (OR 2.67, CI [1.62–4.42], p<0.001 and OR 2.18, CI [1.29–3.70], p=0.004, respectively), whereas the use of second-generation antiplatelet agent was not. Increased MACE and NACE were observed in HBR patients beyond 1 month of DAPT.
Conclusion
Among patients with ACS undergoing PCI, those with HBR had higher risk for both ischemic and bleeding complications. Novel strategies need to be considered for this high-risk group. Current guidelines, recommending 1 year of DAPT for patients with ACS, should be re-evaluated among patients with HBR.
Funding Acknowledgement
Type of funding sources: None. Kaplan-Meier curve for 1 year MACEKaplan-Meier curve for 1 year death
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Affiliation(s)
- A Fu
- University of Ottawa Heart Institute, Ottawa, Canada
| | - Q Barry
- University of Ottawa Heart Institute, Ottawa, Canada
| | - R Boudreau
- University of Ottawa Heart Institute, Ottawa, Canada
| | | | - A Chow
- University of Ottawa Heart Institute, Ottawa, Canada
| | - T Simard
- University of Ottawa Heart Institute, Ottawa, Canada
| | - A Y Chong
- University of Ottawa Heart Institute, Ottawa, Canada
| | - A Dick
- University of Ottawa Heart Institute, Ottawa, Canada
| | - M Froeschl
- University of Ottawa Heart Institute, Ottawa, Canada
| | - C Glover
- University of Ottawa Heart Institute, Ottawa, Canada
| | - B Hibbert
- University of Ottawa Heart Institute, Ottawa, Canada
| | - M Labinaz
- University of Ottawa Heart Institute, Ottawa, Canada
| | - M Le May
- University of Ottawa Heart Institute, Ottawa, Canada
| | - J Russo
- University of Ottawa Heart Institute, Ottawa, Canada
| | - D So
- University of Ottawa Heart Institute, Ottawa, Canada
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14
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Goodman S, Bagai A, Tan M, Andrade J, Spindler C, Malek-Marzban P, Har B, Yip A, Paniagua M, Elbarouni B, Bainey K, Paradis J, Maranda R, Cantor W, Doucet M, Khan R, Eisenberg M, Dery J, Schwalm J, Madan M, Lam A, Hameed A, Noronha L, Cieza T, Matteau A, Roth S, So D, Lavi S, Glanz A, Gao D, Tahiliani R, Welsh R, Kim H, Robinson S, Daneault B, Chong A, Le May M, Ahooja V, Gregoire J, Nadeau P, Laksman Z, Heilbron B, Bonakdar H, Yung D, Yan A. ANTITHROMBOTIC THERAPIES IN CANADIAN ATRIAL FIBRILLATION PATIENTS WITH CONCOMITANT CORONARY ARTERY DISEASE: INSIGHTS FROM THE CONNECT AF+PCI-I AND -II PROGRAMS. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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15
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Joynt GM, Leung AKH, Ho CM, So D, Shum HP, Chow FL, Yeung AWT, Lee KL, Tang GKY, Yan WW. Admission triage tool for adult intensive care unit admission in Hong Kong during the COVID-19 outbreak. Hong Kong Med J 2021; 28:64-72. [PMID: 33518531 DOI: 10.12809/hkmj209033] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Intensive care is expensive, and the numbers of intensive care unit (ICU) beds and trained specialist medical staff able to provide services in Hong Kong are limited. The most recent increase in coronavirus disease 2019 (COVID-19) infections over July to August 2020 resulted in more than 100 new cases per day for a prolonged period. The increased numbers of critically ill patients requiring ICU admission posed a capacity challenge to ICUs across the territory, and it may be reasonably anticipated that should a substantially larger outbreak occur, ICU services will be overwhelmed. Therefore, a transparent and fair prioritisation process for decisions regarding patient ICU admission is urgently required. This triage tool is built on the foundation of the existing guidelines and framework for admission, discharge, and triage that inform routine clinical practice in Hospital Authority ICUs, with the aim of achieving the greatest benefit for the greatest number of patients from the available ICU resources. This COVID-19 Crisis Triage Tool is expected to provide structured guidance to frontline doctors on how to make triage decisions should ICU resources become overwhelmed by patients requiring ICU care, particularly during the current COVID-19 pandemic. The triage tool takes the form of a detailed decision aid algorithm based on a combination of established prognostic scores, and it should increase objectivity and transparency in triage decision making and enhance decision-making consistency between doctors within and across ICUs in Hong Kong. However, it remains an aid rather than a complete substitute for the carefully considered judgement of an experienced intensive care clinician.
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Affiliation(s)
- G M Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong
| | - A K H Leung
- Department of Intensive Care, Queen Elizabeth Hospital, Hong Kong
| | - C M Ho
- Department of Intensive Care, Tuen Mun Hospital, Hong Kong
| | - D So
- Department of Intensive Care, Princess Margaret Hospital, Hong Kong
| | - H P Shum
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - F L Chow
- Department of Intensive Care, Caritas Medical Centre, Hong Kong
| | - A W T Yeung
- Department of Medicine and Geriatrics, Ruttonjee & Tang Shiu Kin Hospitals, Hong Kong
| | - K L Lee
- Department of Intensive Care, United Christian Hospital, Hong Kong
| | - G K Y Tang
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong
| | - W W Yan
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong
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16
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Valdes DS, So D, Gill PA, Kellow NJ. Effect of Dietary Acetic Acid Supplementation on Plasma Glucose, Lipid Profiles, and Body Mass Index in Human Adults: A Systematic Review and Meta-analysis. J Acad Nutr Diet 2021; 121:895-914. [PMID: 33436350 DOI: 10.1016/j.jand.2020.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/10/2020] [Accepted: 12/03/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Acetic acid is a short-chain fatty acid that has demonstrated biomedical potential as a dietary therapeutic agent for the management of chronic and metabolic illness comorbidities. In human beings, its consumption may improve glucose regulation and insulin sensitivity in individuals with cardiometabolic conditions and type 2 diabetes mellitus. Published clinical trial evidence evaluating its sustained supplementation effects on metabolic outcomes is inconsistent. OBJECTIVE This systematic review and meta-analysis summarized available evidence on potential therapeutic effects of dietary acetic acid supplementation via consumption of acetic acid-rich beverages and food sources on metabolic and anthropometric outcomes. METHODS A systematic search was conducted in Medline, Scopus, EMBASE, CINAHL Plus, and Web of Science from database inception until October 2020. Randomized controlled trials conducted in adults evaluating the effect of dietary acetic acid supplementation for a minimum of 1 week were included. Meta-analyses were performed using a random-effects model on fasting blood glucose (FBG), triacylglycerol (TAG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), glycated hemoglobin (HbA1c), body mass index (BMI), and body fat percentage. Statistical heterogeneity was assessed by calculation of Q and I2 statistics, and publication bias was assessed by calculation of Egger's regression asymmetry and Begg's test. RESULTS Sixteen studies were included, involving 910 participants who consumed between 750 and 3600 mg acetic acid daily in interventions lasting an average of 8 weeks. Dietary acetic acid supplementation resulted in significant reductions in TAG concentrations in overweight and obese but otherwise healthy individuals (mean difference [MD] = -20.51 mg/dL [95% confidence intervals = -32.98, -8.04], P = .001) and people with type 2 diabetes (MD = -7.37 mg/dL [-10.15, -4.59], P < .001). Additionally, acetic acid supplementation significantly reduced FBG levels (MD = -35.73 mg/dL [-63.79, -7.67], P = .01) in subjects with type 2 diabetes compared with placebo and low-dose comparators. No other changes were seen for other metabolic or anthropometric outcomes assessed. Five of the 16 studies did not specify the dose of acetic acid delivered, and no studies measured blood acetate concentrations. Only one study controlled for background acetic acid-rich food consumption during intervention periods. Most studies had an unclear or high risk of bias. CONCLUSION Supplementation with dietary acetic acid is well tolerated, has no adverse side effects, and has clinical potential to reduce plasma TAG and FBG concentrations in individuals with type 2 diabetes, and to reduce TAG levels in people who are overweight or obese. No significant effects of dietary acetic acid consumption were seen on HbA1c, HDL, or anthropometric markers. High-quality, longer-term studies in larger cohorts are required to confirm whether dietary acetic acid can act as an adjuvant therapeutic agent in metabolic comorbidities management.
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17
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Avram R, So D, Iturriaga E, Byrne J, Lennon R, Murthy V, Geller N, Goodman S, Rihal C, Bailey K, Farkouh M, Olgin J, Pereira N. Transitioning a randomized controlled trial to a digital registry – experience from the TAILOR-PCI digital follow-up study on onboarding, engagement and geofencing consent rate. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3458] [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/Introduction
TAILOR-PCI is the largest cardiovascular genotype-based randomized trial (NCT#01742117) investigating whether genotype-guided selection of oral P2Y12 inhibitor therapy improves ischemic outcomes after percutaneous coronary intervention (PCI). The TAILOR-PCI Digital Sub-Study tests the feasibility of extending original follow-up of 1 year to 2 years using state-of-the-art digital solutions. Deep phenotyping acquired during a clinical trial can be leveraged by extending follow-up in an efficient and cost-effective manner using digital technology.
Purpose
Our objective is to describe onboarding and engagement of participants initially recruited in a large, pragmatic, international, multi-center clinical trial to a digital registry.
Methods
TAILOR-PCI participants, within 23 months of their index PCI, were invited by letters containing a URL to the Digital Sub-Study website (http://tailorpci.eurekaplatform.org). These invitations were followed by phone calls, if no response to the letter, to determine reason for non-participation. A NIH-funded direct-to-participant digital research platform (the Eureka Research Platform) was used to onboard, consent and enroll participants for the digital follow-up. Participants were asked to answer health-related surveys at fixed intervals using the Eureka mobile app and desktop platform. To capture hospitalizations, participants could enable geofencing to allow background location tracking, which triggered surveys if a hospitalization was detected.
Result(s)
Letters were mailed to 893 of 929 eligible participants across 22 sites in the United States and Canada leading to 226 homepage visits and 118 registrations. There were 107 consents (12.0% of invited; mean age: 66.4±9.0; 19 females [18%]): 47 (44%) participants consented after the letter, 36 (34%) consented after the 1st call and 24 (22%) consented after a 2nd call. Among those who consented, 100 were eligible (7 did not have a smartphone) 81 downloaded the study mobile app and 73 agreed for geofencing (Figure 1). Among the 722 invited participants who were surveyed, 354 declined participation: due to lack of time (146; 20.2%), lack of smartphone (125; 17.3%), difficulty understanding (41; 5.7%), concern about using smartphone (34; 4.7%), concern of data privacy (14; 1.9%), concerns of location tracking (6; 0.8%) and other reasons (57; 7.9%).
Conclusion
Extended follow-up of a clinical trial using a digital platform is feasible but uptake in this study population was limited largely due to lack of time or a smartphone among participants. Based on data from other digital studies, uptake may also have been limited since digital follow-up consent was not incorporated at the time of consent for the main trial.
Figure 1. Onboarding of the digital substudy
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institute of Health (NIH), National Heart, Lung, and Blood Institute (NHLBI)
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Affiliation(s)
- R Avram
- University of California San Francisco, San Francisco, United States of America
| | - D So
- Ottawa Heart Institute, Cardiology, Ottawa, Canada
| | - E Iturriaga
- National Institutes of Health, Bethesda, United States of America
| | - J Byrne
- Mayo Clinic, Rochester, United States of America
| | - R.J Lennon
- Mayo Clinic, Rochester, United States of America
| | - V Murthy
- Mayo Clinic, Rochester, United States of America
| | - N Geller
- National Heart, Lung, and Blood Institute, Bethesda, United States of America
| | | | - C.S Rihal
- Mayo Clinic, Rochester, United States of America
| | - K.R Bailey
- Mayo Clinic, Rochester, United States of America
| | - M Farkouh
- Peter Munk Cardiac Centre, Toronto, Canada
| | - J Olgin
- University of California San Francisco, San Francisco, United States of America
| | - N.L Pereira
- Mayo Clinic, Rochester, United States of America
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18
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Boudreau R, Fu A, Barry Q, Tran U, Perry-Nuygen D, Simard T, Le May M, Labinaz L, Dick A, Glover C, Froeschl M, Hibbert B, Chong A, So D. Comparing clinical outcomes following 1 year of dual antiplatelet therapy in patients risk stratified by the PRECISE-DAPT and DAPT scores. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3382] [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
Dual antiplatelet therapy (DAPT) is the standard of care following PCI. DAPT reduces ischemic events but increases bleeding risk. Duration of DAPT following PCI remains controversial. Current guidelines recommend duration be individualized based on risk of ischemia and bleeding. Although multiple strategies exist to risk stratify patients, including application of the PRECISE-DAPT and DAPT scores, there is currently no standardized risk assessment protocol.
Purpose
To determine if the PRECISE-DAPT and DAPT scores can identify patients at increased risk of ischemia or bleeding in a cohort prescribed 12 months of DAPT following PCI.
Methods
We calculated the PRECISE-DAPT and DAPT scores for 469 consecutive patients at baseline after PCI. Patients were grouped based on score treatment recommendation; PRECISE-DAPT prolonged or shortened (PRECISE DAPT <25 vs. ≥25) and DAPT prolonged or shortened (DAPT ≥2 vs <2). End points included 1-year rates of major adverse cardiovascular events (MACE) and TIMI major or minor bleeding.
Results
Among 469 patients, mean age was 64.4 (SD 12.2); 102 (21.7%) were women. Index presentation consisted of a STEMI in 207 (44.1%), NSTEMI in 99 (21.1%), and UA in 60 (12.8%). At presentation, 174 (37.1%) were current smokers, 115 (24.5%) had a prior MI, 118 (25.2%) had diabetes, 249 (53.1%) had dyslipidemia and 281 (60.0%) were previously diagnosed as hypertensive. Overall, there was an increase in bleeding and no difference in MACE for patients with a PRECISE-DAPT score ≥25 (13.3% vs. 4.1% P<0.001). No difference in bleeding or MACE was present in patients stratified by the DAPT score.
Conclusion
A PRECISE-DAPT score ≥25 was associated with an increased rate of bleeding and no difference in MACE in patients prescribed 12 months of DAPT. This supports the use of the PRECISE-DAPT as a prospective tool in clinical practice.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- R Boudreau
- University of Ottawa Heart Institute, Ottawa, Canada
| | - A Fu
- University of Ottawa Heart Institute, Ottawa, Canada
| | - Q Barry
- University of Ottawa Heart Institute, Ottawa, Canada
| | - U Tran
- University of Ottawa, Ottawa, Canada
| | | | - T Simard
- University of Ottawa Heart Institute, Ottawa, Canada
| | - M Le May
- University of Ottawa Heart Institute, Ottawa, Canada
| | - L Labinaz
- University of Ottawa Heart Institute, Ottawa, Canada
| | - A Dick
- University of Ottawa Heart Institute, Ottawa, Canada
| | - C Glover
- University of Ottawa Heart Institute, Ottawa, Canada
| | - M Froeschl
- University of Ottawa Heart Institute, Ottawa, Canada
| | - B Hibbert
- University of Ottawa Heart Institute, Ottawa, Canada
| | - A Chong
- University of Ottawa Heart Institute, Ottawa, Canada
| | - D So
- University of Ottawa Heart Institute, Ottawa, Canada
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19
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Winfree K, Wang X, Kiiskinen U, Reppen G, Papagiannopoulos C, Nassim M, Haeussler K, So D, Taipale K, Molife C, Jen MH, Traore S, Varea R. 1357P Outcomes of treated patients with EGFR-mutated advanced or metastatic non-small cell lung cancer harboring exon 19 deletions or L858R substitution (Exon 21) mutations: A systematic literature review. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1671] [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: 11/25/2022] Open
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20
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MacKenzie-Shalders K, Kelly JT, So D, Coffey VG, Byrne NM. The effect of exercise interventions on resting metabolic rate: A systematic review and meta-analysis. J Sports Sci 2020; 38:1635-1649. [PMID: 32397898 DOI: 10.1080/02640414.2020.1754716] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The systematic review and meta-analysis evaluated the effect of aerobic, resistance and combined exercise on RMR (kCal·day-1) and performed a methodological assessment of indirect calorimetry protocols within the included studies. Subgroup analyses included energy/diet restriction and body composition changes. Randomized control trials (RCTs), quasi - RCTs and cohort trials featuring a physical activity intervention of any form and duration excluding single exercise bouts were included. Participant exclusions included medical conditions impacting upon RMR, the elderly (≥65 years of age) or pregnant, lactating or post-menopausal women. The review was registered in the International Prospective Register of Systematic Reviews (CRD 42,017,058,503). 1669 articles were identified; 22 were included in the qualitative analysis and 18 were meta-analysed. Exercise interventions (aerobic and resistance exercise combined) did not increase resting metabolic rate (mean difference (MD): 74.6 kCal·day-1[95% CI: -13.01, 161.33], P = 0.10). While there was no effect of aerobic exercise on RMR (MD: 81.65 kCal·day-1[95% CI: -57.81, 221.10], P = 0.25), resistance exercise increased RMR compared to controls (MD: 96.17 kCal·day-1[95% CI: 45.17, 147.16], P = 0.0002). This systematic review effectively synthesises the effect of exercise interventions on RMR in comparison to controls; despite heterogenous methodologies and high risk of bias within included studies.
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Affiliation(s)
- Kristen MacKenzie-Shalders
- Faculty of Health Sciences and Medicine, Bond University, Bond Institute of Health and Sport , Gold Coast, Australia
| | - Jaimon T Kelly
- Faculty of Health Sciences and Medicine, Bond University, Bond Institute of Health and Sport , Gold Coast, Australia.,Menzies Health Institute Queensland, Griffith University , Gold Coast, Queensland, Australia
| | - Daniel So
- Faculty of Health Sciences and Medicine, Bond University, Bond Institute of Health and Sport , Gold Coast, Australia.,Faculty of Medicine Nursing and Health Sciences, Central Clinical School, Department of Gastroenterology, Monash University , Melbourne, Australia
| | - Vernon G Coffey
- Faculty of Health Sciences and Medicine, Bond University, Bond Institute of Health and Sport , Gold Coast, Australia
| | - Nuala M Byrne
- School of Health Sciences, College of Health and Medicine, University of Tasmania , Launceston, Australia
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21
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Shah H, Belanger E, Chong A, So D, Beanlands R, Stadnick E, Mielniczuk L, Chih S. Discordant Microvascular and Epicardial Disease in Cardiac Allograft Vasculopathy. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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22
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MacKenzie-Shalders K, Maunder K, So D, Norris R, McCray S. Impact of electronic bedside meal ordering systems on dietary intake, patient satisfaction, plate waste and costs: A systematic literature review. Nutr Diet 2020; 77:103-111. [PMID: 31957199 PMCID: PMC7383857 DOI: 10.1111/1747-0080.12600] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/08/2019] [Accepted: 11/09/2019] [Indexed: 11/28/2022]
Abstract
Aim Hospital foodservices provide an important opportunity to deliver valuable dietary support to patients, address hospital‐acquired malnutrition risk and enhance patient satisfaction. Modifying the meal ordering process through the adoption of technology may actively engage patients in the process and provide an opportunity to influence patient and organisational outcomes. This systematic review was undertaken to evaluate the impact of electronic bedside meal ordering systems in hospitals on patient dietary intake, patient satisfaction, plate waste and costs. Methods A systematic search following PRISMA guidelines was conducted across MEDLINE, CINAHL, EMBASE and Web of Science for randomised controlled trials and observational studies comparing the effect of electronic bedside meal ordering systems with traditional menus on dietary intake, patient satisfaction, plate waste and cost. The quality of included studies was assessed using the Quality Criteria Checklist for Primary Research tool. Results Five studies involving 720 patients were included. Given the heterogeneity of the included studies, the results were narratively synthesised. Electronic bedside meal ordering systems positively impacted patient dietary intake, patient satisfaction, plate waste and costs compared with traditional menus. Conclusions Despite the increase in healthcare foodservices adopting digital health solutions, there is limited research specifically measuring the impact of electronic bedside meal ordering systems on patient and organisational outcomes. This study highlights potential benefits of electronic bedside meal ordering systems for hospitals using traditional paper menu systems, while also identifying the need for continued research to generate evidence to understand the impact of this change and inform future successful innovations.
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Affiliation(s)
- Kristen MacKenzie-Shalders
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | - Kirsty Maunder
- The CBORD Group Incorporated, Sydney, New South Wales, Australia.,Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Daniel So
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia.,Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Faculty of Medicine Nursingand Health Sciences, Monash University, Central Clinical School, Department of Gastroenterology, Melbourne, Australia
| | - Rebecca Norris
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | - Sally McCray
- Dietetics and Foodservices, Mater Health, Brisbane, Queensland, Australia
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Barry Q, Fu A, Boudreau R, Perry-Nguyen D, Tran U, Simard T, Le May M, Labinaz M, Dick A, Glover C, Froeschl M, Hibbert B, Chong A, So D. OUTCOMES OF APPROPRIATE VERSUS INAPPROPRIATE DE-ESCALATION OF P2Y12 INHIBITOR THERAPY POST PERCUTANEOUS CORONARY INTERVENTION: A RETROSPECTIVE COHORT STUDY. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.548] [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] Open
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24
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Boczar K, Dowlatshahi D, Liu P, DeKemp R, Kelly C, Garrard L, Lefebvre C, Zhang L, Guo A, Chong A, So D, Beanlands R. OTTAWA CRP STUDY AFTER TIA AND VASCULAR EVENTS (OCTAVE). Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.555] [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: 11/25/2022] Open
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25
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Boudreau R, Fu A, Barry Q, Perry-Nguyen D, Tran U, Simmard T, Le May M, Labinaz M, Dick A, Glover C, Froeschl M, Hibbert B, Chong AY, So D. P1933Comparing treatment recommendations for the DAPT and PRECISE-DAPT scores after percutaneous coronary intervention. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Dual antiplatelet therapy (DAPT), with aspirin and a P2Y12 inhibitor, is the standard therapy for patients following PCI. Duration of treatment with DAPT has been controversial despite large studies. Current guidelines recommend treatment duration be individualized based on risk of ischemia and bleeding. To facilitate treatment decisions, risk assessment tools, including the DAPT and PRECISE-DAPT scores, have been developed.
Purpose
As components of these scores differ, the variability of recommendation remains unknown. We set to evaluate inter-tool concordance in treatment recommendation in a cohort of patients after PCI.
Methods
Using data from our local PCI registry, we calculated the PRECISE-DAPT at baseline following PCI and the DAPT after 1 year of treatment for 311 consecutive patients with complete data for both scores to be calculated. Based on their DAPT and PRECISE-DAPT scores, patients were grouped into concordant for long-term treatment (DAPT ≥2 and PRECISE-DAPT <25) or concordant for shortened treatment (DAPT <2 and PRECISE- DAPT ≥25). All other patients were considered discordant. We then performed a concordance analysis using Cohen's kappa to measure degree of agreement.
Results
Among the 311 patients, mean age was 63.4 (SD 11.6); 245 (79%) were men, 93 (29.9%) had history of a prior MI, 130 (41.8%) were current smokers, 32 (10.3%) had a history of CHF or LVEF <30%, 82 (26.3%) had diabetes and 196 (63.0%) were previously diagnosed with hypertension. Index event consisted of a STEMI in 101 (32.4%), NSTEMI in 93 (29.9%), unstable angina in 27 (8.7%), stable angina in 67 (21.5%) and the remaining 23 (7.4%) had other indications for PCI. Mean DAPT score was 1.52 (SD 1.37). Mean PRECISE-DAPT was 17.65 (SD 12.73). The DAPT recommended long-term treatment for 162 (52.1%) and shortened treatment for 149 (47.9%). The PRECISE-DAPT recommended long-term treatment for 245 (78.9%) and shortened treatment for 66 (21.2%). The overall proportion of agreement between the two risk scores was 56.6% with a Cohen's kappa index of 0.110 (95% CI, 0.017 to 0.204). See Table.
Concordance Analysis PRECISE-DAPT Score Recommendation Long Term (N=245) Shortened (N=66) DAPT Score Recommendation Long Term (N=162) 136 (43.7%) 26 (8.4%) Concordant for Long Term Treatment Shortened (N=149) 109 (35%) 40 (12.8%) Concordant for Shortened Treatment
Conclusion
Comparison of the DAPT score and the PRECISE-DAPT score showed concordance in treatment recommendation in only 56.6% of patients. Given the poor agreement between these tools, prospective concurrent evaluations and correlation to outcomes will be required in future studies.
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Affiliation(s)
- R Boudreau
- University of Ottawa Heart Institute, Ottawa, Canada
| | - A Fu
- University of Ottawa Heart Institute, Ottawa, Canada
| | - Q Barry
- University of Ottawa Heart Institute, Ottawa, Canada
| | | | - U Tran
- University of Ottawa, Ottawa, Canada
| | - T Simmard
- University of Ottawa Heart Institute, Ottawa, Canada
| | - M Le May
- University of Ottawa Heart Institute, Ottawa, Canada
| | - M Labinaz
- University of Ottawa Heart Institute, Ottawa, Canada
| | - A Dick
- University of Ottawa Heart Institute, Ottawa, Canada
| | - C Glover
- University of Ottawa Heart Institute, Ottawa, Canada
| | - M Froeschl
- University of Ottawa Heart Institute, Ottawa, Canada
| | - B Hibbert
- University of Ottawa Heart Institute, Ottawa, Canada
| | - A Y Chong
- University of Ottawa Heart Institute, Ottawa, Canada
| | - D So
- University of Ottawa Heart Institute, Ottawa, Canada
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Aleksova N, So D, Simard T, Davies R, Stadnick E, Mielniczuk L, Chih S. ANTIPLATELET THERAPY AND PLATELET REACTIVITY AFTER HEART TRANSPLANTATION. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.223] [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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27
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Hutson J, Garuba H, Boodhwani M, McDonald B, So D, De Roock S, Ruel M, Stadnick E, Rubens F, Davies R, Le May M, Labinaz M, Bowes B, Mielniczuk L, Chih S. MULTIDISCIPLINARY SHOCK TEAM APPROACH TO MANAGEMENT OF CARDIOGENIC SHOCK. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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28
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Fu A, Barry Q, Boudreau R, Perry-Nguyen D, Tran U, Simard T, Le May M, Labinaz M, Dick A, Glover C, Froeschl M, Hibbert B, Chong A, So D. INCIDENCE AND RATIONALE FOR P2Y12 INHIBITOR SWITCHING IN PATIENTS WITHIN 1 YEAR OF PERCUTANEOUS CORONARY INTERVENTION. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.245] [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: 10/28/2022] Open
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29
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Barry Q, Fu A, Boudreau R, Simard T, Le May M, Labinaz M, Dick A, Glover C, Froeschl M, Hibbert B, Chong A, So D, Perry-Nguyen D, Tran U. APPROPRIATE VERSES INAPPROPRIATE DE-ESCALATION OF P2Y12 INHIBITOR THERAPY POST PERCUTANEOUS CORONARY INTERVENTION: A RETROSPECTIVE COHORT STUDY. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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30
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Jabagi H, Chong A, So D, Glineur D, Rubens F. NATIVE CORONARY DISEASE PROGRESSION POST CORONARY ARTERY BYPASS GRAFTING. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.295] [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: 10/28/2022] Open
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31
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So D, Whelan K, Rossi M, Morrison M, Holtmann G, Kelly JT, Shanahan ER, Staudacher HM, Campbell KL. Dietary fiber intervention on gut microbiota composition in healthy adults: a systematic review and meta-analysis. Am J Clin Nutr 2018; 107:965-983. [PMID: 29757343 DOI: 10.1093/ajcn/nqy041] [Citation(s) in RCA: 345] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 02/14/2018] [Indexed: 12/17/2022] Open
Abstract
Background Dysfunction of the gut microbiota is frequently reported as a manifestation of chronic diseases, and therefore presents as a modifiable risk factor in their development. Diet is a major regulator of the gut microbiota, and certain types of dietary fiber may modify bacterial numbers and metabolism, including short-chain fatty acid (SCFA) generation. Objective A systematic review and meta-analysis were undertaken to assess the effect of dietary fiber interventions on gut microbiota composition in healthy adults. Design A systematic search was conducted across MEDLINE, EMBASE, CENTRAL, and CINAHL for randomized controlled trials using culture and/or molecular microbiological techniques evaluating the effect of fiber intervention on gut microbiota composition in healthy adults. Meta-analyses via a random-effects model were performed on alpha diversity, prespecified bacterial abundances including Bifidobacterium and Lactobacillus spp., and fecal SCFA concentrations comparing dietary fiber interventions with placebo/low-fiber comparators. Results A total of 64 studies involving 2099 participants were included. Dietary fiber intervention resulted in higher abundance of Bifidobacterium spp. (standardized mean difference (SMD): 0.64; 95% CI: 0.42, 0.86; P < 0.00001) and Lactobacillus spp. (SMD: 0.22; 0.03, 0.41; P = 0.02) as well as fecal butyrate concentration (SMD: 0.24; 0.00, 0.47; P = 0.05) compared with placebo/low-fiber comparators. Subgroup analysis revealed that fructans and galacto-oligosaccharides led to significantly greater abundance of both Bifidobacterium spp. and Lactobacillus spp. compared with comparators (P < 0.00001 and P = 0.002, respectively). No differences in effect were found between fiber intervention and comparators for α-diversity, abundances of other prespecified bacteria, or other SCFA concentrations. Conclusions Dietary fiber intervention, particularly involving fructans and galacto-oligosaccharides, leads to higher fecal abundance of Bifidobacterium and Lactobacillus spp. but does not affect α-diversity. Further research is required to better understand the role of individual fiber types on the growth of microbes and the overall gut microbial community. This review was registered at PROSPERO as CRD42016053101.
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Affiliation(s)
- Daniel So
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Kevin Whelan
- Department of Nutritional Sciences, King's College, London, United Kingdom
| | - Megan Rossi
- Department of Nutritional Sciences, King's College, London, United Kingdom
| | - Mark Morrison
- The University of Queensland Diamantina Institute, Translational Research Institute.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Gerald Holtmann
- Faculty of Medicine, University of Queensland, Brisbane, Australia.,Department of Gastroenterology & Hepatology
| | - Jaimon T Kelly
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Erin R Shanahan
- The University of Queensland Diamantina Institute, Translational Research Institute.,Department of Gastroenterology & Hepatology
| | | | - Katrina L Campbell
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.,Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia
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Simard T, Motazedian P, Ramirez F, Jung R, Feder J, Di Santo P, Russo J, Pourdjabbar A, Le May M, So D, Chong A, Hibbert B. PRE-CLINICAL COMPARISON OF SALINE AND CONTRAST FOR INTRAVASCULAR IMAGING USING OPTICAL COHERENCE TOMOGRAPHY. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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33
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Chih S, Chong A, Erthal F, deKemp R, So D, Davies R, Stadnick E, Mielniczuk L, Beanlands R. Rubidium 82 Positron Emission Tomography in Cardiac Allograft Vasculopathy. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1464] [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: 10/19/2022] Open
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34
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Goubran D, Shiau J, Dent R, James T, So D. UTILITY OF SCREENING ELECTROCARDIOGRAM IN PATIENT MANAGEMENT DECISIONS IN A TERTIARY BARIATRIC PROGRAM: A RETROSPECTIVE COHORT STUDY. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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35
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So D, Pradhan S, Konstantatos G. Solid-state colloidal CuInS 2 quantum dot solar cells enabled by bulk heterojunctions. Nanoscale 2016; 8:16776-16785. [PMID: 27714085 DOI: 10.1039/c6nr05563j] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Colloidal copper indium sulfide (CIS) nanocrystals (NCs) are Pb- and Cd-free alternatives for use as absorbers in quantum dot solar cells. In a heterojunction with TiO2, non-annealed ligand-exchanged CIS NCs form solar cells yielding a meager power conversion efficiency (PCE) of 0.15%, with photocurrents plummeting far below predicted values from absorption. Decreasing the amount of zinc during post-treatment leads to improved mobility but marginal improvement in device performance (PCE = 0.30%). By incorporating CIS into a porous TiO2 network, we saw an overall drastic improvement in device performance, reaching a PCE of 1.16%, mainly from an increase in short circuit current density (Jsc) and fill factor (FF) and a 10-fold increase in internal quantum efficiency (IQE). We have determined that by moving from a bilayer to a bulk heterojunction architecture, we have reduced the trap-assisted recombination as seen in changes in the ideality factor, the intensity dependence of the photocurrent and transient photocurrent (TPC) and photovoltage (TPV) characteristics.
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Affiliation(s)
- D So
- ICFO, Institute of Photonic Sciences, The Barcelona Institute of Science and Technology, Castelldefels 08860, Spain.
| | - S Pradhan
- ICFO, Institute of Photonic Sciences, The Barcelona Institute of Science and Technology, Castelldefels 08860, Spain.
| | - G Konstantatos
- ICFO, Institute of Photonic Sciences, The Barcelona Institute of Science and Technology, Castelldefels 08860, Spain. and Institució Catalana de Recerca i Estudis Avançats (ICREA), Passeig Lluís Companys 23, 08010 Barcelona, Spain
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Shimony A, Pilote L, Al Lawati H, Bagai A, Behlouli H, Eisenberg M, So D, Karp I, Cheema A. Spontaneous Coronary Artery Dissection in Young Women Presenting with Acute Coronary Syndrome. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Dong J, Zhao W, Shi A, Toneff M, Lydon J, So D, Li Y. The PR status of the originating cell of ER/PR-negative mouse mammary tumors. Oncogene 2015; 35:4149-54. [PMID: 26640140 DOI: 10.1038/onc.2015.465] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 09/29/2015] [Accepted: 10/19/2015] [Indexed: 01/01/2023]
Abstract
Progesterone receptor (PR) is usually co-localized with estrogen receptor (ER) in normal mammary cells. It is not known whether ER/PR-negative human breast cancer arises from an ER/PR-negative cell or from an ER/PR-positive cell that later lost ER/PR. Using intraductal injection of a lentivirus to deliver both an oncogene (ErbB2) and a floxed green fluorescent protein (GFP) in PR(Cre/+)mice, whose Cre gene is under the control of the PR promoter, we were able to trace the PR status of the infected cells as they progressed to cancer. We found that the resulting early lesions stained negative for PR in most of the cells and usually retained GFP. The resulting tumors lacked ER and PR, and 75% (15/20) of them retained the GFP signal in all tumor cells, suggesting PR was never expressed throughout the evolution of a majority of these tumors. In conclusion, our data demonstrate that ErbB2-initiated ER/PR-negative mammary tumors primarily originate from the subset of the mammary epithelium that is negative for PR and probably ER as well. These findings also provide an explanation for why antihormonal therapy fails to prevent ER-negative breast cancers.
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Affiliation(s)
- J Dong
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA.,Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - W Zhao
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA
| | - A Shi
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA.,Department of Breast Surgery, First Hospital of Jilin University, Changchun, China
| | - M Toneff
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA.,Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - J Lydon
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - D So
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA
| | - Y Li
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA.,Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA.,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
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Shin H, Cho K, Rhee C, Hong I, So D, Cho J, Park J. Hypoxia-inducible 5-eicosatetraenoates are potential markers for diagnosing obstructive sleep apnea. Sleep Med 2015. [DOI: 10.1016/j.sleep.2015.02.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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39
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Choi J, Winters N, Pelletier R, Eisenberg M, Bacon S, Cox J, Daskalopoulou S, Lavoie K, Karp I, Shimony A, So D, Thanassoulis G, Pilote L. SEX DIFFERENCES IN CLINICAL OUTCOMES AFTER PREMATURE ACUTE CORONARY SYNDROME. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Fu A, Abunassar J, Le May M, Chong A, Labinaz M, Dick A, Glover C, Froeschl M, Marquis J, Malhotra N, Tran L, Hibbert B, So D. TICAGRELOR VERSUS CLOPIDOGREL AMONG PATIENTS USING TRIPLE THERAPY AFTER PERCUTANEOUS CORONARY INTERVENTION: THE CAPITAL ATACC STUDY. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Malhotra N, Abunassar J, Fu A, Hibbert B, Labinaz M, Dick A, Glover C, Froeschl M, Marquis J, Chong A, Le May M, Bernick J, So D. A PHARMACODYNAMIC COMPARISON OF PERSONALIZED STRATEGY TO ANTIPLATLET THERAPY AGAINST TICAGRELOR IN ACHIEVING A THERAPEUTIC WINDOW. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.593] [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] Open
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42
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Harnett D, Maze R, Pourdjabbar A, Ramirez F, Simard T, So D, Le May M, Labinaz M, Hibbert B, Chong A, Glover C. PERCUTANEOUS CORONARY INTERVENTION WITH RACER RENAL STENTS. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.111] [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: 11/17/2022] Open
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43
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Garuba H, Gallagher S, Kass M, Glover C, So D. FIRST VERSUS SECOND-GENERATION DRUG-ELUTING STENTS IN THE TREATMENT OF IN-STENT RESTENOSIS: FROM THE CAPITAL PCI REGISTRY. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Osborne C, Maze R, Hibbert B, Glover C, Dick A, So D, Chong A, Marquis J, Froeschl M, Labinaz M, Blondeau M, Le May M. FEASIBILITY OF ACHIEVING AND MAINTAINING MODERATE THERAPEUTIC HYPOTHERMIA (31 DEGREES CELSIUS) IN POST-CARDIAC ARREST PATIENTS. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.036] [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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45
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Yousef A, Simard T, Pourdjabbar A, Hibbert B, Webb J, Le May M, Glover C, Labinaz M, Chong A, So D. PERFORMANCE OF TRANSCATHETER AORTIC VALVE IMPLANTATION IN PATIENTS WITH BICUSPID AORTIC VALVE: SYSTEMATIC REVIEW. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Acharya S, Wells G, Dick A, Froeschl M, Glover C, Marquis J, Labinaz M, So D, Blondeau M, Bernick J, Le May M. Warfarin Prescription Following St-Elevation Myocardial Infarction: Need for a Change? Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Elbarasi E, Glover C, So D, Froeschl M, Dick A, Marquis J, Labinaz M, Blondeau M, Le May M. The Influence of Initial Thrombolysis in Myocardial Infarction Flow Grades on Outcomes of Patients With St-Elevation Myocardial Infarction. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.384] [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] Open
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48
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So D, Joly Y, Knoppers B. Clinical Trial Transparency and Orphan Drug Development: Recent Trends in Data Sharing by the Pharmaceutical Industry. Public Health Genomics 2013; 16:322-35. [DOI: 10.1159/000355941] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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49
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Le May M, Froeschl M, Glover C, So D, Marquis J, Dick A, Wells G, Weaver J, Chong A, Thomas A, Labinaz M. 791 Platelet Function Monitoring in Patients Treated With Clopidogrel at the Time of Primary Percutaneous Coronary Angioplasty. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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50
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Moudgil R, Al-Turbak H, Le May M, Wells G, So D, Dick A, Froeschl M, Glover C, Marquis J, Labinaz M. 474 Markedly Reduced Platelet Inhibition With Clopidogrel Given to Patients Undergoing Therapeutic Hypothermia Post Cardiac Arrest. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.435] [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: 11/25/2022] Open
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