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Shohdy K, Pillai M, Abbas K, Allison J, Waddell T, Darlington E, Mohammad S, Hood S, Atkinson S, Simpson K, Morgan D, Nathan P, Kilgour E, Dive C, Thistlethwaite F. Immune biomarker evaluation of sequential tyrosine kinase inhibitor and nivolumab monotherapies in renal cell carcinoma: the phase I TRIBE trial. Immunooncol Technol 2024; 22:100712. [PMID: 38694705 PMCID: PMC11059457 DOI: 10.1016/j.iotech.2024.100712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Background Predictive biomarkers for immune checkpoint blockade in the second-line treatment of metastatic renal cell carcinoma (mRCC) are lacking. Materials and methods Patients with histologically confirmed RCC who started nivolumab after at least 4 months of tyrosine kinase inhibitors (TKIs) were recruited for this study. Serial tissue and blood samples were collected for immune biomarker evaluation. The primary endpoint was to determine the association of specific T-cell subsets with clinical outcomes tested using Wilcoxon rank sum for clinical benefit rate (CBR) and log-rank test for progression-free survival (PFS). Results Twenty patients were included in this trial with a median age of 64 years and followed-up for a median of 12 months. The median PFS for patients who received TKI was 13.8 months, while for those subsequently treated with nivolumab following TKI therapy, the median PFS was 2.6 months. CBR of nivolumab was 20% with two partial responses. Functionally active programmed cell death protein 1+ CD4+ T cells were enriched in non-responders (q = 0.003) and associated with worse PFS on nivolumab (P = 0.04). Responders showed a significant reduction in the effector CD4+T-cell (TEF) fraction compared to non-responders at 3 months on nivolumab (0.40 versus 0.80, P = 0.0005). CD127+CD4+ T cells were enriched in patients who developed immune-related adverse effects (q = 0.003). Using in-house validated multiplex immunohistochemistry for six markers, we measured tumour-associated immune cell densities in tissue samples. Responders to nivolumab showed a significantly higher mean of immune cell densities in tissue samples compared to non-responders (346 versus 87 cells/mm2, P = 0.04). Conclusions In this small study, analysis of tissue-based and peripheral blood immune cell subsets predicted clinical outcomes of nivolumab. Further studies are warranted with larger populations to validate these observations.
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Affiliation(s)
- K.S. Shohdy
- The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - M. Pillai
- The Christie NHS Foundation Trust, Manchester, UK
| | - K.S. Abbas
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - J. Allison
- The Christie NHS Foundation Trust, Manchester, UK
| | - T. Waddell
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - S. Mohammad
- Cancer Biomarker Centre, Cancer Research UK Manchester Institute, Manchester, UK
| | - S. Hood
- Cancer Biomarker Centre, Cancer Research UK Manchester Institute, Manchester, UK
| | - S. Atkinson
- Cancer Biomarker Centre, Cancer Research UK Manchester Institute, Manchester, UK
| | - K. Simpson
- Cancer Biomarker Centre, Cancer Research UK Manchester Institute, Manchester, UK
| | - D. Morgan
- Cancer Biomarker Centre, Cancer Research UK Manchester Institute, Manchester, UK
| | - P. Nathan
- Mount Vernon Cancer Centre - East and North Herts NHS Trust, Northwood, Middlesex, UK
| | - E. Kilgour
- Cancer Biomarker Centre, Cancer Research UK Manchester Institute, Manchester, UK
| | - C. Dive
- Cancer Biomarker Centre, Cancer Research UK Manchester Institute, Manchester, UK
| | - F. Thistlethwaite
- The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
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Akhtar N, Kate M, Kamran S, Joseph S, Morgan D, Uy R, Babu B, Shanti S, Shuaib A. Short-term functional outcomes of patients with acute intracerebral hemorrhage in the native and expatriate population. Front Neurol 2024; 15:1384985. [PMID: 38756212 PMCID: PMC11097684 DOI: 10.3389/fneur.2024.1384985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/19/2024] [Indexed: 05/18/2024] Open
Abstract
Objectives Functional outcomes in patients with intracerebral hemorrhage (ICH) have not been well characterized in the Middle East and North Africa Region. We report the 30 and 90-day clinical outcomes in the native and expatriate of Qatar with ICH. Methods We evaluated the Glasgow Coma Scale (GCS), NIHSS, and imaging in the Qatar Stroke Registry (2013-22). The outcome measures were a modified Rankin Scale (mRS) at 90 days and mortality at 30 and 90 days. Unfavorable outcome was defined as mRS of 4-6. We performed non-parametric ROC analyses to measure the concordance index (C-index) to assess the goodness-of-fit of ICH score for predicting 30 day and 90-day mortality and functional outcome. Results 1,660 patients (median age of 49 (41.5-58) years; male 83.1%, expatriates 77.5%) with ICH, including supratentorial deep in 65.2%, cortical in 16.2%, infratentorial 16% and primary intraventricular in 2.5% were studied. The median baseline ICH volume was 7.5 (3.2-15.8) ml. An unfavorable outcome was seen in 673 (40.5%) patients at 90 days. The unfavorable 90-day outcome (mRS 4-6) was 49.2% in the native population vs. 44.4% in Africans, 39.0% in South Asian, 35.3% in Far Eastern, and 7.7% in Caucasians, p < 0.001. Mortality at 30 days and 90 days was 10.4 and 15.1%. Increasing age [OR (95% CI), 1.02 (1.00-1.03)], lower GCS [0.77 (0.73-0.80)], prior use of antiplatelet medications [1.82 (1.19-2.08)], higher ICH volume [1.03 (1.02-1.04)], and presence of any intraventricular hemorrhage [1.57(1.19-2.08)], were associated with unfavorable outcome. Conclusion In this relatively younger ICH cohort more than 75% were expatriates. The ICH volume, 90-day unfavorable outcome and mortality was lower in the expatriates compared to the local Arab population, likely related to the younger age and smaller size of the hemorrhages. Prognostic scoring systems may have to be modified in this population to avoid early withdrawal of care.
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Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mahesh Kate
- Neurology Division, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ryan Uy
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Blessy Babu
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Shobhna Shanti
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Neurology Division, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Akhtar N, Singh R, Kamran S, Joseph S, Morgan D, Uy RT, Treit S, Shuaib A. Association between serum triglycerides and stroke type, severity, and prognosis. Analysis in 6558 patients. BMC Neurol 2024; 24:88. [PMID: 38443844 PMCID: PMC10913234 DOI: 10.1186/s12883-024-03572-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 02/15/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Hypertriglyceridemia (HT) may increase the risk of stroke. Limited studies have shown that stroke severity and infarction size are smaller in patients with HT. We explored the relationship between triglyceride levels and stroke risk factors, severity and outcome in a large prospective database. DESIGN Prospective Cross-sectional study. SETTING We retrospectively interrogated the Qatar Stroke Database in all patients admitted between 2014-2022 with acute ischemic stroke and evaluated the relationship between triglyceride, diabetes, stroke severity (measured on NIHSS), stroke type (TOAST classification) and the short- (mRS at 90 days) and long-term outcomes (MACE at 1 year) in patients with HT. PARTICIPANTS Six thousand five hundred fifty-eight patients ≥20 years were included in this study RESULTS: Six thousand five hundred fifty-eight patients with ischemic stroke [mean age 54.6 ± 12. 9; male 82.1%) were included. Triglyceride levels upon admission were low-normal (≤1.1 mmol/L) in 2019 patients, high-normal (1.2-1.7 mmol/L) in 2142 patients, borderline-high (1.8-2.2 mmol/L) in 1072 patients and high (≥2.3 mmol/L) in 1325 patients. Higher triglyceride levels were associated with stroke and increased likelihood of having diabetes, obesity, active smoking, and small vessel/lacunar stroke type. An inverse relationship was noted whereby higher triglyceride levels were associated with lower stroke severity and reduced likelihood of poorer outcome (mRS 3-6) at discharge and 90 days. Long-term MACE events were less frequent in patients with higher triglyceride levels. After adjusting age, gender, diabetes, prior stroke, CAD, and obesity, multivariate analysis showed that hypertension and triglyceride levels were higher in mild ischemic strokes patients. CONCLUSIONS Increasing triglycerides are associated with higher risk of small vessel disease and requires further prospective cohort studies for confirmation.
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Affiliation(s)
- Naveed Akhtar
- Hamad Medical Corporation, Neurology, North Tower, Doha, Qatar
| | - Rajvir Singh
- Hamad Medical Corporation, Neurology, North Tower, Doha, Qatar
| | - Saadat Kamran
- Hamad Medical Corporation, Neurology, North Tower, Doha, Qatar
| | - Sujatha Joseph
- Hamad Medical Corporation, Neurology, North Tower, Doha, Qatar
| | - Deborah Morgan
- Hamad Medical Corporation, Neurology, North Tower, Doha, Qatar
| | - Ryan Ty Uy
- Hamad Medical Corporation, Neurology, North Tower, Doha, Qatar
| | - Sarah Treit
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ashfaq Shuaib
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
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Imam YZ, Chandra P, Singh R, Hakeem I, Al Sirhan S, Kotob M, Akhtar N, Kamran S, Al Jerdi S, Muhammad A, Haroon KH, Hussain S, Perkins JD, Elalamy O, Alhatou M, Ali L, Abdelmoneim MS, Joseph S, Morgan D, Uy RT, Bhutta Z, Azad A, Ayyad A, Elsotouhy A, Own A, Deleu D. Incidence, clinical features, and outcomes of posterior circulation ischemic stroke: insights from a large multiethnic stroke database. Front Neurol 2024; 15:1302298. [PMID: 38385041 PMCID: PMC10879388 DOI: 10.3389/fneur.2024.1302298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/08/2024] [Indexed: 02/23/2024] Open
Abstract
Background Posterior cerebral circulation ischemic stroke (PCS) comprises up to 25% of all strokes. It is characterized by variable presentation, leading to misdiagnosis and morbidity and mortality. We aim to describe PCS in large multiethnic cohorts. Methods A retrospective review of a large national stroke database from its inception on the 1st of January 2014 till 31 December 2020. Incidence per 100,000 adult population/year, demographics, clinical features, stroke location, and outcomes were retrieved. We divided the cohort into patients from MENA (Middle East and North Africa) and others. Results In total, 1,571 patients were identified. The incidence of PCS was observed to be rising and ranged from 6.3 to 13.2/100,000 adult population over the study period. Men were 82.4% of the total. The mean age was 54.9 ± 12.7 years (median 54 years, IQR 46, 63). MENA patients comprised 616 (39.2%) while others were 954 (60.7%); of these, the majority (80.5%) were from South Asia. Vascular risk factors were prevalent with 1,230 (78.3%) having hypertension, 970 (61.7%) with diabetes, and 872 (55.5%) having dyslipidemia. Weakness (944, 58.8%), dizziness (801, 50.5%), and slurred speech (584, 36.2%) were the most commonly presenting symptoms. The mean National Institute of Health Stroke Score (NIHSS) score was 3.8 ± 4.6 (median 3, IQR 1, 5). The overall most frequent stroke location was the distal location (568, 36.2%). The non-MENA cohort was younger, less vascularly burdened, and had more frequent proximal stroke location (p < 0.05). Dependency or death at discharge was seen in 39.5% and was associated with increasing age, and proximal and multilocation involvement; while at 90 days it was 27.4% and was associated with age, male sex, and having a MENA nationality (p < 0.05). Conclusion In a multiethnic cohort of posterior circulation stroke patients from the MENA region and South Asia, we noted a rising incidence over time, high prevalence of vascular risk factors, and poor outcomes in older men from the MENA region. We also uncovered considerable disparities between the MENA and non-MENA groups in stroke location and outcome. These disparities are crucial factors to consider when tailoring individualized patient care plans. Further research is needed to thoroughly investigate the underlying reasons for these variations.
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Affiliation(s)
- Yahia Z. Imam
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
| | - Prem Chandra
- Statistics, Medical Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Cardiology Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Ishrat Hakeem
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Mona Kotob
- College of Medicine, Qatar University, Doha, Qatar
| | - Naveed Akhtar
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
| | - Saadat Kamran
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | - Ahmad Muhammad
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | - Suhail Hussain
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Jon D. Perkins
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Osama Elalamy
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Mohamed Alhatou
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Liaquat Ali
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Sujatha Joseph
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ryan Ty Uy
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Zain Bhutta
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Aftab Azad
- College of Medicine, Qatar University, Doha, Qatar
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ali Ayyad
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Elsotouhy
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Own
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Dirk Deleu
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
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Naveed H, Akhtar N, Al-Jerdi S, Uy RT, Joseph S, Morgan D, Babu B, Shanthi S, Shuaib A. Appropriate use of antiplatelet medications following transient ischemic attacks and stroke: a 9-year study from the Middle East. Front Neurol 2023; 14:1269292. [PMID: 38020628 PMCID: PMC10666165 DOI: 10.3389/fneur.2023.1269292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background and purpose Guidelines recommend that patients with high-risk TIAs and minor strokes presenting within 1-3 days from onset should be offered dual antiplatelet therapy (DAPT). There are little data on real-world adherence to these recommendations. We evaluated the appropriateness of DAPT use in TIA and stroke patients in a prospective database. Methods The Qatar Stroke Database began the enrollment of patients with TIAs and acute stroke in 2014 and currently has ~16,000 patients. For this study, we evaluated the rates of guideline-adherent use of antiplatelet treatment at the time of discharge in patients with TIAs and stroke. TIAs were considered high-risk with an ABCD2 score of 4, and a minor stroke was defined as an NIHSS of 3. Patient demographics, clinical features, risk factors, previous medications, imaging and laboratory investigations, final diagnosis, discharge medications, and discharge and 90-day modified Rankin Scale (mRS) were analyzed. Results After excluding patients with ICH, mimics, and rare secondary causes, 8,082 patients were available for final analysis (TIAs: 1,357 and stroke: 6,725). In high-risk TIAs, 282 of 666 (42.3%) patients were discharged on DAPT. In patients with minor strokes, 1,207 of 3,572 (33.8%) patients were discharged on DAPT. DAPT was inappropriately offered to 238 of 691 (34.4%) low-risk TIAs and 809 of 3,153 (25.7%) non-minor stroke patients. Conclusion This large database of prospectively collected patients with TIAs and stroke shows that, unfortunately, despite several guidelines, a large majority of patients with TIAs and stroke are receiving inappropriate antiplatelet treatment at discharge from the hospital. This requires urgent attention and further investigation.
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Affiliation(s)
- Hiba Naveed
- Department of Medical Education, Weill Cornell College of Medicine, Doha, Qatar
| | - Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Salman Al-Jerdi
- Department of Medical Education, Weill Cornell College of Medicine, Doha, Qatar
| | - Ryan Ty Uy
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Blessy Babu
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Shobana Shanthi
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Neurology Division, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Morgan D, Spiess C, Millington G, Schmidt A, Smith H, Okwuone DDD, Berggren K, Lominska CE, Markiewicz MA, Yelder T, Gao H, Wang J, Gan GN. Investigating the Role of MK2 in Head and Neck Squamous Cell Carcinoma Growth, Metastasis and STING Pathway Activation. Int J Radiat Oncol Biol Phys 2023; 117:S159. [PMID: 37784399 DOI: 10.1016/j.ijrobp.2023.06.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Our prior work demonstrated that inhibition of MAPKAPK2 (MK2) can enhance radiation (RT)-mediated in vivo head and neck squamous cell carcinoma (HNSCC) tumor control and survival in preclinical immune incompetent models. The cytosolic DNA sensor cyclic GMP-AMP synthetase (cGAS) and its downstream adaptor protein, stimulator of interferon genes (STING), are conserved proteins within the innate immune signaling pathways and are important for mediating host defense against microbial infection and can play a role in anti-cancer immunity. We hypothesized that loss of MK2 enhances radiation-induced cGAS-STING pathway activation leading to improved tumor control and survival. MATERIALS/METHODS MK2 shRNA knockdown human (Tu167, CAL27) and MK2 Cas9/CRISPR knockout (KO) syngeneic murine (Ly2, MLM3) HNSCC cell lines were treated with 10 Gy irradiation. Micronuclei were quantitated by DAPI-immunofluorescence (IF). Protein changes in cGAS-STING were evaluated by immunoblot. Inflammatory cytokine production including Type I IFNβ1 were evaluated by RT-qPCR. Ly2 and MLM3 cells were orthotopically or flank engrafted into immune competent mice (Balb/c, C57Bl/6, respectively) for animal tumor control-survival studies. Tumor immune cell infiltrate was examined using FACS and immunohistochemistry. Selected drug studies using the MK2 inhibitor, ATI-450, were performed with RT. RESULTS Loss of MK2 in HNSCC (Tu167, CAL27, Ly2, MLM3) treated with RT led to a significant increase in micronuclei formation compared to control cells. MK2-enhanced micronuclei generation following RT could be inhibited with the actin filament polymerization inhibitor, cytochalasin B. RT treatment of MK2 shRNA cells led to increased cGAS and phospho-STING levels compared to either treatment alone. IFNβ1 levels were significantly higher in HNSCC cell lines treated with RT and with MK2 inhibited by an MK2 inhibitor (ATI-450) or genetic reduction compared to either treatment alone. In-vivo implantation of MLM3 cells into C57Bl/6 comparing control vs MK2 KO tumors treated with ±8 Gy RT demonstrated improved mouse survival favoring RT+MK2 KO over RT, MK2 KO or parental (63, 58, 58.5, 35 days, respectively). FACS analysis of MLM3 WT v KO tumors 3 days post RT showed an overall increase in the number of CD3/CD8 T-cells infiltrating into the tumor in all groups except for parental tumors. Further analysis demonstrated that loss of MK2 reversed CD8 T-cell exhaustion and when combined with radiotherapy led to increased CD8 T-cell activation. Furthermore, activated CD4 and CD8 T cells were reduced in WT+RT cells compared to WT tumors whereas no reduction was seen in the KO or KO+RT. CONCLUSION HNSCC tumor MK2 inhibition enhances RT-mediated micronuclei formation and subsequent cGAS-STING-IFNβ1 levels. Loss of HNSCC MK2 leads to increased CD4-CD8 T-cell infiltration into the tumor and this effect is enhanced following RT. Targeting tumor MK2 may facilitate improved tumor control.
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Affiliation(s)
- D Morgan
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS
| | | | - G Millington
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS
| | - A Schmidt
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS
| | - H Smith
- Tulane University, New Orleans, KS
| | | | - K Berggren
- University of New Mexico School of Medicine, Albuquerque, NM
| | - C E Lominska
- Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, KS
| | - M A Markiewicz
- Department of Microbiology, Molecular Genetics and Immunology, University of Kansas Medical Center, Kansas City, KS
| | - T Yelder
- KUCC Masonic Cancer Alliance, Kansas City, KS
| | - H Gao
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS
| | - J Wang
- Department of Medicinal Chemistry, The University of Kansas, Kansas City, KS
| | - G N Gan
- Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, KS
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Francis J, Bright J, Esnaashari S, Hashem Y, Morgan D, Straub VJ. Unsupervised feature extraction of aerial images for clustering and understanding hazardous road segments. Sci Rep 2023; 13:10922. [PMID: 37407750 DOI: 10.1038/s41598-023-38100-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/03/2023] [Indexed: 07/07/2023] Open
Abstract
Aerial image data are becoming more widely available, and analysis techniques based on supervised learning are advancing their use in a wide variety of remote sensing contexts. However, supervised learning requires training datasets which are not always available or easy to construct with aerial imagery. In this respect, unsupervised machine learning techniques present important advantages. This work presents a novel pipeline to demonstrate how available aerial imagery can be used to better the provision of services related to the built environment, using the case study of road traffic collisions (RTCs) across three cities in the UK. In this paper, we show how aerial imagery can be leveraged to extract latent features of the built environment from the purely visual representation of top-down images. With these latent image features in hand to represent the urban structure, this work then demonstrates how hazardous road segments can be clustered to provide a data-augmented aid for road safety experts to enhance their nuanced understanding of how and where different types of RTCs occur.
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Affiliation(s)
| | | | | | | | - Deborah Morgan
- The Alan Turing Institute, London, NW1 2DB, UK
- Accountable, Responsible and Transparent AI CDT, Department of Computer Science, University of Bath, Bath, UK
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Watson SM, McLean DL, Balcom BJ, Birchenough SNR, Brand AM, Camprasse ECM, Claisse JT, Coolen JWP, Cresswell T, Fokkema B, Gourvenec S, Henry LA, Hewitt CL, Love MS, MacIntosh AE, Marnane M, McKinley E, Micallef S, Morgan D, Nicolette J, Ounanian K, Patterson J, Seath K, Selman AGL, Suthers IM, Todd VLG, Tung A, Macreadie PI. Offshore decommissioning horizon scan: Research priorities to support decision-making activities for oil and gas infrastructure. Sci Total Environ 2023; 878:163015. [PMID: 36965737 DOI: 10.1016/j.scitotenv.2023.163015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 05/13/2023]
Abstract
Thousands of oil and gas structures have been installed in the world's oceans over the past 70 years to meet the population's reliance on hydrocarbons. Over the last decade, there has been increased concern over how to handle decommissioning of this infrastructure when it reaches the end of its operational life. Complete or partial removal may or may not present the best option when considering potential impacts on the environment, society, technical feasibility, economy, and future asset liability. Re-purposing of offshore structures may also be a valid legal option under international maritime law where robust evidence exists to support this option. Given the complex nature of decommissioning offshore infrastructure, a global horizon scan was undertaken, eliciting input from an interdisciplinary cohort of 35 global experts to develop the top ten priority research needs to further inform decommissioning decisions and advance our understanding of their potential impacts. The highest research priorities included: (1) an assessment of impacts of contaminants and their acceptable environmental limits to reduce potential for ecological harm; (2) defining risk and acceptability thresholds in policy/governance; (3) characterising liability issues of ongoing costs and responsibility; and (4) quantification of impacts to ecosystem services. The remaining top ten priorities included: (5) quantifying ecological connectivity; (6) assessing marine life productivity; (7) determining feasibility of infrastructure re-use; (8) identification of stakeholder views and values; (9) quantification of greenhouse gas emissions; and (10) developing a transdisciplinary decommissioning decision-making process. Addressing these priorities will help inform policy development and governance frameworks to provide industry and stakeholders with a clearer path forward for offshore decommissioning. The principles and framework developed in this paper are equally applicable for informing responsible decommissioning of offshore renewable energy infrastructure, in particular wind turbines, a field that is accelerating rapidly.
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Affiliation(s)
- Sarah M Watson
- Centre for Integrative Ecology, School of Life and Environmental Sciences, Deakin University, Burwood, VIC 3125, Australia
| | - Dianne L McLean
- Australian Institute of Marine Science, Indian Ocean Marine Research Centre, Perth, Western Australia 6009, Australia; Oceans Institute, The University of Western Australia, Perth, Western Australia 6009, Australia.
| | | | - Silvana N R Birchenough
- The Centre for Environment, Fisheries and Aquaculture Science (Cefas), Lowestoft NR33 0HT, United Kingdom
| | - Alison M Brand
- Manta Environmental Limited, Aberdeen, Scotland, United Kingdom
| | - Elodie C M Camprasse
- Centre for Integrative Ecology, School of Life and Environmental Sciences, Deakin University, Burwood, VIC 3125, Australia
| | - Jeremy T Claisse
- California State Polytechnic University, Pomona, CA 91786, USA; Vantuna Research Group, Occidental College, Los Angeles, CA 90041, USA
| | | | - Tom Cresswell
- Australian Nuclear Science and Technology Organisation, New Illawarra Road, Lucas Heights, New South Wales 2234, Australia
| | - Bert Fokkema
- Shell Global Solutions International B.V., 2596HR The Hague, the Netherlands
| | - Susan Gourvenec
- Centre of Excellence for Intelligent & Resilient Ocean Engineering, University of Southampton, Southampton SO16 7QF, UK
| | - Lea-Anne Henry
- School of GeoSciences, University of Edinburgh, King's Buildings Campus, James Hutton Road, EH9 3FE Edinburgh, United Kingdom
| | - Chad L Hewitt
- Harry Butler Institute, Murdoch University, Murdoch, Western Australia 6150, Australia; Lincoln University, Lincoln, New Zealand
| | - Milton S Love
- Marine Science Institute, University of California, Santa Barbara, CA 93016, USA
| | - Amy E MacIntosh
- Australian Nuclear Science and Technology Organisation, New Illawarra Road, Lucas Heights, New South Wales 2234, Australia; School of Natural Sciences, Macquarie University, Macquarie Park, Sydney, New South Wales 2109, Australia
| | - Michael Marnane
- Chevron Energy Technology Pty Ltd, 250 St Georges Terrace, Perth, Western Australia 6000, Australia
| | - Emma McKinley
- School of Earth and Environmental Sciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Shannon Micallef
- Department of Climate Change, Energy, the Environment and Water, Australia
| | - Deborah Morgan
- Xodus Group, Xodus House, Huntly Street, Aberdeen AB10 1RS, Scotland, United Kingdom
| | - Joseph Nicolette
- Montrose Environmental Solutions Inc., Northridge Road, Sandy Springs, GA 30350, USA
| | - Kristen Ounanian
- Centre for Blue Governance, Aalborg University, Aalborg, Denmark
| | | | - Karen Seath
- Society for Underwater Technology, International Salvage & Decommissioning Committee, UK; Karen Seath Solutions, Anstruther, Scotland, UK
| | - Allison G L Selman
- Asset Lifecycle Manager, Atteris Pty Ltd, Perth, Western Australia 6000, Australia
| | - Iain M Suthers
- School of Biological, Earth & Environmental Science, University of New South Wales, Sydney, New South Wales 2052, Australia
| | - Victoria L G Todd
- Ocean Science Consulting Ltd., Spott Road, Dunbar, East Lothian EH42 1RR, Scotland, United Kingdom
| | - Aaron Tung
- University of Aberdeen, School of Law, Aberdeen, UK; Curtin Institute for Energy Transition, Technology Park, Bentley, Western Australia 6102, Australia; Woodside Energy, Mia Yellagonga, 11 Mount Street, Perth, Western Australia 6000, Australia
| | - Peter I Macreadie
- Centre for Integrative Ecology, School of Life and Environmental Sciences, Deakin University, Burwood, VIC 3125, Australia
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Akhtar N, Singh R, Kamran SI, Joseph S, Morgan D, Uy RT, Treit S, Shuaib A. Abstract TP174: The Impact Of Serum Triglycerides On Stroke Severity And Prognosis. Analysis In 6558 Patients (2014-2022). Stroke 2023. [DOI: 10.1161/str.54.suppl_1.tp174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hypothesis:
Hypertriglyceridemia (HT) may increase the risk of stroke. Limited studies have shown that stroke severity and infarction size are smaller with HT. We explored the relationship between triglyceride and stroke risk factors, severity and outcome in a large prospective database.
Methods:
We interrogated the Qatar Stroke Database in all patients admitted between 2014-2022 with acute ischemic stroke and evaluated the relationship between vascular risk factors, stroke severity (measured on NIHSS), stroke type (TOAST classification) and the short- (mRS at 90 days) and long-term outcomes (MACE at 1 year) in patients with and without HT.
Results:
6558 patients with ischemic stroke [mean age 54.6 ± 12. 9; male 82.1%) with normal (<1.7 mmol/L) in 4161 (63.4%) and high (≥1.7 mmol/L) in 2397 (36.6%) were analyzed. Patients with HT were younger (53.1 ±11.4 versus 55.4 ±13.6, p <0.001), and had more diabetes, obesity, and active smoking. Stroke severity was higher with normal triglycerides (NIHSS: <1.7 mmol/l - 5.5 ±5.6 vs. >1.7 mmol/l - 4.4 ±4.6; p<0.001). Lacunar stroke was more common with HT (53.4% vs. 45.7%, p<0.001). mRS of 3-6 was more common with normal triglycerides (i.e. poorer outcome) at discharge (42% vs 35.5 p<0.001) and 90-days (31.7% vs 25.5%, p<0.001). Multivariate analysis showed that age, hypertension, HT, obesity, active smoking, and diabetes were independently associated with stroke severity.
Conclusion:
Onset of stroke occurs earlier in HT. The lower severity of symptoms and better prognosis evident with HT may in part be related to higher rates of lacunar stroke. Long-term MACE are however more frequently seen in HT subjects.
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Woo JA, Zhao X, Khan H, Penn C, Wang X, Joly-Amado A, Weeber E, Morgan D, Kang DE. Correction to: Slingshot-Cofilin activation mediates mitochondrial and synaptic dysfunction via A β ligation to β1-integrin conformers. Cell Death Differ 2022; 29:2562. [DOI: 10.1038/s41418-022-01055-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Akhtar N, Abid F, Singh R, Kamran S, Imam Y, Al-Jerdi S, Salamah S, Al Attar R, Yasir M, Shabir H, Morgan D, Joseph S, AlMaslamani M, Shuaib A. Ischemic stroke in patients that recover from COVID-19: Comparisons to historical stroke prior to COVID-19 or stroke in patients with active COVID-19 infection. PLoS One 2022; 17:e0270413. [PMID: 35749524 PMCID: PMC9232148 DOI: 10.1371/journal.pone.0270413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 06/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background and purpose Understanding the relationship of COVID-19 to stroke is important. We compare characteristics of pre-pandemic historical stroke (Pre-C), cases in acute COVID infection (Active-C) and in patients who have recovered from COVID-19 infection (Post-C). Methods We interrogated the Qatar stroke database for all stroke admissions between Jan 2019 and Feb 2020 (Pre-C) to Active-C (Feb2020-Feb2021) and Post-C to determine how COVID-19 affected ischemic stroke sub-types, clinical course, and outcomes prior to, during and post-pandemic peak. We used the modified Rankin Scale (mRS) to measure outcome at 90-days (mRS 0–2 good recovery and mRS 3–6 as poor recovery). For the current analysis, we compared the clinical features and prognosis in patients with confirmed acute ischemic stroke. Results There were 1413 cases admitted (pre-pandemic: 1324, stroke in COVID-19: 46 and recovered COVID-19 stroke: 43). Patients with Active-C were significantly younger, had more severe symptoms, fever on presentation, more ICU admissions and poor stroke recovery at discharge when compared to Pre-C and Post-C. Large vessel disease and cardioembolic disease was significantly more frequent in Active-C compared to PRE-C or post-C. Conclusions Stroke in Post-C has characteristics similar to Pre-C with no evidence of lasting effects of the virus on the short-term. However, Active-C is a more serious disease and tends to be more severe and have a poor prognosis.
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Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Fatma Abid
- Infectious Diseases Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Cardiology Research, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Yahia Imam
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Sarah Salamah
- Infectious Diseases Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Rand Al Attar
- Infectious Diseases Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Muhammad Yasir
- Emergency Department, Hamad Medical Corporation, Doha, Qatar
| | - Hammad Shabir
- Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Muna AlMaslamani
- Infectious Diseases Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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Akhtar N, Singh R, Kamran S, Babu B, Sivasankaran S, Joseph S, Morgan D, Shuaib A. Diabetes: Chronic Metformin Treatment and Outcome Following Acute Stroke. Front Neurol 2022; 13:849607. [PMID: 35557626 PMCID: PMC9087832 DOI: 10.3389/fneur.2022.849607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Aim To evaluate if in patients with known diabetes, pretreatment metformin will lead to less severe stroke, better outcome, and lower mortality following acute stroke. Methods The Qatar stroke database was interrogated for stroke severity and outcome in patients with ischemic stroke. Outcome was compared in nondiabetic vs. diabetic patients and in diabetic patients on metformin vs. other hypoglycemic agents. The National Institute of Health Stroke Scale was used to measure stroke severity and 90-day modified Rankin scale (mRS) score to determine outcome following acute stroke. Results In total, 4,897 acute stroke patients [nondiabetic: 2,740 (56%) and diabetic: 2,157 (44%)] were evaluated. There were no significant differences in age, risk factors, stroke severity and type, or thrombolysis between the two groups. At 90 days, mRS (shift analysis) showed significantly poor outcome in diabetic patients (p < 0.001) but no differences in mortality. In the diabetic group, 1,132 patients were on metformin and 1,025 on other hypoglycemic agents. mRS shift analysis showed a significantly better outcome in metformin-treated patients (p < 0.001) and lower mortality (8.1 vs. 4.6% p < 0.001). Multivariate negative binomial analyses showed that the presence of diabetes negatively affected the outcome (90-day mRS) by factor 0.17 (incidence risk ratio, IRR, 1.17; CI [1.08-1.26]; p < 0.001) when all independent variables were held constant. In diabetic patients, pre-stroke treatment with metformin improved the outcome (90-day mRS) by factor 0.14 (IRR 0.86 [CI 0.75-0.97] p = 0.006). Conclusion Similar to previous reports, our study shows that diabetes adversely affects stroke outcome. The use of prior metformin is associated with better outcome in patients with ischemic stroke and results in lower mortality. The positive effects of metformin require further research to better understand its mechanism.
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Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Cardiology Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Blessy Babu
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Sujatha Joseph
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Neurology Division, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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13
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Akhtar N, Abid F, Singh R, Kamran S, Imam Y, Al Jerdi S, Salameh S, Al Attar R, Yasir M, Shabir H, Morgan D, Joseph S, AlMaslamani M, Shuaib A. Characteristics and comparisons of acute stroke in "recovered" to "active COVID-19 and "pre-pandemic" in Qatar database. J Thromb Thrombolysis 2022; 53:824-828. [PMID: 35244832 PMCID: PMC8894126 DOI: 10.1007/s11239-021-02581-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 12/02/2022]
Abstract
Understanding the relationship of COVID-19 to stroke is important. We compare characteristics of pre-pandemic stroke (PPS), cases in acute COVID infection (CS) and in patients who have recovered from COVID-19 infection (RCS). We interrogated the Qatar stroke database for all stroke admissions between Jan 2020 and Feb 2021 (PPS) to CS and RCS to determine how COVID-19 affected ischemic stroke sub-types, clinical course, and outcomes prior to, during and post-pandemic peak. There were 3264 cases admitted (pre-pandemic: 3111, stroke in COVID-19: 60 and recovered COVID-19 stroke: 93). Patients with CS were significantly younger, had more severe symptoms, fever on presentation, more ICU admissions and poor stroke recovery at discharge when compared to PPS and RCS. Large vessel disease and cardioembolic disease was significantly higher in CS compared to PPS or RCS. There was a significant decline in stroke mimics in CS. Stroke in RCS has characteristics similar to PPS with no evidence of lasting effects of the virus on the short-term. However, CS is a more serious disease and tends to be more severe and have a poor prognosis.
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Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Fatma Abid
- Infectious Diseases Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Cardiology Research, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Yahia Imam
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Sarah Salameh
- Infectious Diseases Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Rand Al Attar
- Infectious Diseases Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Muhammad Yasir
- Emergency Department, Hamad Medical Corporation, Doha, Qatar
| | - Hammad Shabir
- Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Muna AlMaslamani
- Infectious Diseases Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Department of Medicine, University of Alberta, Edmonton, AB Canada
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14
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Akhtar N, Kamran S, Al-Jerdi S, Imam Y, Joseph S, Morgan D, Abokersh M, Uy RT, Shuaib A. Trends in stroke admissions before, during and post-peak of the COVID-19 pandemic: A one-year experience from the Qatar stroke database. PLoS One 2022; 17:e0255185. [PMID: 35324905 PMCID: PMC8947388 DOI: 10.1371/journal.pone.0255185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/10/2021] [Indexed: 12/23/2022] Open
Abstract
Background Several reports document a decrease in the rates of stroke hospital admissions during the covid-19 pandemic. There is very little information whether the admission rates will change as the infection is controlled. We report on our rates of admissions before, during and following the peak of covid-19 infections in a prospective database from Qatar. Methods and results The stroke admissions in the six months prior to COVID-19 pandemic averaged 229/month. There was a decrease to 157/month in March-June during the peak of the pandemic. In the 6 months following the peak, as covid-19 numbers began to decrease, the average numbers increased back to 192/month. There was an increase in severe ischemic strokes and decreased in functional recovery. The decreased admissions were mainly driven by fewer stroke mimics. Patients presenting with ischemic stroke or cerebral hemorrhage remained unchanged. Conclusions Fewer stroke mimics presenting to the hospital can explain the fewer admissions and poor outcome at the height of the covid-19 pandemic. The continued decrease in the number of ischemic stroke and stroke mimic admissions following the pandemic peak requires more study.
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Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Salman Al-Jerdi
- Weill Cornell Medical College- Qatar Foundation, Doha, Qatar
| | - Yahia Imam
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Abokersh
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - R. T. Uy
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Neurology Division, Department of Medicine, University of Alberta, Edmonton, Canada
- * E-mail:
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15
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Hong C, Kamdar N, Morgan D. Prediction models for same-day discharge following benign minimally invasive hysterectomy. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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16
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DeBlanc J, Brummett C, Gunaseelan V, As-Sanie S, Morgan D. Patient recovery and opioid use after hysterectomy. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Singhal S, Veeratterapillay J, Locks S, Morgan D, Patil R. Magnetic Resonance Imaging-Guided Adaptive Brachytherapy for the Treatment of Cervical Cancer and its Impact on Clinical Outcome. Clin Oncol (R Coll Radiol) 2022; 34:442-451. [DOI: 10.1016/j.clon.2022.01.039] [Citation(s) in RCA: 1] [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] [Received: 09/30/2021] [Revised: 12/22/2021] [Accepted: 01/19/2022] [Indexed: 12/24/2022]
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18
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Akhtar N, Al-Jerdi S, Kamran S, Singh R, Babu B, Abdelmoneim MS, Morgan D, Joseph S, Francis R, Shuaib A. Night-Time Non-dipping Blood Pressure and Heart Rate: An Association With the Risk of Silent Small Vessel Disease in Patients Presenting With Acute Ischemic Stroke. Front Neurol 2021; 12:719311. [PMID: 34867710 PMCID: PMC8637909 DOI: 10.3389/fneur.2021.719311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Nocturnal non-dipping blood pressure and heart rate are associated with an increased risk of cardiovascular disease. The effects of such variance on cerebrovascular disease have not been well studied. Methods: The 24-h ambulatory blood pressure (ABPM) and heart rate were monitored with B-pro in patients with acute stroke within the initial week of hospital admission. The risk factor profiles, clinical presentation, imaging, and short-term prognosis were compared in nocturnal dippers and non-dippers (more than 10% nocturnal decrease) of blood pressure and heart rate. Results: We enrolled 234 patients in whom ABPM and MRI data were available. Heart rate data were available in 180 patients. Lacunar sub-cortical stroke was the most common acute lesion (58.9%), while hypertension (74%) and diabetes (41.5%) were the most common associated risk factors. ABPM revealed non-dipping in 69% of patients. On univariate analysis, Small Vessel Disease (SVD) was significantly more frequent in non-dippers vs. dippers (BP: 56.8 vs. 40.3% p = 0.02; heart rate: 57.9 vs. 40.7% p = 0.03). Silent strokes were also more frequent in non-dippers vs. dippers (BP: 40.7 vs. 26.4% p = 0.35; heart rate: 44.6 vs. 25.4% p = 0.01). Multivariate analysis revealed SVD to be significantly related to age, hypertension, blood pressure non-dipping, and severity of symptoms at index event. Conclusions: The presence of nocturnal non-dipping of blood pressure and heart rate are associated with an increased risk of silent stroke and SVD. Increased use of ABPM may allow for improved diagnosis of non-dippers.
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Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Blessy Babu
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Deborah Morgan
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Reny Francis
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Neurology Division, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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19
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Waterman J, Jayaraju U, Nadimi J, Morgan D. 940 Neck of Femur Fracture Management and Outcomes during COVID-19: Overview of the Results from a District General Hospital in Wales. Br J Surg 2021. [PMCID: PMC8524569 DOI: 10.1093/bjs/znab259.1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction The COVID-19 pandemic has delivered significant challenges to the Orthopaedic community. Our study aims to assess the impact of COVID-19 on the management and outcomes of patient’s presenting with Hip Fractures to our DGH. Method Retrospective data analysis was performed on a cohort of hip fracture patients who presented to our DGH before the COVID-19 pandemic (23/03/2019 to 05/05/2019) and were compared to those who presented during the COVID-19 pandemic (23/03/2020 to 05/05/2020). Minimum follow up was 30 days postoperatively. Results 38 patients with hip fractures presented to our unit in the pre-COVID-19 period compared to 27 patients in the COVID-19 period. Total time from presentation to discharge, during COVID-19, demonstrated a 70.23% decrease when compared to the pre-COVID cohort. 30-day Mortality rates were higher in the COVID-19 cohort. Conclusions During the COVID-19 pandemic our time to theatre and discharge of hip fractures has seen an improvement, with time to discharge decreasing by 70.23%. Comparison of our mortality rates has seen a fourfold increase likely influenced by the detrimental effects of COVID-19. Further work and larger numbers are required to see the true impact of COVID-19 on the management and outcomes of hip fractures in our DGH.
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Affiliation(s)
- J Waterman
- Royal Glamorgan Hospital, Llantrisant, United Kingdom
| | - U Jayaraju
- Royal Glamorgan Hospital, Llantrisant, United Kingdom
| | - J Nadimi
- Royal Glamorgan Hospital, Llantrisant, United Kingdom
| | - D Morgan
- Royal Glamorgan Hospital, Llantrisant, United Kingdom
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20
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Giovannini S, Carter CS, Leeuwenburgh C, Flex A, Biscetti F, Morgan D, Laudisio A, Coraci D, Maccauro G, Zuccalà G, Caliandro P, Bernabei R, Marzetti E. Effects of aging and life-long moderate calorie restriction on IL-15 signaling in the rat white adipose tissue. Eur Rev Med Pharmacol Sci 2021; 24:2738-2749. [PMID: 32196625 DOI: 10.26355/eurrev_202003_20547] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Phosphorylation of insulin receptor substrate (IRS) 1 by tumor necrosis factor alpha (TNF-α) has been implicated as a factor contributing to insulin resistance. Administration of IL-15 reduces adipose tissue deposition in young rats and stimulates secretion of adiponectin, an insulin sensitizing hormone that inhibits the production and activity of TNF-α. We aimed at investigating the effects of age life-long moderate calorie restriction (CR) on IL-15 and TNF-α signaling in rat white adipose tissue (WAT). MATERIALS AND METHODS Thirty-six 8-month-old, 18-month-old, and 29-month-old male Fischer344´Brown Norway F1 rats (6 per group) were either fed ad libitum (AL) or calorie restricted by 40%. The serum levels of IL-15 and IL-15 receptor α-chain (IL-15Rα) were increased by CR controls regardless of age. An opposite pattern was detected in WAT. In addition, CR reduced gene expression of TNF-α and cytosolic IRS1 serine phosphorylation in WAT, independently from age. RESULTS IL-15 signaling in WAT is increased over the course of aging in AL rats compared with CR rodents. Protein levels of IL-15Rα are greater in WAT of AL than in CR rats independently from age. This adaptation was paralleled by increased IRS1 phosphorylation through TNF-α-mediated insulin resistance. Adiponectin decreased at old age in AL rats, while no changes were evident in CR rats across age groups. CONCLUSIONS IL-15 signaling could therefore represent a potential target for interventions to counteract metabolic alterations and the deterioration of body composition during aging.
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Affiliation(s)
- S Giovannini
- Department of Geriatrics, Neurosciences, and Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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21
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Akhtar N, Al Jerdi S, Mahfoud Z, Imam Y, Kamran S, Saqqur M, Morgan D, Joseph S, Khan K, Shuaib A. Impact of COVID-19 pandemic on stroke admissions in Qatar. BMJ Neurol Open 2021; 3:e000084. [PMID: 33665617 PMCID: PMC7817384 DOI: 10.1136/bmjno-2020-000084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 02/03/2023] Open
Abstract
Introduction The COVID-19 pandemic has resulted in a dramatic unexplained decline in hospital admissions due to acute coronary syndromes and stroke. Several theories have emerged aiming to explain this decline, mostly revolving around the fear of contracting the disease and thus avoiding hospital visits. Aims In this study, we aim to examine the impact of the COVID-19 pandemic on stroke admissions to a tertiary care centre in Qatar. Methods The Hamad General Hospital stroke database was interrogated for stroke admissions between September 2019 and May 2020. The number of stroke admissions, stroke subtypes and short-term outcomes was compared between the ‘pre-COVID-19’ period (September 2019 to February 2020) and the COVID-19 pandemic period (March to May 2020). Results We observed a significant decline in monthly admissions in March (157), April (128) and May (135) compared with the pre-COVID-19 6-month average (229) (p=0.024). The reduction in admissions was most evident in functional stroke mimics. The average admissions decreased from 87 to 34 per month (p=0.0001). Although there were no significant differences in admissions due to ischaemic stroke (IS), intracranial haemorrhage or transient ischaemic attacks between the two periods, we noted a relative decrease in IS due to small vessel disease and an increase in those due to large vessel atherosclerosis in March to May 2020. Conclusions The decline in overall stroke admissions during the COVID-19 pandemic is most likely related to concerns of contracting the infection, evidenced mainly by a decline in admissions of stroke mimics. However, a relative increase in large vessel occlusions raises suspicion of pathophysiological effects of the virus, and requires further investigation.
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Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Yahia Imam
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Maher Saqqur
- University of Alberta, Edmonton, Alberta, Canada
| | - Deborah Morgan
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
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22
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Aartsen M, Morgan D, Dahlberg L, Waldegrave C, Mikulionienė S, Rapolienė G, Lamura G. Exclusion From Social Relations and Loneliness: Individual and Country-Level Changes. Innov Aging 2020. [PMCID: PMC7742607 DOI: 10.1093/geroni/igaa057.2509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Social isolation and loneliness have profound implications for quality of life and health and welfare budgets, but interventions to reduce loneliness are limited effective. The aim of this study is to examine the often-ignored impact of macro-level drivers of loneliness, in addition to micro-level drivers by adopting a cross-national perspective. We use longitudinal data from 2013 and 2015 from the Survey of Health, Aging, and Retirement in Europe (SHARE), combined with macro-level data from additional sources. Our study confirms that key micro-level drivers of loneliness are gender, health and partnership status, frequency of contact with children and changes therein. Macro level drivers are level of safety in the neighbourhood, and poverty and social deprivation of a society. In order to understand and reduce loneliness we require not just a focus on individual risk factors, behaviours and expectations, but also on macro-level factors that are associated with exclusion from social relations.
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Affiliation(s)
| | - Deborah Morgan
- Swansea University Wales, Swansea, Wales, United Kingdom
| | - Lena Dahlberg
- Aging Research Center, Karolinska Institutet, Solna, Stockholms Lan, Sweden
| | - Charles Waldegrave
- Family Centre Social Policy Research Unit, Lower Hutt, Wellington, New Zealand
| | | | - Gražina Rapolienė
- Lithuanian Social Research Centre, Vilnius, Vilniaus Apskritis, Lithuania
| | - Giovanni Lamura
- Centre for Socio-Economic Research on Ageing, Ancona, Marche, Italy
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Smith H, Morgan D, Berggren K, Hixon M, Shen X, Woolbright B, Taylor J, Gan G. The MAPKAPK2 Pathway Mediates Radiation-Induced Tumor Inflammation And Proliferation In Bladder Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1678] [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]
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25
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Smith RY, Morgan D, Sharma L, Cherny VV, Tidswell N, Molo MW, DeCoursey TE. Voltage-gated proton channels exist in the plasma membrane of human oocytes. Hum Reprod 2020; 34:1974-1983. [PMID: 31633762 DOI: 10.1093/humrep/dez178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/10/2019] [Indexed: 12/25/2022] Open
Abstract
STUDY QUESTION Do human oocytes express voltage-gated proton channels? SUMMARY ANSWER Human oocytes exhibit voltage-gated proton currents. WHAT IS KNOWN ALREADY Voltage-gated proton currents have been reported in human sperm, where they contribute to capacitation and motility. No such studies of human oocytes exist. STUDY DESIGN, SIZE, DURATION Voltage-clamp studies were undertaken using entire oocytes and vesicles derived from oocytes and in excised patches of membrane from oocytes. PARTICIPANTS/MATERIALS, SETTING, METHODS Frozen, thawed human metaphase II oocytes were obtained from material donated to the gamete repository at the Rush Center for Advanced Reproductive Care. Prior to patch clamping, oocytes were warmed and equilibrated. Formation of an electrically tight seal requires exposing bare oolemma. Sections of the zona pellucida (ZP) were removed using a laser, followed by repeated pipetting, to further separate the oocyte from the ZP. Patch-clamp studies were performed using the whole-cell configuration on oocytes or vesicles derived from oocytes, and using inside-out patches of membrane, under conditions optimized to detect voltage-gated proton currents. MAIN RESULTS AND THE ROLE OF CHANCE Proton currents are present at significant levels in human oocytes where they exhibit properties similar to those reported in other human cells, as well as those in heterologous expression systems transfected with the HVCN1 gene that codes for the voltage-gated proton channel. LARGE SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION Human oocytes are large cells, which limits our ability to control the intracellular solution. Subtle effects of cryopreservation by vitrification and subsequent warming on properties of HVCN1, the HVCN1 gene product, cannot be ruled out. WIDER IMPLICATIONS OF THE FINDINGS Possible functions for voltage-gated proton channels in human oocytes may now be contemplated. STUDY FUNDING/COMPETING INTEREST(S) NIH R35GM126902 (TED), Bears Care (DM). No competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- R Ya Smith
- Rush Center for Advanced Reproductive Care, Department of Obstetrics and Gynecology, Rush University Medical Center, Chicago, IL 60612, USA
| | - D Morgan
- Department of Physiology & Biophysics, Rush University, Chicago, IL 60612, USA
| | - L Sharma
- Rush Center for Advanced Reproductive Care, Department of Obstetrics and Gynecology, Rush University Medical Center, Chicago, IL 60612, USA
| | - V V Cherny
- Department of Physiology & Biophysics, Rush University, Chicago, IL 60612, USA
| | - N Tidswell
- Rush Center for Advanced Reproductive Care, Department of Obstetrics and Gynecology, Rush University Medical Center, Chicago, IL 60612, USA
| | - M W Molo
- Rush Center for Advanced Reproductive Care, Department of Obstetrics and Gynecology, Rush University Medical Center, Chicago, IL 60612, USA
| | - T E DeCoursey
- Department of Physiology & Biophysics, Rush University, Chicago, IL 60612, USA
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Akhtar N, Bhutta Z, Kamran S, Babu B, Jose N, Joseph S, Morgan D, Francis R, Own A, Shuaib A. Stroke Mimics: A five-year follow-up study from the Qatar Stroke Database. J Stroke Cerebrovasc Dis 2020; 29:105110. [PMID: 32912536 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/02/2020] [Accepted: 06/28/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Mimics comprise a third of patients presenting with an acute stroke. There is limited information on their natural history. METHODS We evaluate long term major cardiovascular events (MACE) in stroke mimics in a prospective database from Qatar. RESULTS Between Feb 2014 and Jan 2019, 481 patients (male: 238; female: 243) mean age 57.5 years (±18.0), with 399 (83%) medical mimics and 82 (17%) functional mimics were evaluated. Imaging revealed previous old stroke in 26.6% and small vessel disease in 5%. MACE occurred in 57 (11.9%) and there were 31 deaths (6.4%) with majority of deaths (5.6%) from cardiovascular causes. MACE was significantly higher in patients with previous stroke, p < 0.0001), coronary artery disease, p = 0.002), diabetic, p = 0.01), and hypertensive on admission, p < 0.0001. MACE were also significantly higher in patients where imaging showed a previous stroke, p = 0.006). CONCLUSION The occurrence of MACE during follow-up suggests that patients with existing vascular disease require aggressive management of vascular risk factors.
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Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Zain Bhutta
- Department of Accident and Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Blessy Babu
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Namitha Jose
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Sujatha Joseph
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Deborah Morgan
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Reny Francis
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Ahmed Own
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Ashfaq Shuaib
- Department of Medicine (Stroke Program), University of Alberta, Edmonton, Alberta, Canada.
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Akhtar N, Kate M, Kamran S, Singh R, Bhutta Z, Saqqur M, Elzouki AN, Babu B, Bourke P, Morgan D, Joseph S, Jose N, Francis R, Imam Y, Amir N, Own A, Shuaib A. Sex-Specific Differences in Short-Term and Long-Term Outcomes in Acute Stroke Patients from Qatar. Eur Neurol 2020; 83:154-161. [PMID: 32434193 DOI: 10.1159/000507193] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/09/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sex differences may determine presentation, utility of treatment, rehabilitation, and occurrences of major adverse cardiovascular events (MACEs) in acute stroke (AS). OBJECTIVE The purpose of the study was to evaluate the short-term prognosis and long-term outcomes in MACEs in Qatari nationals admitted with AS. METHODS All AS patients admitted between January 2014 and February 2019 were included. We evaluated the preadmission modified Rankin scale (mRS) score, etiology and severity of symptoms, complications, and functional recovery at discharge and 90 days. MACEs were recorded for 5 years. RESULTS There were 891 admissions for AS (mean age 64.0 ± 14.2 years) (male, n = 519 [mean age ± SD 62.9 ± 14.1 years]; female, n = 372 [mean age ± SD 65.6 ± 14.2 years] p = 0.005). There were no differences in the preadmission mRS and severity of symptoms as measured on National Institute of Stroke Scale. At discharge, the outcome was better (mRS 0-2) in men (57.8 vs. 46.0%), p = 0.0001. This difference persisted at the 90-day follow-up (mRS 0-2, male 69.4% vs. female 53.2%, p = 0.0001). At the 90-day follow-up, more women died (total deaths 70; women 38 [10.2%] versus men 32 [6.2%], p = 0.03). MACEs occurred in 25.6% (133/519) males and 30.9% (115/372) females over the 5-year follow-up period (odds ratio 0.77, 95% confidence interval 0.57-1.0, p = 0.83). CONCLUSIONS Female patients have a poor short-term outcome following an AS when corrected for age and comorbidities. While our study cannot explain the reasons for the discrepancies, higher poststroke depression and social isolation in women may be important contributory factors, and requires further studies are required to confirm these findings.
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Affiliation(s)
- Naveed Akhtar
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mahesh Kate
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Saadat Kamran
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Accident & Emergency, Hamad Medical Corporation, Doha, Qatar
| | - Zain Bhutta
- Accident & Emergency, Hamad Medical Corporation, Doha, Qatar
| | - Maher Saqqur
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Blessy Babu
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Paula Bourke
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Namitha Jose
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Reny Francis
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Yahia Imam
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Numan Amir
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Own
- Stroke Program, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada,
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28
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Schmidt P, Kamdar N, Swenson C, Uppal S, Morgan D. 06: Development of a preoperative prediction tool for postoperative complications after hysterectomy. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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29
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Uppal S, Tilea A, Morgan D, Pearlman M. 16: Bundled interventions and an institutional focus on infection prevention significantly reduces post-hysterectomy infectious morbidity. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.12.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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30
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Ford J, Steel N, Aasheim E, Devleesschauwer B, Gallay A, Morgan D, Schmidt J, Ziese T, Newton J. Slowing improvements in life expectancy across European Economic Area countries. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Life expectancy improvements have slowed down in several European countries since around 2011. The relative contributions from changes in specific conditions (e.g. cancers) and broader risk factors (e.g. smoking or austerity) remain unclear. We aimed to explore the different potential causes in 17 European Economic Area (EEA) countries.
Methods
We compared Global Burden of Disease (GBD) study estimates for life expectancy, years of life lost (YLLs) and population attributable fractions (PAFs) for risk factors, for 2005-2011 and 2011-2017 for 17 EEA countries. Three countries with the largest absolute improvements and three with the smallest were selected for analysis by gender, age, condition and risk factors.
Results
Norway, France and Belgium had the largest improvement in life expectancy (+1.5, +1.2 and +1.2 years respectively) from 2011 to 2017, and Germany, Iceland and the UK the smallest (+0.1, +0.2 and +0.2 years). Life expectancy reduced slightly for women aged over 80 in Germany and UK, men aged over 50 in Germany, and for men in all age groups up to 90 years in Iceland. Norway, France and Belgium saw faster improvements in YLLs from lung cancer and Norway and France for COPD in both men and women, and from self-harm in men, after 2011 than before. PAF for tobacco declined faster after 2011. Germany, Iceland and the UK saw slower improvements in cardiovascular disease and in Germany and the UK lung cancer. In Iceland, YLLs for cancers, self harm, respiratory disease, cirrhosis and dementia all worsened after 2011. PAF for tobacco remained high or declined less after 2011 in all 3 countries. PAFs for alcohol and drug use remained high in Iceland and UK.
Conclusions
Differential changes in major fatal diseases and risk factors help explain national changes in life expectancies, but national differences in data availability may affect results. Further research is needed into the ‘causes of the causes’, such as the 2008 economic crash in Iceland.
Key messages
Differential changes in major fatal diseases and risk factors help explain national changes in life expectancies. Norway, France and Belgium had the largest improvement in life expectancy from 2011 to 2017, and Germany, Iceland and the UK the smallest.
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Affiliation(s)
- J Ford
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - N Steel
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - E Aasheim
- Norwegian Directorate of Health, Ministry of Health and Care Services, Oslo, Norway
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - B Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
| | - A Gallay
- Santé Publique France, Saint-Maurice, Paris, France
| | - D Morgan
- Health Statistics, OECD, Paris, France
| | - J Schmidt
- Public Health Data Science, Public Health England, London, UK
| | - T Ziese
- Department of Epidemiology and Health Monitoring, Robert Koch Institut, Berlin, Germany
| | - J Newton
- Chief Knowledge Officer, Public Health England, London, UK
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Joly-Amado A, Davtyan H, Serraneau K, Jules P, Zitnyar A, Pressman E, Zagorski K, Antonyan T, Hovakimyan A, Paek HJ, Gordon MN, Cribbs DH, Petrovsky N, Agadjanyan MG, Ghochikyan A, Morgan D. Active immunization with tau epitope in a mouse model of tauopathy induced strong antibody response together with improvement in short memory and pSer396-tau pathology. Neurobiol Dis 2019; 134:104636. [PMID: 31629891 DOI: 10.1016/j.nbd.2019.104636] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/30/2019] [Accepted: 10/07/2019] [Indexed: 12/16/2022] Open
Abstract
Abnormal tau hyperphosphorylation and its aggregation into neurofibrillary tangles are a hallmark of tauopathies, neurodegenerative disorders that include Alzheimer's disease (AD). Active and passive Tau-immunotherapy has been proposed as a therapeutic approach to AD with mixed results. One of the limitations of active immunotherapy may be associated with the mediocre immunogenicity of vaccines that are not inducing therapeutically potent titers of antibodies. The aim of this study was to test the efficacy of an anti-tau vaccine, AV-1980R/A composed of N terminal peptide of this molecule fused with an immunogenic MultiTEP platform and formulated in a strong adjuvant, AdvaxCpG in a Tg4510 mouse model of tauopathy. Experimental mice were immunized with AV-1980R/A and a control group of mice were injected with adjuvant only. Nontransgenic and tetracycline transactivator (tTA) transgenic littermates were included as baseline controls to contrast with the tau phenotype. Active immunization with AV-1980R/A induced very strong anti-tau humoral immune responses in both nontransgenic and transgenic mice with evidence of IgG in brains of AV-1980R/A vaccinated mice. These experimental animals displayed an improvement in short-term memory during a novel object recognition test. However, impairments in other behavioral tasks were not prevented by AV-1980R/A vaccinations. At the same time, high titers of anti-tau antibodies reduced hyperphosphorylated pSer396 tau but did not lower the level of other phosphorylated tau species in the brains of AV-1980R/A vaccinated mice. These data indicate that active immunotherapy with an N-terminal Tau epitope was only partially effective in improving cognition and reducing pathology in the stringent Tg4510 mouse model of tauopathy.
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Affiliation(s)
- A Joly-Amado
- USF Health Byrd Alzheimer's Institute, Tampa, FL 33613, USA.
| | - H Davtyan
- The Institute for Molecular Medicine, Huntington Beach, CA 92647, USA; Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine, CA 92697, USA
| | - K Serraneau
- USF Health Byrd Alzheimer's Institute, Tampa, FL 33613, USA
| | - P Jules
- USF Health Byrd Alzheimer's Institute, Tampa, FL 33613, USA
| | - A Zitnyar
- USF Health Byrd Alzheimer's Institute, Tampa, FL 33613, USA
| | - E Pressman
- USF Health Byrd Alzheimer's Institute, Tampa, FL 33613, USA
| | - K Zagorski
- The Institute for Molecular Medicine, Huntington Beach, CA 92647, USA
| | - T Antonyan
- The Institute for Molecular Medicine, Huntington Beach, CA 92647, USA
| | - A Hovakimyan
- The Institute for Molecular Medicine, Huntington Beach, CA 92647, USA
| | - H J Paek
- Molecular Pharmacology and Physiology, College of Medicine, University of South Florida, Tampa, FL, USA
| | - M N Gordon
- USF Health Byrd Alzheimer's Institute, Tampa, FL 33613, USA
| | - D H Cribbs
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine, CA 92697, USA
| | - N Petrovsky
- Flinders Med. Ctr., Bedford Park, Adelaide 5042, Australia
| | - M G Agadjanyan
- The Institute for Molecular Medicine, Huntington Beach, CA 92647, USA
| | - A Ghochikyan
- The Institute for Molecular Medicine, Huntington Beach, CA 92647, USA
| | - D Morgan
- USF Health Byrd Alzheimer's Institute, Tampa, FL 33613, USA
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McLeod G, Finch C, Morgan D, Kountouris A, Fortington L. Medically treated cricket injuries in Victoria: a 15 year review of emergency department presentations and hospital admissions. J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.270] [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]
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Oeser C, Aarons E, Heath P, Johnson K, Khalil A, Knight M, Lynn RM, Morgan D, Pebody R. Surveillance of congenital Zika syndrome in England and Wales: methods and results of laboratory, obstetric and paediatric surveillance. Epidemiol Infect 2019; 147:e262. [PMID: 31481135 PMCID: PMC6805733 DOI: 10.1017/s0950268819001535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/06/2019] [Indexed: 11/06/2022] Open
Abstract
The spread of the Zika virus (ZIKV) in the Americas led to large outbreaks across the region and most of the Southern hemisphere. Of greatest concern were complications following acute infection during pregnancy. At the beginning of the outbreak, the risk to unborn babies and their clinical presentation was unclear. This report describes the methods and results of the UK surveillance response to assess the risk of ZIKV to children born to returning travellers. Established surveillance systems operating within the UK - the paediatric and obstetric surveillance units for rare diseases, and national laboratory monitoring - enabled rapid assessment of this emerging public health threat. A combined total of 11 women experiencing adverse pregnancy outcomes after possible ZIKV exposure were reported by the three surveillance systems; five miscarriages, two intrauterine deaths and four children with clinical presentations potentially associated with ZIKV infection. Sixteen women were diagnosed with ZIKV during pregnancy in the UK. Amongst the offspring of these women, there was unequivocal laboratory evidence of infection in only one child. In the UK, the number and risk of congenital ZIKV infection for travellers returning from ZIKV-affected countries is very small.
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Affiliation(s)
- C. Oeser
- National Infection Service, Public Health England, London, UK
| | - E. Aarons
- Rare and Imported Pathogens Laboratory, Public Health England, Porton, Salisbury, UK
| | - P.T. Heath
- Institute of Infection and Immunity, St George's, University of London, London, UK
| | - K. Johnson
- Neonatal Service, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A. Khalil
- Obstetrics and Maternal-Fetal Medicine, St George's, University of London, London, UK
| | - M Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - R. M. Lynn
- National Infection Service, Public Health England, London, UK
| | - D. Morgan
- National Infection Service, Public Health England, London, UK
| | - R. Pebody
- National Infection Service, Public Health England, London, UK
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Abstract
PURPOSE In 1959, Maroteaux and Lamy initially designated pseudoachondroplasia as a distinct dysplasia different from achondroplasia the most common form of skeletal dysplasia. Pseudoachondroplasia is caused by a mutation in the collagen oligomeric matrix protein gene (COMP) gene on chromosome 19p13.1-p12 encoding the COMP. The COMP gene mutations result in rendering the articular and growth plate cartilages incapable of withstanding routine biomechanical loads with resultant deformity of the joints. The purpose of the study was to characterize the typical orthopaedic findings in pseudoachondroplasia. METHODS The charts and radiographs of 141 patients with pseudoachondroplasia were analyzed. This cohort, to our knowledge, represents the largest group of patients describing the typical orthopaedic manifestations of pseudoachondroplasia. RESULTS Patients with pseudoachondroplasia have normal craniofacial appearance with normal intelligence. Short stature is not present at birth and generally appears by two to four years of age. The condition is a form of spondyloepiphyseal dysplasia and the long bones are characterized by dysplastic changes in the epiphysis, metaphysis and vertebral bodies. Radiographically the long bones have altered the appearance and structure of the epiphyses with small irregularly formed or fragmented epiphyses or flattening. The metaphyseal regions of the long bones show flaring, widening or 'trumpeting'. The cervical (89%) and thoracic and lumbar vertebrae show either platyspondyly, ovoid, 'cod-fish' deformity or anterior 'beaking'. Kyphosis (28%), scoliosis (58%) and lumbar lordosis (100%) are commonly seen. The femoral head and acetabulum are severely dysplastic (100%). The knees show either genu valgum (22%), genu varum (56%) or 'windswept' deformity (22%). CONCLUSION Most commonly these distortions of the appendicular and the axial skeleton lead to premature arthritis particularly of the hips and often the knees not uncommonly in the 20- to 30-year-old age group. LEVEL OF EVIDENCE III.
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Affiliation(s)
- D. S. Weiner
- Department of Orthopaedics, Akron Children’s Hospital, Akron, Ohio, USA,Correspondence should be sent to D. S. Weiner, Department of Orthopaedics, Akron Children’s Hospital, 300 Locust Street, Ste. 250, Akron, OH 44302-1821, USA.
| | - J. Guirguis
- Department of Orthopaedics, Akron Children’s Hospital, Akron, Ohio, USA
| | - M. Makowski
- Department of Orthopaedics, Cleveland Clinic/Akron General, Akron, Ohio, USA
| | - S. Testa
- Rebecca D. Considine Research Institute/Akron Children’s Hospital, Akron, Ohio, USA
| | - L. Shauver
- Rebecca D. Considine Research Institute/Akron Children’s Hospital, Akron, Ohio, USA
| | - D. Morgan
- Rebecca D. Considine Research Institute/Akron Children’s Hospital, Akron, Ohio, USA
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35
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Shen C, Zhao YQ, Liu RB, Morgan D, Wei T. Enhancing wastewater remediation by drinking water treatment residual-augmented floating treatment wetlands. Sci Total Environ 2019; 673:230-236. [PMID: 30991314 DOI: 10.1016/j.scitotenv.2019.04.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 06/09/2023]
Abstract
In this study, the involvement of aluminum-based drinking water treatment residual (DWTR) as substrate in floating treatment wetland (FTW) to enhance its treatment performance was firstly proposed and trialed. A laboratory scale DWTR-FTW fed with synthetic wastewater containing COD, nitrogen (N), phosphorus (P) and mineral salts was operated in three stages of unplanted (1-30 days), planted (31-60 days) and aerated (61-135 days) modes. The results showed that the average removal rates of COD, total nitrogen (TN), total phosphorus (TP) in stage 3 were 88%, 85%, and 90.2%, respectively, indicating the outstanding purification performance of DWTR-FTW in comparison of traditional FTWs. The embedded DWTR enriches the biomass and robustly adsorbs P, while aeration supplies sufficient dissolved oxygen for the microorganism. The results revealed that 7.022 g P was accumulated in DWTR, which is 400 times higher than that in sediment and plants during the experimental period, reflecting that DWTR adsorption is the major P removal pathway in DWTR-FTW. Overall, DWTR-FTW could significantly remove pollutants, especially P, and provide an alternative pathway to enhance purification performance of FTW.
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Affiliation(s)
- C Shen
- UCD Dooge Centre for Water Resource Research, School of Civil Engineering, University College Dublin, Belfield, Dublin 4, Ireland; Key Laboratory of Subsurface Hydrology and Ecology in Arid Areas (Ministry of Education), School of Environmental Science and Engineering, Chang'an University, Xi'an 710064, Shaanxi, PR China
| | - Y Q Zhao
- UCD Dooge Centre for Water Resource Research, School of Civil Engineering, University College Dublin, Belfield, Dublin 4, Ireland; Key Laboratory of Subsurface Hydrology and Ecology in Arid Areas (Ministry of Education), School of Environmental Science and Engineering, Chang'an University, Xi'an 710064, Shaanxi, PR China; State Key Laboratory of Eco-Hydraulics in Northwest Arid Region of China, Xi'an University of Technology, Xi'an 710048, PR China.
| | - R B Liu
- UCD Dooge Centre for Water Resource Research, School of Civil Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - D Morgan
- UCD Dooge Centre for Water Resource Research, School of Civil Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - T Wei
- State Key Laboratory of Eco-Hydraulics in Northwest Arid Region of China, Xi'an University of Technology, Xi'an 710048, PR China
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Almirall N, Wells PB, Ke H, Edmondson P, Morgan D, Yamamoto T, Odette GR. On the Elevated Temperature Thermal Stability of Nanoscale Mn-Ni-Si Precipitates Formed at Lower Temperature in Highly Irradiated Reactor Pressure Vessel Steels. Sci Rep 2019; 9:9587. [PMID: 31270423 PMCID: PMC6610118 DOI: 10.1038/s41598-019-45944-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 06/19/2019] [Indexed: 11/17/2022] Open
Abstract
Atom probe tomography (APT) and scanning transmission electron microscopy (STEM) techniques were used to probe the long-time thermal stability of nm-scale Mn-Ni-Si precipitates (MNSPs) formed in intermediate and high Ni reactor pressure vessel steels under high fluence neutron irradiation at ≈320 °C. Post irradiation annealing (PIA) at 425 °C for up to 57 weeks was used to determine if the MNSPs are: (a) non-equilibrium solute clusters formed and sustained by radiation induced segregation (RIS); or, (b) equilibrium G or Γ2 phases, that precipitate at accelerated rates due to radiation enhanced diffusion (RED). Note the latter is consistent with both thermodynamic models and x-ray diffraction (XRD) measurements. Both the experimental and an independently calibrated cluster dynamics (CD) model results show that the stability of the MNSPs is very sensitive to the alloy Ni and, to a lesser extent, Mn content. Thus, a small fraction of the largest MNSPs in the high Ni steel persist, and begin to coarsen at long times. These results suggest that the MNSPs remain a stable phase, even at 105 °C higher than they formed at, thus are most certainly equilibrium phases at much lower service relevant temperatures of ≈290 °C.
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Affiliation(s)
- N Almirall
- Materials Department, University of California, Santa Barbara, CA, 93106, USA
| | - P B Wells
- Materials Department, University of California, Santa Barbara, CA, 93106, USA.,Intel Corporation, Hillsboro, OR, 97124, USA
| | - H Ke
- Department of Materials Science and Engineering Department, University of Wisconsin, Madison, WI, 53706, USA.,Materials Science and Engineering Department, Ohio State University, Columbus, OH, 43210, USA
| | - P Edmondson
- Materials Science and Technology Division, Oak Ridge National Laboratory, Oak Ridge, TN, 37831, USA
| | - D Morgan
- Department of Materials Science and Engineering Department, University of Wisconsin, Madison, WI, 53706, USA
| | - T Yamamoto
- Materials Department, University of California, Santa Barbara, CA, 93106, USA
| | - G R Odette
- Materials Department, University of California, Santa Barbara, CA, 93106, USA.
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Akkach S, Shukla L, Morgan D. Everolimus-induced osteonecrosis of the jaw in the absence of bisphosphonates: a case report. Br J Oral Maxillofac Surg 2019; 57:688-690. [PMID: 31202510 DOI: 10.1016/j.bjoms.2019.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/28/2019] [Indexed: 11/19/2022]
Abstract
Osteonecrosis of the jaw (ONJ) is a rare, but severe, condition that has traditionally been associated with the use of bisphosphonates. We report what is, to our knowledge, the first case of ONJ secondary to the use of everolimus, in the absence of treatment with bisphosphonates in a 65-year-old man who was given it for immunosuppression after a renal transplant. After 18 months of treatment, he was diagnosed with severe ONJ and underwent radical debridement of the palate and complete dental clearance of the maxilla.
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Affiliation(s)
- S Akkach
- Faciomaxillary Unit, The Alfred, 55 Commercial Rd, Melbourne, Victoria, 3004, Australia.
| | - L Shukla
- Faciomaxillary Unit, The Alfred, 55 Commercial Rd, Melbourne, Victoria, 3004, Australia
| | - D Morgan
- Faciomaxillary Unit, The Alfred, 55 Commercial Rd, Melbourne, Victoria, 3004, Australia
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Diefenbach C, Hong F, Ambinder R, Cohen J, Robertson M, David K, Advani R, Fenske T, Barta S, Palmisano N, Svoboda J, Morgan D, Karmali R, Kahl B, Ansell S. EXTENDED FOLLOW-UP OF A PHASE I TRIAL OF IPILIMUMAB, NIVOLUMAB AND BRENTUXIMAB VEDOTIN IN RELAPSED HODGKIN LYMPHOMA: A TRIAL OF THE ECOG-ACRIN RESEARCH GROUP (E4412). Hematol Oncol 2019. [DOI: 10.1002/hon.83_2629] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- C.S. Diefenbach
- Hematology-Oncology; Perlmutter Cancer Center at NYU Langone Health; New York United States
| | - F. Hong
- ECOG-ACRIN Biostatistics Center; Dana Farber Cancer Institute; Boston United States
| | - R. Ambinder
- Sidney Kimmel Cancer Center; Johns Hopkins University; Baltimore MD United States
| | - J. Cohen
- Winship Cancer Institute; Emory University; Atlanta United States
| | - M. Robertson
- Hematology-Oncology; Indiana Unversity School of Medicine; Indianapolis United States
| | - K. David
- Hematology-Oncology; Rutgers Cancer Institute of New Jersey; New Brunswick United States
| | - R. Advani
- Oncology; Stanford Cancer Institute; San Francisco United States
| | - T. Fenske
- Hematology-Oncology; Froedtert and the Medical College of Wisconsin; Milwaukee United States
| | - S. Barta
- Abramson Cancer Center; University of Pennsylvania; Philadelphia United States
| | - N. Palmisano
- Hematology-Oncology; Thomas Jefferson University Hospital; Philadelphia United States
| | - J. Svoboda
- Abramson Cancer Center; University of Pennsylvania; Philadelphia United States
| | - D. Morgan
- Hematology-Oncology; Vanderbilt Ingram Henry Cancer Center; Nashville United States
| | - R. Karmali
- Feinberg School of Medicine; Northwestern University; Chicago United States
| | - B. Kahl
- Oncology; Washington University School of Medicine; St. Louis United States
| | - S. Ansell
- Hematology-Oncology; Mayo Clinic; Rochester United States
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Monakova J, Wong J, Blais I, Langan A, Ratansi N, Morgan D, Baxter NN. Establishing funding rates for colonoscopy and gastroscopy procedures in Ontario. ACTA ACUST UNITED AC 2019; 26:98-101. [PMID: 31043810 DOI: 10.3747/co.26.4405] [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: 11/15/2022]
Abstract
Introduction This paper describes the funding rates established in Ontario to reflect best practices in hospital-based care delivery for these endoscopic procedures: colonoscopy, colonoscopy biopsy, gastroscopy, gastroscopy biopsy, and colonoscopy combined with gastroscopy. Methods The funding rates are based on direct costs and were established using a micro-costing approach after receipt of inputs from 3 working groups and a review of the administrative data and literature, where applicable. The first group advised on nursing activities, time, and staffing ratios along the patient pathway for each of the procedures. The second group provided recommendations about the duration for each procedure, and the third group provided information about supplies and equipment, their use, and costs. Results The resulting funding rates are $161.18 for colonoscopy and $151.08 for gastroscopy (without accompanying interventions), $16.06 for colonoscopy biopsy and $8.22 for gastroscopy biopsy (added to the respective procedures), and $207.26 for combined colonoscopy and gastroscopy. Detailed costs for each component embedded in the rates are also provided. Conclusions The rates came into effect in April 2018. The process and outcomes described here allowed for a transparent pricing mechanism in which funding follows the patient, clinical expert consensus is the basis for practice, and providers and payers both understand the components.
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Affiliation(s)
| | - J Wong
- Cancer Care Ontario, Toronto, ON
| | - I Blais
- Cancer Care Ontario, Toronto, ON.,Ontario Medical Association, Toronto, ON.,Mastercard Foundation, Toronto, ON.,Service of Gastroenterology, St. Joseph's Hospital, and Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, ON.,Department of Surgery, Li Ka Shing Knowledge Institute, and Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - A Langan
- Ontario Medical Association, Toronto, ON
| | | | - D Morgan
- Service of Gastroenterology, St. Joseph's Hospital, and Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, ON
| | - N N Baxter
- Cancer Care Ontario, Toronto, ON.,Department of Surgery, Li Ka Shing Knowledge Institute, and Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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Morgan D, Chorneyko K, Swain D, Bowes B, Lee V, Tinmouth J. A209 VALIDATION OF A NATURAL LANGUAGE PROCESSING ALGORITHM TO EXTRACT DATA FOR SYSTEM-LEVEL ADENOMA DETECTION RATE CALCULATION. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Morgan
- St. Joseph’s Healthcare, Hamilton, Hamilton, ON, Canada
| | - K Chorneyko
- Brantford General Hospital, Brantford, ON, Canada
| | - D Swain
- Cancer Care Ontario, Toronto, ON, Canada
| | - B Bowes
- Cancer Care Ontario, Toronto, ON, Canada
| | - V Lee
- Cancer Care Ontario, Toronto, ON, Canada
| | - J Tinmouth
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Khan K, Nehvi A, Khan M, Fergani H, Ganguli S, Jalali S, Morgan D, Spaziani R, Tsoi K, Armstrong D. A233 BASELINE BOWEL ROUTINE AND OTHER PREDICTORS OF BOWEL PREPARATION IN PATIENTS UNDERGOING OUT-PATIENT COLONOSCOPY; RESULTS FROM A PROSPECTIVE SINGLE-CENTRE STUDY. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Khan
- McMaster University, Hamilton, ON, Canada
| | - A Nehvi
- McMaster University, Hamilton, ON, Canada
| | - M Khan
- McMaster University, Hamilton, ON, Canada
| | - H Fergani
- McMaster University, Hamilton, ON, Canada
| | - S Ganguli
- McMaster University, Hamilton, ON, Canada
| | - S Jalali
- McMaster University, Hamilton, ON, Canada
| | - D Morgan
- McMaster University, Hamilton, ON, Canada
| | - R Spaziani
- McMaster University, Hamilton, ON, Canada
| | - K Tsoi
- McMaster University, Hamilton, ON, Canada
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Imam YZ, Kamran S, Akhtar N, Deleu D, Singh R, Malik RA, Abdelmoneim MS, Bermejo P, Bourke P, Morgan D, Santos M, Joseph S, Shuaib A. Incidence, clinical features and outcomes of atrial fibrillation and stroke in Qatar. Int J Stroke 2019; 15:85-89. [PMID: 30789323 DOI: 10.1177/1747493019830577] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 12/30/2022]
Abstract
BACKGROUND Atrial fibrillation is an important risk factor for stroke but there are limited data on atrial fibrillation-related stroke from the Middle East. METHODS We interrogated the Qatar Stroke Database to establish the occurrence, clinical features, and outcomes of atrial fibrillation-related stroke at Hamad General Hospital, the sole provider of acute stroke care in Qatar. RESULTS A total of 4079 patients (81.4% male, mean age 55.4 ± 13.3 years) were enrolled in the stroke database between January 2014 and 21 October 2017. Atrial fibrillation was present in 260 (6.4%) patients, of whom 106 (2.6%) had newly diagnosed atrial fibrillation. The National Institute of Health Stroke Scale (NIHSS) was significantly higher (7.9 + 7.0 (median 6; IQR 11) vs. 5.9 + 6.4 (median 4; IQR 6), P < 0.001) in atrial fibrillation patients. The modified Rankin Score (mRS) (P < 0.001) and mortality at 90-day follow-up (P = 0.002) were significantly higher in atrial fibrillation compared to non-atrial fibrillation stroke patients. CONCLUSION We demonstrate a low rate of atrial fibrillation and stroke in Qatar, perhaps reflecting the relatively young age of these patients. Atrial fibrillation-related strokes had higher admission NIHSS, greater disability, and higher mortality at 90 days when compared to non-atrial fibrillation strokes.
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Affiliation(s)
- Yahia Z Imam
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Naveed Akhtar
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Dirk Deleu
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Cardiac Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Doha, Qatar.,Division of Cardiovascular Medicine, Central Manchester University Hospitals Foundation Trust, University of Manchester, Manchester, UK
| | - M S Abdelmoneim
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Pablo Bermejo
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Paula Bourke
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mark Santos
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.,Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
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O’connor C, Wilburn J, Walsh A, Morgan D. Epidemic intelligence activities during major international incidents involving emerging infections. Int J Infect Dis 2019. [DOI: 10.1016/j.ijid.2018.11.284] [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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Danylyshen-Laycock T, Morgan D, Stewart N, O’Connell M, Goodridge D. THE IMPACT OF LEADERSHIP AND CULTURE ON SUSTAINABILITY OF A DEMENTIA TRAINING PROGRAM IN LONG-TERM CARE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - D Morgan
- Canadian Centre for Health & Safety in Agriculture
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Danylyshen-Laycock T, Morgan D, Stewart N, O’Connell M, Goodridge D. THE ROLE OF FACILITATION IN SUSTAINABILITY OF A DEMENTIA TRAINING PROGRAM IN RURAL LONG-TERM CARE HOMES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - D Morgan
- Canadian Centre for Health & Safety in Agriculture
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McLeod G, O’Conner S, Morgan D, Finch C, Fortington L. Injuries in organised community level cricket, how much do we know? A systematic review. J Sci Med Sport 2018. [DOI: 10.1016/j.jsams.2018.09.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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47
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Bacsu J, Viger M, Abonyi S, Jeffery B, Johnson S, Novik N, Morgan D. LONGER LIVES AND THE DETERMINANTS OF COGNITIVE HEALTH: RURAL OLDER ADULTS’ PERSPECTIVES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - B Jeffery
- Faculty of Social Work, University of Regina, Canada
| | - S Johnson
- Faculty of Kinesiology and Health Studies, University of Regina
| | - N Novik
- Faculty of Social Work, University of Regina
| | - D Morgan
- Canadian Centre for Health & Safety in Agriculture
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O’Connell M, Scerbe A, Wiley K, Gould B, Carter J, Bourassa C, Morgan D, Jacklin K, Warry W. Anticipated needs and worries about maintaining independence of rural/remote older adults: Opportunities for technology development in the context of the double digital divide. ACTA ACUST UNITED AC 2018. [DOI: 10.4017/gt.2018.17.3.001.00] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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49
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BUBU OM, Andrade A, Hogan MM, Umasabor-Bubu OQ, Mukhtar F, Sharma RA, Miller M, Mbah A, Borenstein A, Mortimer J, Kip K, Morgan D, Jean-Louis G, Osorio R. 0737 Obstructive Sleep Apnea: A Distinct Physiological Phenotypic Risk Factor in older adults with Cognitive decline and Alzheimer’s disease. Sleep 2018. [DOI: 10.1093/sleep/zsy061.736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- O M BUBU
- University of South Florida, Tampa, FL
- Wheaton College, Wheaton, IL
| | | | | | | | - F Mukhtar
- University of South Florida, Tampa, FL
| | | | - M Miller
- New York University, New York, NY
| | - A Mbah
- University of South Florida, Tampa, FL
| | | | | | - K Kip
- University of South Florida, Tampa, FL
| | - D Morgan
- University of South Florida, Tampa, FL
- Byrd Alzheimer’s Institute, Tampa, FL
- Michigan State University, East Lansing, MI
| | | | - R Osorio
- New York University, New York, NY
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BUBU OM, Umasabor-Bubu OQ, Sharma RA, Mukhtar F, Smith AH, Mbah A, Borenstein A, Mortimer J, Seixas A, Jean-Louis G, Kip K, Morgan D, Varga A, Osorio R. 1007 Obstructive Sleep Apnea (OSA) Is Associated with Longitudinal Increases in Brain Florbetapir PET Imaging, CSF TAU, PTAU, And Decrease in CSF AB42 burden, In Elderly Cognitive Normal (NL) And Mild Cognitive Impairment (MCI) Individuals. Sleep 2018. [DOI: 10.1093/sleep/zsy061.1006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- O M BUBU
- University of South Florida, Tampa, FL
- Wheaton College, Wheaton, IL
| | | | | | - F Mukhtar
- University of South Florida, Tampa, FL
| | | | - A Mbah
- University of South Florida, Tampa, FL
| | | | | | - A Seixas
- New York University, New York, NY
| | | | - K Kip
- University of South Florida, Tampa, FL
| | - D Morgan
- University of South Florida, Tampa, FL
- Byrd Alzheimer’s Institute, Tampa, FL
- Michigan State University, East Lansing, MI
| | - A Varga
- New York University, New York, NY
| | - R Osorio
- New York University, New York, NY
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