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Sharma D, Kozanoğlu I, Ataga KI, Benachi A, Büyükkurt S, Lanzkron S, Ozdogu H, Pancham S, Pecker LH, Robinson SE, Yilmaz Baran S, Howard J. Managing sickle cell disease and related complications in pregnancy: results of an international Delphi panel. Blood Adv 2024; 8:1018-1029. [PMID: 38206762 PMCID: PMC10879679 DOI: 10.1182/bloodadvances.2023011301] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 01/13/2024] Open
Abstract
ABSTRACT Data to guide evidence-based management of pregnant people with sickle cell disease (SCD) are limited. This international Delphi panel aimed to identify consensus among multidisciplinary experts for SCD management during pregnancy. The 2-round Delphi process used questionnaires exploring 7 topics (antenatal care, hydroxyurea use, transfusion, prevention of complications, treatment of complications, delivery and follow-up, and bottlenecks and knowledge gaps) developed by a steering committee. Thirteen panelists (hematologists, physiologists, obstetricians, maternal fetal medicine, and transfusion medicine physicians) from the United States, the United Kingdom, Turkey, and France completed the first survey; 12 panelists completed the second round. Anonymized responses were collected and summarized by a contract research organization (Akkodis Belgium). Consensus and strong consensus were predefined as 75% to 90% (9-10 of 12) and >90% (≥11 of 12) of panelists, respectively, agreeing or disagreeing on a response to a predefined clinical scenario or statement. In several areas of SCD management, consensus was achieved: experts recommended performing at least monthly multidisciplinary antenatal follow-up, administering prophylactic aspirin for preeclampsia prevention between gestational weeks 12 and 36, initiating prophylactic transfusion therapy in certain cases, or choosing automated red blood cell exchange over other transfusion methods for patients with iron overload or severe acute chest syndrome. No consensus was reached on several topics including the prophylactic aspirin dose, indications for starting infection prophylaxis, routine use of prophylactic transfusions, or use of prophylactic transfusions for preventing fetal complications. These recommendations could inform clinical care for patients with SCD who are pregnant in the absence of large clinical trials involving this population; the identified knowledge gaps can orient future research.
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Affiliation(s)
- Deva Sharma
- Vanderbilt University Medical Center, Nashville, TN
| | - Ilknur Kozanoğlu
- Department of Physiology, Faculty of Medicine, Başkent University, Ankara, Turkey
- Adana Adult Bone Marrow Transplantation Center (CIC. 589), Apheresis Unit, Başkent University, Yuregir, Adana, Turkey
| | - Kenneth I. Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Assistance Publique Hôpitaux de Paris, Paris Saclay University Hospitals, Clamart, France
| | - Selim Büyükkurt
- Department of Obstetrics and Gynecology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Sophie Lanzkron
- Division of Hematology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Hakan Ozdogu
- Department of Hematology, Faculty of Medicine, Başkent University, Ankara, Turkey
- Adana Adult Bone Marrow Transplantation Center (CIC. 589), Apheresis Unit, Başkent University, Yuregir, Adana, Turkey
| | - Shivan Pancham
- Department of Haematology, Sandwell and West Birmingham Hospitals National Health Service Trust, West Bromwich, United Kingdom
| | - Lydia H. Pecker
- Division of Hematology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Susan E. Robinson
- Department of Women's Health, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Safak Yilmaz Baran
- Department of Obstetrics and Gynecology, Başkent University, Dr. Turgut Noyan Application and Research Center, Adana, Turkey
| | - Jo Howard
- Department of Clinical Haematology, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
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2
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Chakravorty S, Drasar E, Kaya B, Kesse-Adu R, Velangi M, Wright J, Howard J. UK Haemoglobin Disorders Peer Review: A Quality Standards-based review programme for sickle cell disease and thalassaemia. Br J Haematol 2024; 204:668-676. [PMID: 37786398 DOI: 10.1111/bjh.19114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/17/2023] [Accepted: 09/08/2023] [Indexed: 10/04/2023]
Abstract
We evaluated the impact of peer reviews in driving improvement in healthcare quality for people with haemoglobinopathy in the United Kingdom. We analysed compliance to four Quality Standards (QS)-based peer reviews from 2010 to 2020 to evaluate its impact in driving healthcare quality. Seventeen paediatric and 29 adult haemoglobinopathy centres were reviewed in 2010/11 and 2012/13 respectively; 33 paediatric and 33 adult centres were reviewed in 2014/16, and 32 paediatric and 32 adult centres were reviewed in 2018/2020. Compliance with QS and participant feedback were analysed to assess the impact of peer review programmes to drive improvement in quality of care. We noted that haemoglobinopathy centres significantly improved their compliance to QS between the first two review programmes, but not in the final review programme. In comparison to other disease-group reviews, the haemoglobinopathy departments were less able to address critical peer review recommendations in their own institutions. The peer review programme was unable to drive sustained improvement in healthcare quality, underscoring the need for sustained development and support for haemoglobinopathy services in the National Health Service. Further work is needed to understand why disparities exist among peer review-driven improvement initiatives within different disease groups.
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Affiliation(s)
| | - E Drasar
- Whittington Hospital NHS Trust, London, UK
| | - B Kaya
- Barts Health NHS Trust, London, UK
| | - R Kesse-Adu
- Guy's and St Thomas's Hospital NHS Trust, London, UK
| | - M Velangi
- Birmingham Children's Hospital NHS Trust, Birmingham, UK
| | - J Wright
- Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - J Howard
- Guy's and St Thomas's Hospital NHS Trust, London, UK
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3
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Lakritz J, Aarnes TK, Alva B, Howard J, Magnin G, Lerche P, Kukanich B. Pharmacokinetics of oral tapentadol in cats. J Vet Pharmacol Ther 2024; 47:14-20. [PMID: 37350452 DOI: 10.1111/jvp.13399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/28/2023] [Accepted: 06/06/2023] [Indexed: 06/24/2023]
Abstract
To evaluate pharmacokinetics of one dose of tapentadol hydrochloride orally administered to cats. Prospective experimental study. Five healthy adult mixed-breed cats. Each cat received 18.8 ± 1.0 mg/kg tapentadol orally. Venous blood samples were collected at time 0 (immediately prior to administration of tapentadol) 1, 2, 5, 10, 15, 30, 45, 60, 90 min, and 2, 4, 8, 12 to 24 h after drug administration. Plasma tapentadol concentrations and its metabolites were determined using ultra-performance liquid chromatography-tandem mass spectrometry. Geometric mean Tmax of tapentadol, desmethyltapentadol, tapentadol-O-glucuronide, and tapentadol-O-sulfate was 2.3, 7.0, 6.0, and 4.6 h, respectively. Mean Cmax of tapentadol, desmethyltapentadol, tapentadol-O-glucuronide, and tapentadol-O-sulfate was 637, 66, 1134, and 15,757 ng/mL, respectively, after administration. Mean half-life of tapentadol, desmethyltapentadol, tapentadol-O-glucuronide, and tapentadol-O-sulfate was 2.4, 4.7, 2.9, and 10.8 h. The relative exposure of tapentadol and its metabolites were tapentadol 2.65%, desmethyltapentadol 0.54%, tapentadol-O-glucuronide 6.22%, and tapentadol-O-sulfate 90.6%. Tapentadol-O-sulfate was the predominant metabolite following the administration of oral tapentadol in cats. Further studies are warranted to evaluate the association of analgesia with plasma concentrations of tapentadol.
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Affiliation(s)
- J Lakritz
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - T K Aarnes
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - B Alva
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - J Howard
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - G Magnin
- Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| | - P Lerche
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - B Kukanich
- Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
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4
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Wolfer LA, Basso WU, Frey CF, Schuller S, Amphimaque B, Jankovic J, Howard J, Peters LM. Biliary Enterocytozoon bieneusi infection in a dog under immunomodulatory therapy. J Small Anim Pract 2023. [PMID: 37017013 DOI: 10.1111/jsap.13612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/08/2023] [Accepted: 03/05/2023] [Indexed: 04/06/2023]
Abstract
An 8-year-old female spayed Labrador retriever was presented for the evaluation of severe weight loss 10 weeks after starting an immunomodulatory treatment, including prednisolone and cyclosporine, for meningoencephalitis of unknown origin. Plasma biochemistry analysis showed mild to moderate increases in liver enzyme activities and a moderate decrease in urea concentration. Abdominal ultrasound revealed mild hepatomegaly and a large gall bladder with unremarkable wall and content. Cholecystocentesis was performed and bile was examined both cytologically and by molecular methods, which revealed the presence of Enterocytozoon bieneusi. Treatment was initiated with albendazole but was discontinued due to the development of severe neutropenia. The medical management was subsequently changed to fenbendazole and the dog made a complete recovery. This report describes the first case of clinical manifestation and successful treatment of biliary E. bieneusi infection in a dog.
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Affiliation(s)
- L A Wolfer
- Clinical Diagnostic Laboratory, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, 3012, Bern, Switzerland
- Division of Small Animal Internal Medicine, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, 3012, Bern, Switzerland
| | - W U Basso
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, 3012, Bern, Switzerland
| | - C F Frey
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, 3012, Bern, Switzerland
| | - S Schuller
- Division of Small Animal Internal Medicine, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, 3012, Bern, Switzerland
| | - B Amphimaque
- Division of Clinical Radiology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, 3012, Bern, Switzerland
| | - J Jankovic
- Division of Small Animal Internal Medicine, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, 3012, Bern, Switzerland
| | - J Howard
- Clinical Diagnostic Laboratory, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, 3012, Bern, Switzerland
| | - L M Peters
- Clinical Diagnostic Laboratory, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, 3012, Bern, Switzerland
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5
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Stieber F, Allen N, Carpenter K, Hu P, Alagna R, Rao S, Manissero D, Howard J, Nikolayevskyy V. Durability of COVID-19 vaccine induced T-cell mediated immune responses measured using the QuantiFERON SARS-CoV-2 assay. Pulmonology 2023; 29:151-153. [PMID: 36402704 PMCID: PMC9671490 DOI: 10.1016/j.pulmoe.2022.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- F Stieber
- QIAGEN Sciences Inc, 19300 Germantown Road, Germantown, MD 20874, USA.
| | - N Allen
- QIAGEN Sciences Inc, 19300 Germantown Road, Germantown, MD 20874, USA
| | - K Carpenter
- QIAGEN Sciences Inc, 19300 Germantown Road, Germantown, MD 20874, USA
| | - P Hu
- QIAGEN Sciences Inc, 19300 Germantown Road, Germantown, MD 20874, USA
| | - R Alagna
- QIAGEN SRL, Via Filippo Sassetti 16, 20124 Milan, Italy
| | - S Rao
- QIAGEN Sciences Inc, 19300 Germantown Road, Germantown, MD 20874, USA
| | - D Manissero
- QIAGEN Manchester Ltd, Citylabs 2.0 Hathersage Road, Manchester M13 0BH, United Kingdom
| | - J Howard
- QIAGEN Sciences Inc, 19300 Germantown Road, Germantown, MD 20874, USA
| | - V Nikolayevskyy
- QIAGEN Manchester Ltd, Citylabs 2.0 Hathersage Road, Manchester M13 0BH, United Kingdom
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Howard J, Awad M, Ma Y, Abdelwahab M, Poomkonsarn S, Riley R, Yung-Chuan Liu S. Quality of Life after Large Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea using a Single-Item Global Instrument. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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7
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Howard J, Levinger C, Wang W, Takata H, Nathanson S, Fromentin R, Chomont N, Trautmann L, Bosque A. PP 1.10 – 00069 Isotretinoin enhances IL-15 mediated HIV latency reversal and reduces the inducible latent reservoir. J Virus Erad 2022. [DOI: 10.1016/j.jve.2022.100115] [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: 12/24/2022] Open
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8
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Ashkir Z, Teoh Z, Ganesananthan S, Ahmed-Jushuf F, Beattie CJ, Asher A, Kelshiker M, Howard J, Al-Lamee R. Medication adherence assessment and reporting in cardiovascular randomised controlled trials. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Despite the knowledge that suboptimal adherence to medications may have an impact on the impact of treatment interventions, the assessment and reporting of medication adherence in cardiovascular randomised controlled trials has not been well studied. In this review we sought to study the differences in medication adherence assessment and reporting in cardiovascular randomised controlled trials (RCTs) comparing interventional procedures to medical therapy alone in four major cardiovascular conditions: coronary disease (CAD), atrial fibrillation (AF), heart failure (HF) and hypertension (HTN).
Methods
Comprehensive searches of PUBMED/MEDLINE, Clinicaltrials.gov and Cochrane Central Register of Controlled Trials (CENTRAL) were performed. Two independent authors screened and extracted general study data, adherence assessment methodology and adherence reporting characteristics from eligible RCTs.
Results
A total of 568 studies (257 HTN, 120 HF, 116 CAD and 75 AF RCTs) published between 2014–2019 were included in the review. Overall, only 44.7% of RCTs assessed adherence, 14.1% defined “good” adherence and 21.1% reported adherence results. HTN and CAD trials performed significantly better than HF and AF studies in all three parameters. Compared to drug trials, procedural trials were significantly less likely to assess adherence (21.1% vs 45.7%, p<0.001), define good adherence (7% vs 15.5%, p<0.001) or report adherence results (10.5% vs 21.3%, p=0.046). Adherence assessment practices were further significantly influenced by funding, placebo status and study outcome. Pill count/return of packaging was the most utilised method (49.5%) and direct observation the least utilised (1.1%). Adherence was calculated in 55.9% of RCTs with studies using different formulas and setting different thresholds for “good” adherence but most setting this at 80% adherence. Adherence reporting practices also varied significantly between RCTs. Most studies (53%) that assessed adherence, did not in fact report their results.
Conclusion
Our findings expose significant inconsistencies in adherence assessment and reporting practices amongst cardiovascular RCTs. This is a systemic problem with important implications on research quality and reliability. We therefore recommend the incorporation of mandatory adherence assessment and reporting into international reporting guidelines for RCTs such as the CONSORT statement. We also propose a grading system which once validated may be used to appraise standards of adherence assessment and reporting in RCTs.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Z Ashkir
- National Heart and Lung Institute Imperial College , London , United Kingdom
| | - Z Teoh
- Barts and The London School of Medicine and Dentistry , London , United Kingdom
| | - S Ganesananthan
- West Middlesex University Hospital , London , United Kingdom
| | - F Ahmed-Jushuf
- Guy's & St Thomas' NHS Foundation Trust , London , United Kingdom
| | - C J Beattie
- North West London Hospitals NHS Trust , London , United Kingdom
| | - A Asher
- Barts and The London School of Medicine and Dentistry , London , United Kingdom
| | - M Kelshiker
- National Heart and Lung Institute Imperial College , London , United Kingdom
| | - J Howard
- National Heart and Lung Institute Imperial College , London , United Kingdom
| | - R Al-Lamee
- National Heart and Lung Institute Imperial College , London , United Kingdom
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9
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Vimalesvaran K, Uslu F, Zaman S, Howard J, Bharath A, Cole G. Machine learning can accurately detect abnormal aortic valves in CMR. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Improving the efficiency of CMR by acquiring fewer, and more targeted sequences, would improve the diagnostic yield and reduce patient recalls. An AI-assisted clinical decision support system (CDSS) could deliver this efficiency using adaptive scanning protocols which replicate the expertise of highly trained clinicians. Normal aortic valve anatomy on the three-chamber (3CH) cine CMR is a guide to rationalising subsequent sequences, and therefore is a suitable base case for developing an AI-CDSS for CMR.
Purpose
We propose a machine learning approach to differentiate between normal and abnormal aortic valves from the 3CH cine.
Methods
We curated a unique expert-annotated dataset of 1221 frames from eighty CMR studies. For each frame, AV landmarks (two hinge points and two leaflets), and stenotic and regurgitant jets were labelled by three cardiologists.
We then tested two AI models (Figure 1) to detect these AV abnormalities: A) a convolutional neural network (CNN), and B) a random forest approach.
A) Using heat map regression, the AV was localised, and the jets (if present) were identified as pathological curves. We then tracked and quantified the curves in the estimated heatmaps based on their proximity, the length, orientation and angle with respect to the hinge points.
B) We used a random forest approach to classify cases as normal or abnormal by using the characteristics of estimated pathological curves obtained from the heat map regression output.
We trained and evaluated our models on an unseen dataset of 1017 CMR studies obtained from different scanner types across three NHS hospitals. Each CMR study report was manually assigned a binary ground truth label for a normal or abnormal AV. In total 496/1017 patients had an abnormal AV. Of those abnormal cases, 184 patients had aortic stenosis, 222 aortic regurgitation and 90 cases had mixed valve disease.
We assessed the classification performance of our method with accuracy and an F1 score – a composite of precision and recall, where 1 is perfect; and heatmap regression performance for curves with mean absolute error.
Results
This machine learning approach classified abnormal aortic valves with good agreement to the ground truth labels with mean accuracy of 0.93 (representing approximately 451/496 patients) and mean F1 score of 0.91. The AV hinge points were localised with a mean distance error of 3.5 pixels. This was despite the small size of expert labelled data.
Conclusion
This machine learning solution successfully differentiated between normal and abnormal aortic valves from routine 3CH cine CMR views. More labelled datasets will enable further classification of pathology and severity, and greater accuracy. Our results represent an important stepping stone towards an AI-assisted CDSS for CMR.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): This work was supported by the UKRI CDT in AI for Healthcare http://ai4health.io
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Affiliation(s)
| | - F Uslu
- Bursa Technical University, Electrical and Electronics Engineering , Bursa , Turkey
| | - S Zaman
- Imperial College Healthcare NHS Trust , London , United Kingdom
| | - J Howard
- Imperial College Healthcare NHS Trust , London , United Kingdom
| | - A Bharath
- Imperial College London , London , United Kingdom
| | - G Cole
- Imperial College Healthcare NHS Trust , London , United Kingdom
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10
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Stotesbury H, Kawadler JM, Clayden JD, Saunders DE, Hood AM, Koelbel M, Sahota S, Rees DC, Wilkey O, Layton M, Pelidis M, Inusa BPD, Howard J, Chakravorty S, Clark CA, Kirkham FJ. Quantification of Silent Cerebral Infarction on High-Resolution FLAIR and Cognition in Sickle Cell Anemia. Front Neurol 2022; 13:867329. [PMID: 35847220 PMCID: PMC9277177 DOI: 10.3389/fneur.2022.867329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/27/2022] [Indexed: 01/18/2023] Open
Abstract
Research in sickle cell anemia (SCA) has used, with limited race-matched control data, binary categorization of patients according to the presence or absence of silent cerebral infarction (SCI). SCI have primarily been identified using low-resolution MRI, with radiological definitions varying in lesion length and the requirement for abnormality on both fluid attenuated inversion recovery (FLAIR) and T1-weighted images. We aimed to assess the effect of published SCI definitions on global, regional, and lobar lesion metrics and their value in predicting cognition. One hundred and six patients with SCA and 48 controls aged 8-30 years underwent 3T MRI with a high-resolution FLAIR sequence and Wechsler cognitive assessment. Prevalence, number, and volume of lesions were calculated using a semi-automated pipeline for SCI defined as: (1) Liberal: any length (L-SCI); (2) Traditional: >3 mm in greatest dimension (T-SCI); (3) Restrictive; >3 mm in greatest dimension with a corresponding T1-weighted hypo-intensity (R-SCI). Globally, as hypothesized, there were large effects of SCI definition on lesion metrics in patients and controls, with prevalence varying from 24-42% in patients, and 4-23% in controls. However, contrary to hypotheses, there was no effect of any global metric on cognition. Regionally, there was a consistent distribution of SCI in frontal and parietal deep and juxta-cortical regions across definitions and metrics in patients, but no consistent distribution in controls. Effects of regional SCI metrics on cognitive performance were of small magnitude; some were paradoxical. These findings expose the challenges associated with the widespread use of SCI presence as a biomarker of white-matter injury and cognitive dysfunction in cross-sectional high-resolution MRI studies in patients with SCA. The findings indicate that with high-resolution MRI: (1) radiological definitions have a large effect on resulting lesion groups, numbers, and volumes; (2) there is a non-negligible prevalence of lesions in young healthy controls; and (3) at the group-level, there is no cross-sectional association between global lesion metrics and general cognitive impairment irrespective of lesion definition and metric. With high-resolution multi-modal MRI, the dichotomy of presence or absence of SCI does not appear to be a sensitive biomarker for the detection of functionally significant pathology; the search for appropriate endpoints for clinical treatment trials should continue.
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Affiliation(s)
- Hanne Stotesbury
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jamie M Kawadler
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jonathan D Clayden
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Dawn E Saunders
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Anna M Hood
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
| | - Melanie Koelbel
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Sati Sahota
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | | | - Olu Wilkey
- North Middlesex University Hospital NHS Foundation Trust, London, United Kingdom
| | - Mark Layton
- Haematology, Imperial College Healthcare NHS Foundation Trust, London, United Kingdom
| | - Maria Pelidis
- Department of Haematology and Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Baba P D Inusa
- Department of Haematology and Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jo Howard
- Department of Haematology and Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Chris A Clark
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Fenella J Kirkham
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom
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11
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Stotesbury H, Hales PW, Koelbel M, Hood AM, Kawadler JM, Saunders DE, Sahota S, Rees DC, Wilkey O, Layton M, Pelidis M, Inusa BPD, Howard J, Chakravorty S, Clark CA, Kirkham FJ. Venous cerebral blood flow quantification and cognition in patients with sickle cell anemia. J Cereb Blood Flow Metab 2022; 42:1061-1077. [PMID: 34986673 PMCID: PMC9121533 DOI: 10.1177/0271678x211072391] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Received: 08/04/2021] [Revised: 11/29/2021] [Accepted: 12/09/2021] [Indexed: 12/28/2022]
Abstract
Prior studies have described high venous signal qualitatively using arterial spin labelling (ASL) in patients with sickle cell anemia (SCA), consistent with arteriovenous shunting. We aimed to quantify the effect and explored cross-sectional associations with arterial oxygen content (CaO2), disease-modifying treatments, silent cerebral infarction (SCI), and cognitive performance. 94 patients with SCA and 42 controls underwent cognitive assessment and MRI with single- and multi- inflow time (TI) ASL sequences. Cerebral blood flow (CBF) and bolus arrival time (BAT) were examined across gray and white matter and high-signal regions of the sagittal sinus. Across gray and white matter, increases in CBF and reductions in BAT were observed in association with reduced CaO2 in patients, irrespective of sequence. Across high-signal sagittal sinus regions, CBF was also increased in association with reduced CaO2 using both sequences. However, BAT was increased rather than reduced in patients across these regions, with no association with CaO2. Using the multiTI sequence in patients, increases in CBF across white matter and high-signal sagittal sinus regions were associated with poorer cognitive performance. These novel findings highlight the utility of multiTI ASL in illuminating, and identifying objectively quantifiable and functionally significant markers of, regional hemodynamic stress in patients with SCA.
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Affiliation(s)
- Hanne Stotesbury
- Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, UK
| | - Patrick W Hales
- Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, UK
| | - Melanie Koelbel
- Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, UK
| | - Anna M Hood
- Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, UK
| | - Jamie M Kawadler
- Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, UK
| | - Dawn E Saunders
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Sati Sahota
- Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, UK
| | - David C Rees
- Radiology, Great Ormond Hospital for Children NHS Trust, London, UK
| | | | - Mark Layton
- North Middlesex University Hospital NHS Foundation Trust, London, UK
| | - Maria Pelidis
- Haematology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Baba PD Inusa
- Haematology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Jo Howard
- Haematology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | | | - Chris A Clark
- Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, UK
| | - Fenella J Kirkham
- Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, UK
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12
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Achebe M, Hassab H, Alkindi S, Brown C, Telfer P, Biemond B, Gordeuk V, Lipato T, Alfa Cissé O, Darson F, Tonda M, Gray S, Howard J. Sécurité et efficacité à long terme du voxelotor chez des patients atteints de drépanocytose : résultats d’une étude d’extension en ouvert de l’essai de phase 3 HOPE. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.136] [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: 12/01/2022]
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13
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Stotesbury H, Hales PW, Hood AM, Koelbel M, Kawadler JM, Saunders DE, Sahota S, Rees DC, Wilkey O, Layton M, Pelidis M, Inusa BPD, Howard J, Chakravorty S, Clark CA, Kirkham FJ. Individual Watershed Areas in Sickle Cell Anemia: An Arterial Spin Labeling Study. Front Physiol 2022; 13:865391. [PMID: 35592036 PMCID: PMC9110791 DOI: 10.3389/fphys.2022.865391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/22/2022] [Indexed: 12/25/2022] Open
Abstract
Previous studies have pointed to a role for regional cerebral hemodynamic stress in neurological complications in patients with sickle cell anemia (SCA), with watershed regions identified as particularly at risk of ischemic tissue injury. Using single- and multi-inflow time (TI) arterial spin labeling sequences (ASL) in 94 patients with SCA and 42 controls, the present study sought to investigate cerebral blood flow (CBF) and bolus arrival times (BAT) across gray matter, white matter with early arrival times, and in individual watershed areas (iWSAs). In iWSAs, associations between hemodynamic parameters, lesion burden, white matter integrity, and general cognitive performance were also explored. In patients, increases in CBF and reductions in BAT were observed in association with reduced arterial oxygen content across gray matter and white matter with early arrival times using both sequences (all p < 0.001, d = -1.55--2.21). Across iWSAs, there was a discrepancy between sequences, with estimates based on the single-TI sequence indicating higher CBF in association with reduced arterial oxygen content in SCA patients, and estimates based on the multi-TI sequence indicating no significant between-group differences or associations with arterial oxygen content. Lesion burden was similar between white matter with early arrival times and iWSAs in both patients and controls, and using both sequences, only trend-level associations between iWSA CBF and iWSA lesion burden were observed in patients. Further, using the multi-TI sequence in patients, increased iWSA CBF was associated with reduced iWSA microstructural tissue integrity and slower processing speed. Taken together, the results highlight the need for researchers to consider BAT when estimating CBF using single-TI sequences. Moreover, the findings demonstrate the feasibility of multi-TI ASL for objective delineation of iWSAs and for detection of regional hemodynamic stress that is associated with reduced microstructural tissue integrity and slower processing speed. This technique may hold promise for future studies and treatment trials.
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Affiliation(s)
- Hanne Stotesbury
- Imaging and Biophysics Section, Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, United Kingdom
| | - Patrick W. Hales
- Imaging and Biophysics Section, Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, United Kingdom
| | - Anna M. Hood
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
| | - Melanie Koelbel
- Imaging and Biophysics Section, Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, United Kingdom
| | - Jamie M. Kawadler
- Imaging and Biophysics Section, Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, United Kingdom
| | - Dawn E. Saunders
- Radiology, Great Ormond Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Sati Sahota
- Imaging and Biophysics Section, Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, United Kingdom
| | - David C. Rees
- Paediatric Haematology, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Olu Wilkey
- Paediatric Haematology and Oncology, North Middlesex University Hospital NHS Foundation Trust, London, United Kingdom
| | - Mark Layton
- Haematology, Imperial College Healthcare NHS Foundation Trust, London, United Kingdom
| | - Maria Pelidis
- Department of Haematology and Evelina Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Baba P. D. Inusa
- Department of Haematology and Evelina Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Jo Howard
- Department of Haematology and Evelina Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Subarna Chakravorty
- Paediatric Haematology, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Chris A. Clark
- Imaging and Biophysics Section, Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, United Kingdom
| | - Fenella J. Kirkham
- Clinical Neurosciences Section, Developmental Neurosciences, UCL Great Ormond St. Institute of Child Health, London, United Kingdom
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14
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Vora SM, Boyd S, Denny N, Jackson E, Roy NBA, Howard J, Lugthart S. Expanded eligibility for emerging therapies in sickle cell disease in the UK - crizanlizumab and voxelotor. Br J Haematol 2022; 197:502-504. [PMID: 35189668 DOI: 10.1111/bjh.18059] [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] [Received: 10/13/2021] [Revised: 01/06/2022] [Accepted: 01/11/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Sona M Vora
- Haematology Department, University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Stephen Boyd
- Department of Haematology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Nicholas Denny
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Noemi B A Roy
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jo Howard
- Department of Haematology, Guy 's and St Thomas' NHS Foundation Trust, London, UK.,Department of Haematology, King's College London, London, UK
| | - Sanne Lugthart
- Haematology Department, University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK.,School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
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15
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Oakley LL, Mitchell S, von Rege I, Hadebe R, Howard J, Robinson SE, Oteng-Ntim E. Perinatal outcomes in women with sickle cell disease: a matched cohort study from London, UK. Br J Haematol 2021; 196:1069-1075. [PMID: 34881428 DOI: 10.1111/bjh.17983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/01/2021] [Accepted: 11/19/2021] [Indexed: 11/29/2022]
Abstract
There are limited data on contemporary outcomes for women with sickle cell disease (SCD) in pregnancy. We conducted a single-site matched cohort study, comparing 131 pregnancies to women with SCD between 2007 and 2017 to a comparison group of 1310 pregnancies unaffected by SCD. Restricting our analysis to singleton pregnancies that reached 24 weeks of gestation, we used conditional Poisson regression to estimate adjusted risk ratios (aRRs) for perinatal outcomes. Infants born to mothers with SCD were more likely to be small for gestational age [aRR 1·69, 95% confidence interval (CI) 1·13-2·48], preterm (aRR 2·62, 95% CI 1·82-3·78) and require Neonatal Unit (NNU) admission (aRR 3·59, 95% CI 2·18-5·90). Pregnant women with SCD were at higher risk of pre-eclampsia/eclampsia (aRR 3·53, 95% CI 2·00-6·24), more likely to receive induction of labour (aRR 2·50, 95% CI 1·82-1·76) and caesarean birth (aRR 1·44, 95% CI 1·18-1·76). In analysis stratified by genotype, the risk of adverse outcomes was highest in haemoglobin SS (HbSS) pregnancies (n = 80). There was no strong evidence that haemoglobin SC (HbSC) pregnancies (n = 46) were at higher risk of preterm birth, caesarean delivery, or NNU admission. Pre-eclampsia/eclampsia was more frequently observed in HbSC pregnancies. Despite improvements in the care of pregnant women with SCD, the increased risk of adverse perinatal outcomes remains.
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Affiliation(s)
- Laura L Oakley
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Sian Mitchell
- Department of Women & Children's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Inez von Rege
- Department of Women & Children's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ruth Hadebe
- Department of Women & Children's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jo Howard
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Susan E Robinson
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Eugene Oteng-Ntim
- Department of Women & Children's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
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16
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Stieber F, Howard J, Manissero D, Boyle J, Ndunda N, Love J, Yang M, Schumacher A, Uchiyama R, Parsons S, Miller C, Douwes H, Mielens Z, Laing T, Nikolayevskyy V. Evaluation of a lateral-flow nanoparticle fluorescence assay for TB infection diagnosis. Int J Tuberc Lung Dis 2021; 25:917-922. [PMID: 34686234 PMCID: PMC8544925 DOI: 10.5588/ijtld.21.0391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Programmatic management of TB infection is a critical component of the WHO End TB Strategy. Interferon-gamma release assays (IGRAs) overcome some limitations of the tuberculin skin test, but implementation of IGRA testing in low-resource settings is challenging. METHODS: In this feasibility study, we evaluated performance of a novel digital lateral-flow assay, the QIAreach® QuantiFERON® TB (QIAreach-QFT) test, against the QuantiFERON®-TB Gold Plus (QFT-Plus) assay. A population with a mix of risk factors for TB infection (111 donors) were sampled over multiple days. A total of 207 individual blood samples were tested according to the manufacturer’s instructions. RESULTS: The overall percentage agreement was 95.6% (two-sided 95% CI 91.8–98), with a positive percentage agreement (i.e., sensitivity) of 100% (95% CI 94.7–100) and a negative percentage agreement (i.e., specificity) of 95.6% (95% CI 90.6–98.4). All QFT-Plus positive specimens with TB1-Nil and TB2-Nil values less than 1 IU/ml tested positive on QIAreach-QFT. CONCLUSIONS: QIAreach QFT is a deployable, accurate testing solution for decentralised testing. It has the potential to overcome key hurdles for TB infection screening in high-burden settings thus helping to achieve the WHO End TB programme goals.
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Affiliation(s)
| | | | | | | | | | | | - M Yang
- Qiagen Inc, Germantown, MD, USA
| | | | | | - S Parsons
- Ellume Limited, East Brisbane, QLD, Australia
| | - C Miller
- Ellume Limited, East Brisbane, QLD, Australia
| | - H Douwes
- Ellume Limited, East Brisbane, QLD, Australia
| | - Z Mielens
- Ellume Limited, East Brisbane, QLD, Australia
| | - T Laing
- Ellume Limited, East Brisbane, QLD, Australia
| | - V Nikolayevskyy
- Qiagen Manchester Ltd, Manchester, UK, Imperial College, London, UK
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17
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Stowell C, Howard J, Cole G, Ananthan K, Demetrescu C, Pearce K, Rajani R, Sehmi J, Vimalesvaran K, Kanaganayagam S, Ghosh A, Chambers J, Rana B, Francis D, Shun-Shin M. Automated left ventricular dimension assessment using artificial intelligence. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and purpose
Artificial intelligence (AI) has the potential to greatly improve efficiency and reproducibility of quantification in echocardiography, but to gain widespread use it must both meet expert standards of excellence and have a transparent methodology. We developed an online platform to enable multiple collaborators to annotate medical images for training and validating neural networks.
Methods
Using our online collaborative platform 9 expert echocardiographers labelled 2056 images that comprised the training dataset. They labelled the four points from where the standard parasternal long axis (PLAX) measurements (interventricular septum, posterior wall, left ventricular dimension) would be made. Using these labelled images we trained a 2d convolutional neural network to replicate these labels. Separately, we curated an external validation dataset of the systolic and diastolic frames of 100 PLAX acquisitions. Each of these images were labelled twice by 13 different experts, and the average of the 26 measurements was taken as the consensus standard.
We then compared the individual experts and the AI measurements on the external validation dataset to the consensus standard, and calculated the precision standard deviation (SD) of the signed differences from the consensus standard.
Results
For diastolic septum thickness, the AI had a precision SD of 1.8 mm (ICC 0.81; 95% CI 0.73 to 0.97), compared with 2.0 mm for the individual experts (ICC 0.64; 95% CI 0.57 to 0.72). For diastolic posterior wall thickness, the AI had a precision SD 1.4 mm (ICC 0.54; 95% CI 0.38 to 0.66), and the individual experts 2.2 mm (ICC 0.37; 95% CI 0.29 to 0.46).
The AI's precision SD for left ventricular internal dimension was 3.5 mm (ICC 0.93, 95% CI 0.90 to 0.94), and for individual experts was 4.4mm (ICC 0.82, 95% CI 0.78 to 0.95). Both the experts and AI performed better in diastole than systole (precision SD AI 2.5mm vs 4.3mm, p<0.0001; experts 3.3mm vs 5.3mm, p<0.0001).
Conclusions
AI trained by a group of echocardiography experts was able to perform PLAX measurements which matched the reference standard more closely than any individual expert's own measurements.
This open, collaborative approach may be a model for the development of AI that is explainable to, and trusted by clinicians.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NIHR Imperil BRC ITMATDr Howard was additionally funded by Wellcome. Online collaborative platformResults of AI and experts
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Affiliation(s)
- C Stowell
- Imperial College London, NHLI, London, United Kingdom
| | - J Howard
- Imperial College London, NHLI, London, United Kingdom
| | - G Cole
- Imperial College London, NHLI, London, United Kingdom
| | - K Ananthan
- Imperial College London, London, United Kingdom
| | - C Demetrescu
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - K Pearce
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - R Rajani
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - J Sehmi
- West Hertfordshire Hospitals NHS Trust, Watford, United Kingdom
| | | | - S Kanaganayagam
- Chelsea and Westminster Hospital NHS Trust, London, United Kingdom
| | - A Ghosh
- Barts Heart Centre, London, United Kingdom
| | - J Chambers
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - B Rana
- Hammersmith Hospital, London, United Kingdom
| | - D Francis
- Imperial College London, NHLI, London, United Kingdom
| | - M Shun-Shin
- Imperial College London, NHLI, London, United Kingdom
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18
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Stowell C, Howard J, Demetrescu C, Bhattacharyya S, Mangion K, Vimalesvaran K, Cole G, Rajani R, Sehmi J, Alzetani M, Zolgharni M, Rana B, Francis D, Shun-Shin M. Fully automated global longitudinal strain assessment using artificial intelligence developed and validated by a UK-wide echocardiography expert collaborative. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Left ventricular longitudinal strain has been reported to deliver reproducibility, sensitivity and prognostic value over and above ejection fraction. However, it currently relies on uninspectable proprietary algorithms and suffers from a lack of widespread clinical use. Uptake may be improved by increasing user trust through greater transparency.
Purpose
We therefore developed a machine-learning based method, trained, and validated with accredited experts from our AI Echocardiography Collaborative. We make the dataset, code, and trained network freely available under an open-source license.
Methods
AI enables strain to be calculated without relying on speckle tracking by directly locating key points and borders across frames. Strain can then be calculated as the fractional shortening of the left ventricular perimeter. We first curated a dataset of 7523 images, including 2587 apical four chamber, each labelled by a single expert from our collaboration of 17 hospitals, using our online platform (Figure 1). Using both this dataset and a semi-supervised approach, we trained a 3d convolutional neural network to identify the annulus, apex, and the endocardial border throughout the cardiac cycle.
Separately, we constructed an external validation dataset of 100 apical 4 chamber video-loops. The systolic and diastolic frame were identified, and each image was separately labelled by 11 experts. From these labels we then derived the expert consensus strain for each of the 100 video loops. These experts also ordered all 100 echocardiograms by their visual grading of left ventricular longitudinal function. Finally, a single expert calculated strain using two different proprietary commercial packages (A and B).
Results
Consensus strain measurements (obtained by averaging individual assessments by the 11 experts) across the 100 cases ranged from −4% to −27%, with strong correlations with the individual experts and machine methods (Figure 2). Using each cases' consensus across experts as the gold standard, median error from consensus was 3.1% for individual experts, 3.4% for Propriety A, 2.6% for Proprietary B, 2.6% for our AI.
Using the visual grading of longitudinal strain as the reference, the 11 individual experts and 4 machine methods each showed significant correlation: coefficients ranged from 0.55 to 0.69 for experts, and for Proprietary A was 0.68, Proprietary B 0.69, and our AI 0.69.
Conclusions
Our open-source, vendor-independent AI-based strain measure automatically produces values that agree with expert consensus, as strongly as the individual experts do. It also agrees with the subjective visual ranking by longitudinal function. Our open-source AI strain performs at least as well as closed-source speckle-based approaches, and may enable increased clinical and research use of longitudinal strain.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NIHR Imperial BRC ITMAT.Dr Howard was additionally funded by Wellcome. Figure 1. Collaborative online platformFigure 2. Correlations between strain methods
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Affiliation(s)
- C Stowell
- Imperial College London, London, United Kingdom
| | - J Howard
- Imperial College London, London, United Kingdom
| | - C Demetrescu
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - K Mangion
- University of Glasgow, Glasgow, United Kingdom
| | | | - G Cole
- Imperial College London, London, United Kingdom
| | - R Rajani
- King's College London, London, United Kingdom
| | - J Sehmi
- West Hertfordshire Hospitals NHS Trust, Watford, United Kingdom
| | - M Alzetani
- Luton and Dunstable University Hospital, Luton, United Kingdom
| | - M Zolgharni
- University of West London, London, United Kingdom
| | - B Rana
- Hammersmith Hospital, London, United Kingdom
| | - D Francis
- Imperial College London, London, United Kingdom
| | - M Shun-Shin
- Imperial College London, London, United Kingdom
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19
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Hood AM, Kölbel M, Stotesbury H, Kawadler J, Slee A, Inusa B, Pelidis M, Howard J, Chakravorty S, Height S, Awogbade M, Kirkham FJ, Liossi C. Biopsychosocial Predictors of Quality of Life in Paediatric Patients With Sickle Cell Disease. Front Psychol 2021; 12:681137. [PMID: 34594262 PMCID: PMC8476744 DOI: 10.3389/fpsyg.2021.681137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/15/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Sickle cell disease (SCD) refers to a group of inherited blood disorders with considerable morbidity that causes severe pain, reduces life expectancy, and requires significant self-management. Acute painful episodes are the hallmark of SCD, but persistent daily pain is also highly prevalent in this population. Characterising the impact and experience of SCD-related morbidity (i.e., sleep disruption, frequent emergency department visits, cognitive dysfunction) on health-related quality of life (HRQOL) requires multiple assessment methods to best capture the underlying mechanisms. To gain a greater understanding of the effect of common symptom categories on HRQOL and to determine potential pain coping targets, the present study investigated whether demographic, socioeconomic, sleepiness, pain burden, frequency of emergency department (ED) visits, and cognition predicted HRQOL in a paediatric sample of patients with SCD. Our study was a secondary analysis of baseline assessment data of children with SCD aged 8-15 years (n = 30) in the Prevention of Morbidity in Sickle Cell Anaemia Phase 2b (POMSb2) randomised controlled clinical trial of auto-adjusting continuous positive airways pressure. Patients completed cognitive testing (IQ, Processing Speed Index, Delis-Kaplan Executive Function Scale (DKEFS) Tower, Conner's Continuous Performance Test), sleepiness (Epworth Sleepiness Scale), and HRQOL (PedsQL Sickle Cell Module) at baseline. Patients reported pain burden (Sickle Cell Pain Burden Inventory-Youth) each month over 8 visits. Caregivers provided demographic information and reported their child's executive function (Behavioural Rating Inventory of Executive Function) at baseline. Data from our analysis demonstrated that demographic factors (i.e., age, gender, level of neighbourhood deprivation) and treatment variables (i.e., hydroxyurea use) did not independently predict HRQOL, and laboratory values (i.e., haemoglobin, haematocrit, mean oxygen saturation) were not significantly correlated with HRQOL (ps > 0.05). However, sleepiness, pain burden, ED visits, and executive dysfunction independently predicted HRQOL (R 2 = 0.66) with large effects (η2 = 0.16 to 0.32). These findings identify specific, measurable symptom categories that may serve as targets to improve HRQOL that are responsive to change. This knowledge will be useful for multimodal interventions for paediatric patients with SCD that include sleep management, pain coping strategies, and executive function training.
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Affiliation(s)
- Anna M Hood
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Melanie Kölbel
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Hanne Stotesbury
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jamie Kawadler
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - April Slee
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Baba Inusa
- Department of Paediatric Haematology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Maria Pelidis
- Department of Paediatric Haematology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Jo Howard
- Department of Haematological Medicine, King's College London, London, United Kingdom.,Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Subarna Chakravorty
- Paediatric Haematology, King's College Hospital NHS Trust, London, United Kingdom
| | - Sue Height
- Paediatric Haematology, King's College Hospital NHS Trust, London, United Kingdom
| | - Moji Awogbade
- Department of Haematological Medicine, King's College Hospital NHS Trust, London, United Kingdom
| | - Fenella J Kirkham
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.,Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.,Department of Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom
| | - Christina Liossi
- Department of Psychology, University of Southampton, Southampton, United Kingdom.,Paediatric Psychology, Great Ormond Hospital for Children NHS Foundation Trust, London, United Kingdom
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20
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Oteng-Ntim E, Pavord S, Howard R, Robinson S, Oakley L, Mackillop L, Pancham S, Howard J. Management of sickle cell disease in pregnancy. A British Society for Haematology Guideline. Br J Haematol 2021; 194:980-995. [PMID: 34409598 DOI: 10.1111/bjh.17671] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/18/2021] [Accepted: 06/09/2021] [Indexed: 01/17/2023]
Affiliation(s)
- Eugene Oteng-Ntim
- Department of Women's Health, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
- Department of Women's Health, King's College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Sue Pavord
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Richard Howard
- Department of Obstetrics and Gynaecology, Barking, Havering and Redbridge University Hospitals, Romford, United Kingdom of Great Britain and Northern Ireland
| | - Susan Robinson
- Department of Women's Health, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Laura Oakley
- London School of Hygiene and Tropical Medicine, London, United Kingdom of Great Britain and Northern Ireland
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Lucy Mackillop
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Shivan Pancham
- Department of Haematology, Sandwell and West, Birmingham Hospitals NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Jo Howard
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
- Department of Haematology, King's College London, London, United Kingdom of Great Britain and Northern Ireland
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21
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Christopherson AR, Betti R, Forrest CJ, Howard J, Theobald W, Delettrez JA, Rosenberg MJ, Solodov AA, Stoeckl C, Patel D, Gopalaswamy V, Cao D, Peebles JL, Edgell DH, Seka W, Epstein R, Wei MS, Gatu Johnson M, Simpson R, Regan SP, Campbell EM. Direct Measurements of DT Fuel Preheat from Hot Electrons in Direct-Drive Inertial Confinement Fusion. Phys Rev Lett 2021; 127:055001. [PMID: 34397224 DOI: 10.1103/physrevlett.127.055001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/02/2021] [Accepted: 06/11/2021] [Indexed: 06/13/2023]
Abstract
Hot electrons generated by laser-plasma instabilities degrade the performance of laser-fusion implosions by preheating the DT fuel and reducing core compression. The hot-electron energy deposition in the DT fuel has been directly measured for the first time by comparing the hard x-ray signals between DT-layered and mass-equivalent ablator-only implosions. The electron energy deposition profile in the fuel is inferred through dedicated experiments using Cu-doped payloads of varying thickness. The measured preheat energy accurately explains the areal-density degradation observed in many OMEGA implosions. This technique can be used to assess the viability of the direct-drive approach to laser fusion with respect to the scaling of hot-electron preheat with laser energy.
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Affiliation(s)
- A R Christopherson
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
- Department of Mechanical Engineering, University of Rochester, Rochester, New York 14623, USA
| | - R Betti
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
- Department of Mechanical Engineering, University of Rochester, Rochester, New York 14623, USA
- Department of Physics and Astronomy, University of Rochester, Rochester, New York 14623, USA
| | - C J Forrest
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - J Howard
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
- Department of Mechanical Engineering, University of Rochester, Rochester, New York 14623, USA
| | - W Theobald
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - J A Delettrez
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - M J Rosenberg
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - A A Solodov
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - C Stoeckl
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - D Patel
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
- Department of Mechanical Engineering, University of Rochester, Rochester, New York 14623, USA
| | - V Gopalaswamy
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
- Department of Mechanical Engineering, University of Rochester, Rochester, New York 14623, USA
| | - D Cao
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - J L Peebles
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - D H Edgell
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - W Seka
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - R Epstein
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - M S Wei
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - M Gatu Johnson
- Plasma Science and Fusion Center, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - R Simpson
- Plasma Science and Fusion Center, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - S P Regan
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - E M Campbell
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
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22
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Galazis C, Vimalesvaran K, Zaman S, Petri C, Howard J, Linton N, Peters N, Cole G, Bharath AA, Varela M. Framework for large-scale automatic curation of heterogeneous cardiac MRI (ACUR MRI). Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): UKRI CDT in AI for Healthcare http://ai4health.io and British Heart Foundation
Background
Data curation is an important process that structures and organises data, supporting research and the development of artificial intelligence models. However, manually curating a large volume of medical data is a time-consuming, repetitive and costly process that puts additional strain on clinical experts. The curation becomes more complex and demanding as more data sources are used. This leads to an introduction of disparity in the data structure and protocols.
Purpose
Here, we propose an automatic framework to curate large volumes of heterogenous cardiac MRI scans acquired across different sites and scanner vendors. Our framework requires minimal expert involvement throughout and works directly on DICOM images from the scanner or PACS. The resulting structured standardised data allow for straightforward image analysis, hypothesis testing and the training and application of artificial intelligence models.
Methods
It is broken down into three main components
anonymisation, cataloguing and outlier detection (see Figure 1). Anonymisation automatically removes any identifiable patient information from the DICOM image attributes. These data are replaced with anonymised labels, whilst maintaining relevant longitudinal information from each patient. DICOM attributes are also used to automatically group the different images according to imaging sequence (e.g. CINE, Delayed-Enhancement, T1 maps), acquisition geometry (e.g. short-axis, 2-chamber, 4-chamber) and imaging attributes (e.g. slice thickness, TE, TR), for easier querying. The sorting characteristics are flexible and can easily be defined by the user. Finally, we detect and flag, for subsequent manual inspection, any outliers within those groups, based on the similarity levels of chosen DICOM attributes. This framework additionally offers interactive image visualisation to allow users to assess its performance in real time.
Results
We tested the performance of ACUR CMRI on 26,668 CMR image series (723,531 images) from 858 patient examinations, which took place across two sites in four different scanners. With an average execution time per patient of 100 seconds, ACUR was able to sort imaging data with 1191 different sequence names into 43 categories. The framework can be freely downloaded from https://bitbucket.org/cmr-ai-working-group/acur/.
Conclusions
We present ACUR, an automatic framework to curate large volumes of heterogeneous cardiac MRI data. We show how it can quickly and automatically curate data, grouping it according to desired imaging characteristics defined in DICOM attributes. The proposed framework is flexible and ideally suited as a pre-processing tool for large biomedical imaging data studies.
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Affiliation(s)
- C Galazis
- Imperial College London, Department of Computing, Faculty of Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - K Vimalesvaran
- Imperial College London, Myocardial Function, National Heart and Lung Institute, Faculty of Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - S Zaman
- Imperial College London, Myocardial Function, National Heart and Lung Institute, Faculty of Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - C Petri
- Imperial College London, Myocardial Function, National Heart and Lung Institute, Faculty of Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - J Howard
- Imperial College London, Myocardial Function, National Heart and Lung Institute, Faculty of Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - N Linton
- Imperial College London, Myocardial Function, National Heart and Lung Institute, Faculty of Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - N Peters
- Imperial College London, Myocardial Function, National Heart and Lung Institute, Faculty of Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - G Cole
- Imperial College London, Myocardial Function, National Heart and Lung Institute, Faculty of Medicine, London, United Kingdom of Great Britain & Northern Ireland
| | - AA Bharath
- Imperial College London, Department of Bioengineering, Faculty of Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - M Varela
- Imperial College London, Myocardial Function, National Heart and Lung Institute, Faculty of Medicine, London, United Kingdom of Great Britain & Northern Ireland
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Fouché N, Oesch S, Gerber V, Richter H, Howard J, Peters LM. Pre-analytical stability of sorbitol dehydrogenase in equine heparinized plasma. Vet J 2021; 274:105706. [PMID: 34148016 DOI: 10.1016/j.tvjl.2021.105706] [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: 02/23/2021] [Revised: 06/04/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
Sorbitol dehydrogenase (SDH) activity is one of the most sensitive and specific markers for hepatocellular injury in horses, but its reported lability makes it impractical for use in many clinical settings. To date, stability of SDH in equine samples has only been evaluated in a limited number of studies in serum samples of horses with activities within reference intervals. The objective of the study was to determine pre-analytical stability of equine SDH activity in heparinized plasma stored at different temperatures for up to 72 h. Twenty client-owned horses admitted to a veterinary teaching hospital for any reason were included in the study. Blood samples collected in lithium-heparin tubes were immediately centrifuged and SDH activity was analyzed within 1 h of collection (T0). Aliquots of plasma were stored at room temperature, 4 °C and -20 °C and SDH activity was re-analyzed after 4 h (T4), 24 h (T24) and 72 h (T72). A significant difference from values measured at T0 was found for samples stored at room temperature (P = 0.022) and -20 °C (P < 0.001), but not at 4 °C. The activity of SDH was within ±20% of that measured at T0 for all samples under all temperature conditions stored for 4 h, and for all samples stored at 4 °C for 24 h. Bland-Altman plots revealed narrow limits of agreement at T4 for all storage temperatures and at T24 for samples stored at 4 °C. The mean absolute percentage error and 95th percentile of the absolute percentage error were lower for samples stored at 4 °C than those stored at room temperature or -20 °C. The activity of SDH has adequate stability for 4 h regardless of storage temperature and 24 h if stored at 4 °C across a wide range of values. Knowledge of the pre-analytical stability of SDH may permit its broader use in assessing hepatic disorders in horses.
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Affiliation(s)
- N Fouché
- Swiss Institute of Equine Medicine, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, and Agroscope, Bern, Switzerland.
| | - S Oesch
- Swiss Institute of Equine Medicine, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, and Agroscope, Bern, Switzerland
| | - V Gerber
- Swiss Institute of Equine Medicine, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, and Agroscope, Bern, Switzerland
| | - H Richter
- Diagnostic Imaging Research Unit, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - J Howard
- Clinical Diagnostic Laboratory, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - L M Peters
- Clinical Diagnostic Laboratory, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Al-Hity S, Bhamra N, Kumar R, Gupta K, Howard J, Jolly K, Darr A. 908 Personal Protective Equipment (PPE) Guidance During A Global Pandemic: A Statistical Analysis of National Perceived Confidence, Knowledge, And Educational Deficits Amongst U.K. Based Doctors. Br J Surg 2021. [PMCID: PMC8135915 DOI: 10.1093/bjs/znab134.174] [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: 11/18/2022]
Abstract
Introduction March 11th, 2020 saw the World Health Organisation declare a global pandemic following the eruption of the novel coronavirus disease 2019. Unprecedented global demand for personal protective equipment (PPE) was complicated by limited availability and conflicting guidance from healthcare bodies. This study aimed to assess perceived confidence and knowledge of Public Health England’s PPE guidance amongst doctors of varying specialties and grades. Method A nationwide 11-point survey comprising of multiple-choice questions (MCQs) and a Likert scale assessing perceived confidence (1=not confident, 5=very confident) was disseminated to U.K. based doctors using multiple platforms. Results Data collated from 697 respondents revealed average perceived confidence was low. Notably, 59% felt they had received insufficient education regarding up-to-date guidance, with 81% advocating further training. Anaesthetics and ophthalmology were the highest and lowest scoring specialties in knowledge based MCQs, achieving 59% and 31% respectively. Subsequent statistical analysis revealed significant differences between specialties." Conclusions Ensuring consistency in published PPE guidance and education can develop doctor’s confidence and knowledge of appropriate PPE use. The absence of a unified consensus and global education regarding the use of PPE poses significant ramifications for patient and healthcare professional (HCP) safety whilst risking further depletion of already sparse resources.
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Affiliation(s)
- S Al-Hity
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - N Bhamra
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - R Kumar
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - K Gupta
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - J Howard
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - K Jolly
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - A Darr
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
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25
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Howard J, Ataga KI, Brown RC, Achebe M, Nduba V, El-Beshlawy A, Hassab H, Agodoa I, Tonda M, Gray S, Lehrer-Graiwer J, Vichinsky E. Voxelotor in adolescents and adults with sickle cell disease (HOPE): long-term follow-up results of an international, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Haematol 2021; 8:e323-e333. [PMID: 33838113 DOI: 10.1016/s2352-3026(21)00059-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND For decades, patients with sickle cell disease have had only a limited number of therapies available. In 2019, voxelotor (1500 mg), an oral once-daily sickle haemoglobin polymerisation inhibitor, was approved in the USA for the treatment of sickle cell disease in patients aged 12 years and older on the basis of HOPE trial data. To further describe the applicability of voxelotor as a treatment for this chronic illness, we report the long-term efficacy and safety of this drug at 72 weeks of treatment; the conclusion of the placebo-controlled HOPE trial. METHODS HOPE is an international, randomised, double-blind, placebo-controlled, phase 3 trial done at 60 clinical sites in Canada, Egypt, France, Italy, Jamaica, Kenya, Lebanon, Netherlands, Oman, Turkey, the USA, and the UK. Patients (aged 12-65 years) with confirmed sickle cell disease, a haemoglobin concentration of 5·5-10·5 g/dL at enrolment, and who had between one and ten vaso-occlusive crisis events in the previous 12 months were enrolled. Patients receiving regularly scheduled transfusion therapy, who had received a transfusion in the previous 60 days, or who had been admitted to hospital for a vaso-occlusive crisis in the previous 14 days were excluded. Patients were randomly assigned (1:1:1) to receive either once-daily oral voxelotor 1500 mg, voxelotor 900 mg, or placebo for 72 weeks. Randomisation was done centrally by use of an interactive web response system, stratified by baseline hydroxyurea use (yes vs no), age group (adolescents [12 to <18 years] vs adults [18 to 65 years]), and geographic region (North America vs Europe vs other). The primary endpoint (already reported) was the proportion of patients who achieved a haemoglobin response at week 24. In this final analysis, we report prespecified long-term efficacy assessments by intention to treat, including changes in haemoglobin concentrations from baseline to week 72, changes in the concentration of haemolysis markers (absolute and percentage reticulocytes, indirect bilirubin concentrations, and lactate dehydrogenase concentrations) from baseline to week 72, the annualised incidence of vaso-occlusive crises, and patient functioning, as assessed with the Clinical Global Impression of Change (CGI-C) scale. Safety was assessed in patients who received at least one dose of treatment (modified intention-to-treat population). This trial is registered with ClinicalTrials.gov, NCT03036813. FINDINGS Between Dec 5, 2016, and May 3, 2018, 449 patients were screened, of whom 274 were randomly assigned to the voxelotor 1500 mg group (n=90), the voxelotor 900 mg group (n=92), or the placebo group (n=92). At week 72, the adjusted mean change in haemoglobin concentration from baseline was 1·0 g/dL (95% CI 0·7 to -1·3) in the voxelotor 1500 mg group, 0·5 g/dL (0·3 to -0·8) in the voxelotor 900 mg group, and 0·0 g/dL (-0·3 to 0·3) in the placebo group, with a significant difference observed between the voxelotor 1500 mg group and the placebo group (p<0·0001), and between the voxelotor 900 mg group and the placebo group (p=0·014). Significant improvements in markers of haemolysis, as assessed by the difference in adjusted mean percentage change from baseline at week 72 versus placebo, were observed in the voxelotor 1500 mg group in indirect bilirubin concentrations (-26·6% [95% CI -40·2 to -12·9]) and percentage of reticulocytes (-18·6% [-33·9 to -3·3]). The proportion of patients in the voxelotor 1500 mg group who were rated as "moderately improved" or "very much improved" at week 72 with the CGI-C was significantly greater than in the placebo group (39 [74%] of 53 vs 24 [47%] of 51; p=0·0057). Serious adverse events unrelated to sickle cell disease were reported in 25 (28%) of 88 patients in the voxelotor 1500 mg group, 20 (22%) of 92 patients in the voxelotor 900 mg group, and 23 (25%) of 91 patients in the placebo group. Grade 3 or 4 adverse events were infrequent (ie, occurred in <10% of patients); anaemia occurred in five or more patients (two [2%] patients in the voxelotor 1500 mg group, seven [8%] patients in the voxelotor 900 mg group, and three [3%] patients in the placebo group). Of all 274 patients, six (2%) deaths occurred during the study (two deaths in each treatment group), all of which were judged as unrelated to treatment. INTERPRETATION Voxelotor 1500 mg resulted in rapid and durable improvements in haemoglobin concentrations maintained over 72 weeks and has potential to address the substantial morbidity associated with haemolytic anaemia in sickle cell disease. FUNDING Global Blood Therapeutics.
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Affiliation(s)
- Jo Howard
- Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Kenneth I Ataga
- University of Tennessee Health Science Center at Memphis, Memphis, TN, USA
| | - Robert C Brown
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, and Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Maureen Achebe
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Amal El-Beshlawy
- Department of Pediatric Hematology, Cairo University, Cairo, Egypt
| | - Hoda Hassab
- Department of Pediatrics and Clinical Research Center, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Irene Agodoa
- Global Blood Therapeutics, South San Francisco, CA, USA
| | | | - Sarah Gray
- Global Blood Therapeutics, South San Francisco, CA, USA
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Walker I, Trompeter S, Howard J, Williams A, Bell R, Bingham R, Bankes M, Vercueil A, Dalay S, Whitaker D, Elton C. Guideline on the peri-operative management of patients with sickle cell disease: Guideline from the Association of Anaesthetists. Anaesthesia 2021; 76:805-817. [PMID: 33533039 DOI: 10.1111/anae.15349] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 11/30/2022]
Abstract
Sickle cell disease is a multisystem disease characterised by chronic haemolytic anaemia, painful vaso-occlusive crises and acute and chronic end-organ damage. It is one of the most common serious inherited single gene conditions worldwide and has a major impact on the health of affected individuals. Peri-operative complications are higher in patients with sickle cell disease compared with the general population and may be sickle or non-sickle-related. Complications may be reduced by meticulous peri-operative care and transfusion, but unnecessary transfusion should be avoided, particularly to reduce the risk of allo-immunisation. Planned surgery and anaesthesia for patients with sickle cell disease should ideally be undertaken in centres with experience in caring for these patients. In an emergency, advice should be sought from specialists with experience in sickle cell disease through the haemoglobinopathy network arrangements. Emerging data suggest that patients with sickle cell disease are at increased risk of COVID-19 infection but may have a relatively mild clinical course. Outcomes are determined by pre-existing comorbidities, as for the general population.
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Affiliation(s)
- I Walker
- Working Party, on behalf of the Association of Anaesthetists
| | - S Trompeter
- Department of Haematology, University College London NHS Foundation Trust and NHS Blood and Transplant, London, UK
| | - J Howard
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Williams
- Department of Anaesthesia, Bart's Health NHS Trust, London, UK
| | - R Bell
- Department of Anaesthesia, University College London NHS Foundation Trust, London, UK
| | - R Bingham
- 6Department of Paediatric Anaesthesia, Great Ormond Street Hospital NHS Trust and Association of Paediatric Anaesthetists of Great Britain and Ireland, London, UK
| | - M Bankes
- Department of Orthopaedic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Vercueil
- Department of Anaesthesia, Department of Critical Care Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - S Dalay
- Department of Anaesthesia, Worcestershire Acute Hospitals NHS Trust UK and Association of Anaesthetists Trainee Committee
| | - D Whitaker
- Manchester and Royal College of Anaesthetists
| | - C Elton
- Department of Anaesthesia, University Hospitals of Leicester NHS Trust and Obstetric Anaesthetists' Association, Leicester, UK
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Bawor M, Kesse-Adu R, Gardner K, Marino P, Howard J, Webb J. Prevalence of cardiac abnormalities in sickle cell disease identified using cardiac magnetic resonance imaging. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Sickle cell disease (SCD) affects thousands of individuals in the United Kingdom causing significant morbidity and mortality. Modern therapies have been successful in increasing life expectancy, however these patients have an increased risk of cardiovascular complications and the extent to which sickle cell disease affects cardiac function is not well understood. Cardiac magnetic resonance imaging (MRI) is the gold standard imaging modality for evaluating myocardial function. It is known that sickle cell patients can present with pulmonary hypertension, left ventricular diastolic dysfunction, and atrial enlargement however the prevalence of other cardiac abnormalities has not been sufficiently investigated with cardiac MRI. In addition, the European Society of Cardiology (ESC) updated their definition of Heart Failure in 2016 and therefore will need to be re-assessed in this population.
Purpose
To evaluate the prevalence of cardiac abnormalities in the sickle cell population using cardiac MRI and based on the recently updated diagnostic criteria.
Methods
We conducted a retrospective review including all patients with sickle cell disease at a large tertiary hospital in London, United Kingdom who had been referred for cardiac MRI between 2011 and 2019. Data was collected data on various measures of cardiac function including: left ventricular ejection fraction (LVEF), left ventricular hypertrophy, left and right atrial enlargement, regional wall motion abnormalities, valvular disease, myocardial scarring, and cardiac iron load.
Results
82 patients and 123 cardiac MRI scans were reviewed in this study. 68% of patients were female and the average age at time of scan was 37 years. The average left ventricular ejection fraction was 57% (n=82). Cardiac abnormalities were identified in 60% of patients. The most common cardiac abnormalities reported were: valvular regurgitation (46%; n=28), left atrial enlargement (28%; n=19), right atrial enlargement (16%; n=11), left ventricular hypertrophy (11%; n=8), regional wall motion abnormalities (10%; n=7), and myocardial scar with late gadolinium enhancement (9%; n=7). 28% of the patients were diagnosed with Heart Failure; 11% of the patients satisfied the diagnostic criteria for HFpEF (Heart failure with preserved ejection fraction, n=9), 10% with HFrEF (Heart Failure with reduced ejection fraction, n=8), and 7% with HFmrEF (Heart Failure with mid-range ejection fraction, n=6).
Conclusion
Sickle cell disease affects cardiac function in the majority of patients resulting in numerous cardiac abnormalities. We have described the overall extent of these effects using data from cardiac MRI scans, which has not been commonly used thus far. This has implications for both the diagnosis and subsequent management of cardiac abnormalities in this population, and it can be used to further investigate and guide the development of targeted treatments for these patients.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Bawor
- Guys and St Thomas Hospital, London, United Kingdom
| | - R Kesse-Adu
- Guys and St Thomas Hospital, London, United Kingdom
| | - K Gardner
- Guys and St Thomas Hospital, London, United Kingdom
| | - P Marino
- Guys and St Thomas Hospital, London, United Kingdom
| | - J Howard
- Guys and St Thomas Hospital, London, United Kingdom
| | - J Webb
- Guys and St Thomas Hospital, London, United Kingdom
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Telfer P, De la Fuente J, Sohal M, Brown R, Eleftheriou P, Roy N, Piel FB, Chakravorty S, Gardner K, Velangi M, Drasar E, Shah F, Porter JB, Trompeter S, Atoyebi W, Szydlo R, Anie KA, Ryan K, Sharif J, Wright J, Astwood E, Nicolle CS, Webster A, Roberts DJ, Lugthart S, Kaya B, Awogbade M, Rees DC, Hollingsworth R, Inusa B, Howard J, Layton DM. Real-time national survey of COVID-19 in hemoglobinopathy and rare inherited anemia patients. Haematologica 2020; 105:2651-2654. [PMID: 33054122 PMCID: PMC7604629 DOI: 10.3324/haematol.2020.259440] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Josu De la Fuente
- Imperial College Healthcare NHS Trust, London, UK; NIHR Imperial Biomedical Research Centre, London
| | - Mamta Sohal
- Imperial College Healthcare NHS Trust, London
| | - Ralph Brown
- Imperial College Healthcare NHS Trust, London
| | | | - Noémi Roy
- John Radcliffe Hospital, Oxford, UK; NIHR Biomedical Research Centre, Oxford
| | - Frédéric B Piel
- School of Public Health, Faculty of Medicine, Imperial College London, London
| | | | - Kate Gardner
- Guy's and St Thomas' NHS Foundation Trust, London
| | | | - Emma Drasar
- University College London Hospitals NHS Foundation Trust, London, UK; Whittington Health NHS Trust, London
| | - Farrukh Shah
- University College London Hospitals NHS Foundation Trust, London, UK; Whittington Health NHS Trust, London
| | - John B Porter
- University College London Hospitals NHS Foundation Trust, London
| | - Sara Trompeter
- University College London Hospitals NHS Foundation Trust, London, UK; NHS Blood and Transplant, London
| | | | | | - Kofi A Anie
- London North West University Healthcare NHS Trust, London
| | - Kate Ryan
- Manchester University NHS Foundation Trust, Manchester
| | - Joseph Sharif
- Manchester University NHS Foundation Trust, Manchester
| | | | | | - C Sarah Nicolle
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry
| | - Amy Webster
- University Hospitals of Leicester, Leicester
| | - David J Roberts
- John Radcliffe Hospital, Oxford, UK; NIHR Biomedical Research Centre, Oxford, UK; NHS Blood and Transplant, Oxford
| | | | | | - Moji Awogbade
- King's College Hospital NHS Foundation Trust, London
| | - David C Rees
- King's College Hospital NHS Foundation Trust, London
| | | | - Baba Inusa
- Guy's and St Thomas' NHS Foundation Trust, London
| | - Jo Howard
- Guy's and St Thomas' NHS Foundation Trust, London
| | - D Mark Layton
- Imperial College Healthcare NHS Trust, London, UK; NIHR Imperial Biomedical Research Centre, London.
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29
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Dion C, Yamomo G, Howard J, Teeter M, Willing R, Lanting B. Revision total knee arthroplasty using a novel 3D printed titanium augment: A biomechanical cadaveric study. J Mech Behav Biomed Mater 2020; 110:103944. [DOI: 10.1016/j.jmbbm.2020.103944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 05/27/2020] [Accepted: 06/21/2020] [Indexed: 10/23/2022]
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30
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Trapp G, Hurworth M, Christian H, Bromberg M, Howard J, McStay C, Ambrosini G, Martin K, Harray A, Cross D, Oddy W, Hammond D. Prevalence and pattern of energy drink intake among Australian adolescents. J Hum Nutr Diet 2020; 34:300-304. [PMID: 32827226 DOI: 10.1111/jhn.12789] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Energy drinks (ED) are popular among young people despite evidence of associated health risks. Research into the prevalence and pattern of ED intake among young people is sparse. The present study investigates the prevalence and pattern of ED intake among a large sample of adolescents, including how many consume them, how often, for what reasons and in what contexts. METHODS In 2018, all students in grades 7-12 attending 25 randomly selected Western Australian schools were invited to complete an online self-report survey about EDs. RESULTS Of the 3688 respondents, 51.2% reported consuming an ED. Of these 'ever consumers', 23.4% drank them monthly, 19.2% weekly and 2% every day. The average age of first intake was 10.7 years. One-fifth (19.7%) of 'ever consumers' reported consuming more than two EDs in 1 day. Reasons for ED use included taste, to boost energy levels, sport performance and studying. CONCLUSIONS The findings add to limited international evidence about adolescent ED use and provide valuable information to help ensure interventions to reduce intake address the underlying reasons and contexts of ED consumption.
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Affiliation(s)
- G Trapp
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA, Australia.,School of Population and Global Health, The University of Western Australia, Nedlands, WA, Australia
| | - M Hurworth
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA, Australia
| | - H Christian
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA, Australia.,School of Population and Global Health, The University of Western Australia, Nedlands, WA, Australia
| | - M Bromberg
- The Law School, The University of Western Australia, Crawley, WA, Australia
| | - J Howard
- School of Law, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - C McStay
- The Western Australian Department of Health, East Perth, WA, Australia
| | - G Ambrosini
- School of Population and Global Health, The University of Western Australia, Nedlands, WA, Australia.,The Western Australian Department of Health, East Perth, WA, Australia
| | - K Martin
- School of Population and Global Health, The University of Western Australia, Nedlands, WA, Australia
| | - A Harray
- School of Public Health, Curtin University, Bentley, WA, Australia
| | - D Cross
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA, Australia.,School of Population and Global Health, The University of Western Australia, Nedlands, WA, Australia
| | - W Oddy
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - D Hammond
- School of Public Health & Health Systems, University of Waterloo, Waterloo, ON, Canada
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31
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Long T, Allcock JS, Nie L, Sharples RM, Xu M, Ke R, Zhang S, Silburn SA, Howard J, Yu Y, Yuan B, Wang ZH, Song XM, Liu L, Duan XR. Doppler coherence imaging of scrape-off-layer impurity flows in the HL-2A tokamak. Rev Sci Instrum 2020; 91:083504. [PMID: 32872906 DOI: 10.1063/5.0005609] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 07/24/2020] [Indexed: 06/11/2023]
Abstract
A new Doppler coherence imaging spectroscopy interferometer has been developed on the HL-2A tokamak for the scrape-off-layer impurity flow measurement. Its spatial resolution is estimated to be up to ∼0.8 mm in the horizontal direction and ∼9 mm in the vertical direction, with a field of view of ∼34°. Its typical temporal resolution is about 1 ms. This salient feature allows for time-resolved 2D measurements in short-time phenomena on HL-2A, such as edge localized modes. Group delay and interference fringe pattern were calibrated with a dedicated calibration system. The robustness of group delay calibration and the feasibility of the extrapolation model for fringe pattern calibration are demonstrated. In this paper, we report the details of the optical instruments, calibration, and the initial experimental results of this Doppler coherence imaging spectroscopy interferometer.
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Affiliation(s)
- T Long
- Southwestern Institute of Physics, Chengdu 610041, China
| | - J S Allcock
- Centre for Advanced Instrumentation, Department of Physics, Durham University, Durham DH1 3LE, United Kingdom
| | - L Nie
- Southwestern Institute of Physics, Chengdu 610041, China
| | - R M Sharples
- Centre for Advanced Instrumentation, Department of Physics, Durham University, Durham DH1 3LE, United Kingdom
| | - M Xu
- Southwestern Institute of Physics, Chengdu 610041, China
| | - R Ke
- Southwestern Institute of Physics, Chengdu 610041, China
| | - S Zhang
- Southwestern Institute of Physics, Chengdu 610041, China
| | - S A Silburn
- Kingdom Atomic Energy Authority, Culham Centre for Fusion Energy, Culham Science Centre, Abingdon, Oxon OX14 3DB, United Kingdom
| | - J Howard
- Australian National University, Canberra, ACT 0200, Australia
| | - Y Yu
- University of Science and Technology of China, Hefei 230026, China
| | - B Yuan
- Southwestern Institute of Physics, Chengdu 610041, China
| | - Z H Wang
- Southwestern Institute of Physics, Chengdu 610041, China
| | - X M Song
- Southwestern Institute of Physics, Chengdu 610041, China
| | - L Liu
- Southwestern Institute of Physics, Chengdu 610041, China
| | - X R Duan
- Southwestern Institute of Physics, Chengdu 610041, China
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32
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Kalamaras A, NR K, Moore S, Aarnes T, Ricco PC, Howard J, Peng J, SC J. Comparison of Perioperative Analgesic Protocols and Evaluation of the Development of a Chronic Neuropathic Pain State in Dogs Undergoing TPLO for Naturally Occurring Cranial Cruciate Ligament Rupture. Vet Comp Orthop Traumatol 2020. [DOI: 10.1055/s-0040-1714956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A Kalamaras
- The Ohio State University, Columbus, Ohio, United States
| | - Kieves NR
- The Ohio State University, Columbus, Ohio, United States
| | - S Moore
- The Ohio State University, Columbus, Ohio, United States
| | - T Aarnes
- The Ohio State University, Columbus, Ohio, United States
| | | | - J Howard
- The Ohio State University, Columbus, Ohio, United States
| | - J Peng
- Center for Biostatistics, The Ohio State University, Columbus, Ohio, United States
| | - Jones SC
- The Ohio State University, Columbus, Ohio, United States
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33
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Abbas Y, Abdelkader M, Adams M, Addison A, Advani R, Ahmed T, Alexander V, Alexander V, Alli B, Alvi S, Amiraraghi N, Ashman A, Balakumar R, Bewick J, Bhasker D, Bola S, Bowles P, Campbell N, Can Guru Naidu N, Caton N, Chapman J, Chawdhary G, Cherko M, Coates M, Conroy K, Coyle P, Cozar O, Cresswell M, Dalton L, Danino J, Daultrey C, Davies K, Carrie S, Dick D, Dimitriadis PA, Doddi N, Dowling M, Easto R, Edmiston R, Ellul D, Erskine S, Evans A, Farboud A, Forde C, Fussey J, Gaunt A, Gilchrist J, Gohil R, Gosnell E, Grech Marguerat D, Green R, Grounds R, Hall A, Hardman J, Harris A, Harrison L, Hone R, Hoskison E, Howard J, Ioannidis D, Iqbal I, Janjua N, Jolly K, Kamal S, Kanzara T, Keates N, Kelly A, Khan H, Korampalli T, Kuet M, Kul‐loo P, Lakhani R, Lambert A, Lancer H, Leonard C, Lloyd G, Lowe E, Mair J, Maughan E, Gao C, Mayberry T, McCadden L, McClenaghan F, McKenzie G, Mcleod R, Meghji S, Mian M, Millington A, Mirza O, Mistry S, Molena E, Morris J, Myuran T, Navaratnam A, Noon E, Okonkwo O, Oremule B, Pabla L, Papesch E, Puranik V, Roplekar R, Ross E, Rudd J, Schechter E, Senior A, Sethi N, Sharma S, Sharma R, Shelton F, Sherazi Z, Tahir A, Tikka T, Tkachuk Hlinicanova O, To K, Tse A, Toll E, Ubayasiri K, Unadkat S, Upile N, Vijendren A, Walijee H, Wilkie M, Williams R, Williams M, Wilson G, Wong W, Wong G, Xie C, Yao A, Zhang H, Ellis M, Mehta N, Milinis K, Tikka T, Slovick A, Swords C, Hutson K, Smith ME, Hopkins C, Ng Kee Kwong F. Nasal Packs for Epistaxis: Predictors of Success. Clin Otolaryngol 2020; 45:659-666. [DOI: 10.1111/coa.13555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 03/08/2020] [Accepted: 04/13/2020] [Indexed: 11/30/2022]
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Roy NBA, Telfer P, Eleftheriou P, de la Fuente J, Drasar E, Shah F, Roberts D, Atoyebi W, Trompeter S, Layton DM, Lugthart S, Stuart-Smith S, Chakravorty S, Wright J, Porter J, Inusa B, Howard J. Protecting vulnerable patients with inherited anaemias from unnecessary death during the COVID-19 pandemic. Br J Haematol 2020; 189:635-639. [PMID: 32330288 PMCID: PMC7264776 DOI: 10.1111/bjh.16687] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/03/2020] [Indexed: 01/03/2023]
Abstract
With the developing COVID‐19 pandemic, patients with inherited anaemias require specific advice regarding isolation and changes to usual treatment schedules. The National Haemoglobinopathy Panel (NHP) has issued guidance on the care of patients with sickle cell disease, thalassaemia, Diamond Blackfan anaemia (DBA), congenital dyserythropoietic anaemia (CDA), sideroblastic anaemia, pyruvate kinase deficiency and other red cell enzyme and membrane disorders. Cascading of accurate information for clinicians and patients is paramount to preventing adverse outcomes, such as patients who are at increased risk of fulminant bacterial infection due to their condition or its treatment erroneously self‐isolating if their fever is mistakenly attributed to a viral cause, delaying potentially life‐saving antibiotic therapy. Outpatient visits should be minimised for most patients, however some, such as first transcranial dopplers for children with sickle cell anaemia should not be delayed as known risk of stroke will outweigh the unknown risk from COVID‐19 infection. Blood transfusion programmes should be continued, but specific changes to usual clinical pathways can be instituted to reduce risk of patient exposure to COVID‐19, as well as contingency planning for possible reductions in blood available for transfusions. Bone marrow transplants for these disorders should be postponed until further notice. With the current lack of evidence on the risk and complications of COVID‐19 infection in these patients, national data collection is ongoing to record outcomes and eventually to identify predictors of disease severity, particularly important if further waves of infection travel through the population.
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Affiliation(s)
- Noémi B A Roy
- John Radcliffe Hospital, Oxford, UK.,NIHR Biomedical Research Centre, Oxford, UK
| | | | | | - Josu de la Fuente
- Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
| | - Emma Drasar
- University College London Hospital, London, UK.,Whittigton Health NHS Trust, London, UK
| | - Farrukh Shah
- University College London Hospital, London, UK.,Whittigton Health NHS Trust, London, UK
| | | | | | - Sara Trompeter
- NHS Blood and Transplant, London, UK.,University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | | | | | | | - John Porter
- University College London Hospital, London, UK
| | - Baba Inusa
- Guys and St Thomas's NHS Trust, London, UK
| | - Jo Howard
- Guys and St Thomas's NHS Trust, London, UK
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35
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Oakley LL, Awogbade M, Brien S, Briley A, Chorozoglou M, Drasar E, Johns J, Rhodes E, Robinson V, Seed P, Sharif J, Singh C, Telfer P, Thompson H, Watt-Coote I, Howard J, Oteng-Ntim E. Serial prophylactic exchange blood transfusion in pregnant women with sickle cell disease (TAPS-2): study protocol for a randomised controlled feasibility trial. Trials 2020; 21:347. [PMID: 32312326 PMCID: PMC7171865 DOI: 10.1186/s13063-020-4212-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 02/27/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Pregnancies in women with sickle cell disease (SCD) are associated with a higher risk of sickle and pregnancy complications. Limited options exist for treating SCD during pregnancy. Serial prophylactic exchange blood transfusion (SPEBT) has been shown to be effective in treating SCD outside pregnancy, but evidence is lacking regarding its use during pregnancy. The aim of this study is to assess the feasibility and acceptability of conducting a future phase 3 randomised controlled trial (RCT) to establish the clinical and cost effectiveness of SPEBT in pregnant women with SCD. METHODS The study is an individually randomised, two-arm, feasibility trial with embedded qualitative and health economic studies. Fifty women, 18 years of age and older, with SCD and a singleton pregnancy at ≤ 18 weeks' gestation will be recruited from six hospitals in England. Randomisation will be conducted using a secure online database and minimised by centre, SCD genotype and maternal age. Women allocated to the intervention arm will receive SPEBT commencing at ≤ 18 weeks' gestation, performed using automated erythrocytapheresis every 6-10 weeks until the end of pregnancy, aiming to maintain HbS% or combined HbS/HbC% below 30%. Women in the standard care arm will only receive transfusion when clinically indicated. The primary outcome will be the recruitment rate. Additional endpoints include reasons for refusal to participate, attrition rate, protocol adherence, and maternal and neonatal outcomes. Women will be monitored throughout pregnancy to assess maternal, sickle, and foetal complications. Detailed information about adverse events (including hospital admission) and birth outcomes will be extracted from medical records and via interview at 6 weeks postpartum. An embedded qualitative study will consist of interviews with (a) 15-25 trial participants to assess experiences and acceptability, (b) 5-15 women who decline to participate to identify barriers to recruitment and (c) 15-20 clinical staff to explore fidelity and acceptability. A health economic study will inform a future cost effectiveness and cost-utility analysis. DISCUSSION This feasibility study aims to rigorously evaluate SPEBT as a treatment for SCD in pregnancy and its impact on maternal and infant outcomes. TRIAL REGISTRATION NIH registry (www.clinicaltrials.gov), registration number NCT03975894 (registered 05/06/19); ISRCTN (www.isrctn.com), registration number ISRCTN52684446 (retrospectively registered 02/08/19).
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Affiliation(s)
- Laura L Oakley
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
- Centre for Fertility and Health, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, N-0213, Oslo, Norway.
| | - Moji Awogbade
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Sarah Brien
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Annette Briley
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, 5001, South Australia, Australia
| | - Maria Chorozoglou
- Southampton Health Technology Assessment Centre, Faculty of Medicine, University of Southampton, The University of Southampton Science Park, Alpha House, Enterprise Road, Southampton, SO17 1BJ, UK
| | - Emma Drasar
- Whittington Health NHS Trust, Magdala Avenue, London, N19 5NF, UK
| | - Jemma Johns
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Elizabeth Rhodes
- St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Vicky Robinson
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Paul Seed
- Division of Women's Health, Kings College London, St Thomas' Hospital, 10th floor North Wing, Lambeth Palace Road, London, SE1 7EH, UK
| | - Joseph Sharif
- Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK
| | - Claire Singh
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Paul Telfer
- Barts Health NHS Trust, 80 Newark Street, London, E1 2ES, UK
| | - Hilary Thompson
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Ingrid Watt-Coote
- St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Jo Howard
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
- Department of Haematological Medicine, King's College London, Rayne Institute, London, SE5 9NU, UK
| | - Eugene Oteng-Ntim
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
- Division of Women's Health, Kings College London, St Thomas' Hospital, 10th floor North Wing, Lambeth Palace Road, London, SE1 7EH, UK
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36
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Brewin JN, Crowley MP, Kesse-Adu R, Stuart-Smith S, Awogbade M, Howard J. Catheter associated thromboses in patients with sickle cell anaemia and dual lumen Vortex apheresis ports are common and can be clinically asymptomatic. Br J Haematol 2020; 189:e198-e200. [PMID: 32207154 DOI: 10.1111/bjh.16619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 01/02/2023]
Affiliation(s)
- John N Brewin
- King's College Hospital NHS Foundation Trust, London, UK.,King's College London, London, UK
| | | | | | | | - Moji Awogbade
- King's College Hospital NHS Foundation Trust, London, UK
| | - Jo Howard
- King's College London, London, UK.,Guy's and St Thomas' NHS Foundation Trust, London, UK
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37
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Chou ST, Alsawas M, Fasano RM, Field JJ, Hendrickson JE, Howard J, Kameka M, Kwiatkowski JL, Pirenne F, Shi PA, Stowell SR, Thein SL, Westhoff CM, Wong TE, Akl EA. American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support. Blood Adv 2020; 4:327-355. [PMID: 31985807 PMCID: PMC6988392 DOI: 10.1182/bloodadvances.2019001143] [Citation(s) in RCA: 204] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/20/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Red cell transfusions remain a mainstay of therapy for patients with sickle cell disease (SCD), but pose significant clinical challenges. Guidance for specific indications and administration of transfusion, as well as screening, prevention, and management of alloimmunization, delayed hemolytic transfusion reactions (DHTRs), and iron overload may improve outcomes. OBJECTIVE Our objective was to develop evidence-based guidelines to support patients, clinicians, and other healthcare professionals in their decisions about transfusion support for SCD and the management of transfusion-related complications. METHODS The American Society of Hematology formed a multidisciplinary panel that was balanced to minimize bias from conflicts of interest and that included a patient representative. The panel prioritized clinical questions and outcomes. The Mayo Clinic Evidence-Based Practice Research Program supported the guideline development process. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to form recommendations, which were subject to public comment. RESULTS The panel developed 10 recommendations focused on red cell antigen typing and matching, indications, and mode of administration (simple vs red cell exchange), as well as screening, prevention, and management of alloimmunization, DHTRs, and iron overload. CONCLUSIONS The majority of panel recommendations were conditional due to the paucity of direct, high-certainty evidence for outcomes of interest. Research priorities were identified, including prospective studies to understand the role of serologic vs genotypic red cell matching, the mechanism of HTRs resulting from specific alloantigens to inform therapy, the role and timing of regular transfusions during pregnancy for women, and the optimal treatment of transfusional iron overload in SCD.
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Affiliation(s)
- Stella T Chou
- Division of Hematology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Mouaz Alsawas
- Mayo Clinic Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN
| | - Ross M Fasano
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Joshua J Field
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Jeanne E Hendrickson
- Department of Laboratory Medicine and
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Jo Howard
- Department of Haematological Medicine, King's College London, London, United Kingdom
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Michelle Kameka
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL
| | - Janet L Kwiatkowski
- Division of Hematology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - France Pirenne
- INSERM-U955, Laboratory of Excellence, French Blood Establishment, Créteil, France
| | | | - Sean R Stowell
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Swee Lay Thein
- Sickle Cell Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Connie M Westhoff
- Laboratory of Immunohematology and Genomics, New York Blood Center, New York, NY
| | - Trisha E Wong
- Division of Hematology/Oncology, Department of Pediatrics, Oregon Health and Science University, Portland, OR; and
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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38
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Nour D, Shun-shin M, Fung M, Howard J, Ahmed Y, Allahwala U, Alzuhairi K, Bhindi R, Chamie D, Cook C, Doi S, Funayama N, Hansen P, Horinaka R, Ishibashi Y, Hijikata N, Kaihara T, Kawase Y, Koga M, Kotecha T, Kuwata S, Manica A, Matsuo H, Nakayama M, Nijjer S, Petraco R, Rajkumar C, Ramrakha P, Ruparelia N, Seligman H, Sen S, Takahashi T, Tanabe Y, Warisawa T, Watanabe A, Weaver J, Yong T, Francis D, Al-Lamee R. 834 How Accurately can Physicians Predict Invasive Physiology Using Coronary Angiography? Results of an International Multi-Centre Survey. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
In countries with access to organized health care, survival of children with sickle cell disease (SCD) has greatly improved, resulting in a growing population of adults with SCD. Transition from pediatric to adult care presents many challenges for the patient, who now faces the reality of emerging complications in many organs that are cumulative, adding to other age-related nonsickle conditions that interact and add to the disease morbidity. We recommend regular comprehensive annual assessments, monitoring for early signs of organ damage and joint clinics with relevant specialists, if applicable. While maintaining a low threshold for intervention with disease-modifying therapies, we should always keep in mind that there is no single complication that is pathognomonic of SCD, and nonsickle comorbidities should always be excluded and treated if present. We need to reevaluate our approach to managing adults with SCD by putting a greater emphasis on multidisciplinary care while proactively considering curative options (hematopoietic stem cell transplant and gene therapy) and experimental pharmacological agents for adults with SCD of all ages before complications render the patients ineligible for these treatments.
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Affiliation(s)
- Jo Howard
- Department of Haematology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom; and
| | - Swee Lay Thein
- Sickle Cell Branch, National Heart, Lung, and Blood Institute/National Institutes of Health, Bethesda, MD
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40
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Peyronnet B, Jericevic D, Rude T, Ekenchukwu E, Sussman R, Palmerola R, Pape D, Escobar C, Zhovtis L, Howard J, Charlson R, Krupp L, Rosenblum N, Nitti V, Brucker B. Comparaison prospective non randomisée de la solifenacine et du mirabegron chez les patients atteints de sclérose en plaques ayant des symptômes d’hyperactivité vésicale. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.204] [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: 10/25/2022]
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41
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Ruhl AP, Sadreameli SC, Allen JL, Bennett DP, Campbell AD, Coates TD, Diallo DA, Field JJ, Fiorino EK, Gladwin MT, Glassberg JA, Gordeuk VR, Graham LM, Greenough A, Howard J, Kato GJ, Knight-Madden J, Kopp BT, Koumbourlis AC, Lanzkron SM, Liem RI, Machado RF, Mehari A, Morris CR, Ogunlesi FO, Rosen CL, Smith-Whitley K, Tauber D, Terry N, Thein SL, Vichinsky E, Weir NA, Cohen RT. Identifying Clinical and Research Priorities in Sickle Cell Lung Disease. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2019; 16:e17-e32. [PMID: 31469310 PMCID: PMC6812163 DOI: 10.1513/annalsats.201906-433st] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: Pulmonary complications of sickle cell disease (SCD) are diverse and encompass acute and chronic disease. The understanding of the natural history of pulmonary complications of SCD is limited, no specific therapies exist, and these complications are a primary cause of morbidity and mortality.Methods: We gathered a multidisciplinary group of pediatric and adult hematologists, pulmonologists, and emergency medicine physicians with expertise in SCD-related lung disease along with an SCD patient advocate for an American Thoracic Society-sponsored workshop to review the literature and identify key unanswered clinical and research questions. Participants were divided into four subcommittees on the basis of expertise: 1) acute chest syndrome, 2) lower airways disease and pulmonary function, 3) sleep-disordered breathing and hypoxia, and 4) pulmonary vascular complications of SCD. Before the workshop, a comprehensive literature review of each subtopic was conducted. Clinically important questions were developed after literature review and were finalized by group discussion and consensus.Results: Current knowledge is based on small, predominantly observational studies, few multicenter longitudinal studies, and even fewer high-quality interventional trials specifically targeting the pulmonary complications of SCD. Each subcommittee identified the three or four most important unanswered questions in their topic area for researchers to direct the next steps of clinical investigation.Conclusions: Important and clinically relevant questions regarding sickle cell lung disease remain unanswered. High-quality, multicenter, longitudinal studies and randomized clinical trials designed and implemented by teams of multidisciplinary clinician-investigators are needed to improve the care of individuals with SCD.
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Vichinsky E, Hoppe CC, Ataga KI, Ware RE, Nduba V, El-Beshlawy A, Hassab H, Achebe MM, Alkindi S, Brown RC, Diuguid DL, Telfer P, Tsitsikas DA, Elghandour A, Gordeuk VR, Kanter J, Abboud MR, Lehrer-Graiwer J, Tonda M, Intondi A, Tong B, Howard J. A Phase 3 Randomized Trial of Voxelotor in Sickle Cell Disease. N Engl J Med 2019; 381:509-519. [PMID: 31199090 DOI: 10.1056/nejmoa1903212] [Citation(s) in RCA: 348] [Impact Index Per Article: 69.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Deoxygenated sickle hemoglobin (HbS) polymerization drives the pathophysiology of sickle cell disease. Therefore, direct inhibition of HbS polymerization has potential to favorably modify disease outcomes. Voxelotor is an HbS polymerization inhibitor. METHODS In a multicenter, phase 3, double-blind, randomized, placebo-controlled trial, we compared the efficacy and safety of two dose levels of voxelotor (1500 mg and 900 mg, administered orally once daily) with placebo in persons with sickle cell disease. The primary end point was the percentage of participants who had a hemoglobin response, which was defined as an increase of more than 1.0 g per deciliter from baseline at week 24 in the intention-to-treat analysis. RESULTS A total of 274 participants were randomly assigned in a 1:1:1 ratio to receive a once-daily oral dose of 1500 mg of voxelotor, 900 mg of voxelotor, or placebo. Most participants had sickle cell anemia (homozygous hemoglobin S or hemoglobin Sβ0-thalassemia), and approximately two thirds were receiving hydroxyurea at baseline. In the intention-to-treat analysis, a significantly higher percentage of participants had a hemoglobin response in the 1500-mg voxelotor group (51%; 95% confidence interval [CI], 41 to 61) than in the placebo group (7%; 95% CI, 1 to 12). Anemia worsened between baseline and week 24 in fewer participants in each voxelotor dose group than in those receiving placebo. At week 24, the 1500-mg voxelotor group had significantly greater reductions from baseline in the indirect bilirubin level and percentage of reticulocytes than the placebo group. The percentage of participants with an adverse event that occurred or worsened during the treatment period was similar across the trial groups. Adverse events of at least grade 3 occurred in 26% of the participants in the 1500-mg voxelotor group, 23% in the 900-mg voxelotor group, and 26% in the placebo group. Most adverse events were not related to the trial drug or placebo, as determined by the investigators. CONCLUSIONS In this phase 3 randomized, placebo-controlled trial involving participants with sickle cell disease, voxelotor significantly increased hemoglobin levels and reduced markers of hemolysis. These findings are consistent with inhibition of HbS polymerization and indicate a disease-modifying potential. (Funded by Global Blood Therapeutics; HOPE ClinicalTrials.gov number, NCT03036813.).
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Affiliation(s)
- Elliott Vichinsky
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Carolyn C Hoppe
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Kenneth I Ataga
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Russell E Ware
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Videlis Nduba
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Amal El-Beshlawy
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Hoda Hassab
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Maureen M Achebe
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Salam Alkindi
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - R Clark Brown
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - David L Diuguid
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Paul Telfer
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Dimitris A Tsitsikas
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Ashraf Elghandour
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Victor R Gordeuk
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Julie Kanter
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Miguel R Abboud
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Joshua Lehrer-Graiwer
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Margaret Tonda
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Allison Intondi
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Barbara Tong
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Jo Howard
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
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43
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Howard J, Lee SA, Inusa B, Cheng MYE, Bavenjit C, Reading IC, Wakeford SA, Gavlak JC, Murphy PB, Hart N, Gupta A, Sahota S, Jacob E, Chorozoglou M, Ossai C, Gwam M, Kirkham FJ, Wade AM, Liossi C. Prevention of Morbidity in Sickle Cell Disease (POMS2a)-overnight auto-adjusting continuous positive airway pressure compared with nocturnal oxygen therapy: a randomised crossover pilot study examining patient preference and safety in adults and children. Trials 2019; 20:442. [PMID: 31319882 PMCID: PMC6637584 DOI: 10.1186/s13063-019-3461-x] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 05/20/2019] [Indexed: 11/10/2022] Open
Abstract
DESIGN This randomised crossover trial compared nocturnal auto-adjusting continuous positive airway pressure (APAP) and nocturnal oxygen therapy (NOT) in adults and children with sickle cell anaemia, with patient acceptability as the primary outcome. Secondary outcomes included pulmonary physiology (adults), safety, and daily pain during interventions and washout documented using tablet technology. METHODS Inclusion criteria were age > 8 years and the ability to use an iPad to collect daily pain data. Trial participation was 4 weeks; week 1 involved baseline data collection and week 3 was a washout between interventions, which were administered for 7 days each during weeks 2 and 4 in a randomised order. Qualitative interviews were transcribed verbatim and analysed for content using a funnelling technique, starting generally and then gaining more detailed information on the experience of both interventions. Safety data included routine haematology and median pain days between each period. Missing pain day values were replaced using multiple imputation. RESULTS Ten adults (three female, median age 30.2 years, range 18-51.5 years) and eleven children (five female, median age 12 years, range 8.7-16.9 years) enrolled. Nine adults and seven children completed interviews. Qualitative data revealed that the APAP machine was smaller, easier to handle, and less noisy. Of 16 participants, 10 preferred APAP (62.5%, 95% confidence interval (CI) 38.6-81.5%). Haemoglobin decreased from baseline on APAP and NOT (mean difference -3.2 g/L (95% CI -6.0 to -0.2 g/L) and -2.5 g/L (95% CI -4.6 to 0.3 g/L), respectively), but there was no significant difference between interventions (NOT versus APAP, 1.1 (-1.2 to 3.6)). Pulmonary function changed little. Compared with baseline, there were significant decreases in the median number of pain days (1.58 for APAP and 1.71 for NOT) but no significant difference comparing washout with baseline. After adjustment for carry-over and period effects, there was a non-significant median difference of 0.143 (95% CI -0.116 to 0.401) days additional pain with APAP compared with NOT. CONCLUSION In view of the point estimate of patient preference for APAP, and no difference in haematology or pulmonary function or evidence that pain was worse during or in washout after APAP, it was decided to proceed with a Phase II trial of 6 months APAP versus standard care with further safety monitoring for bone marrow suppression and pain. TRIAL REGISTRATION ISRCTN46078697 . Registered on 18 July 2014.
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Affiliation(s)
- Jo Howard
- Department of Haematology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Sophie A Lee
- Centre for Applied Statistics Courses, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Baba Inusa
- Evelina Children's Hospital, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | | | | | - Isabel C Reading
- Research Design Service, University Hospital Southampton, Southampton, UK
| | - Sally Ann Wakeford
- Department of Child Health, University Hospital Southampton, Southampton, UK
| | - Johanna C Gavlak
- Department of Child Health, University Hospital Southampton, Southampton, UK.,Developmental Neurosciences Section and NIHR Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Patrick B Murphy
- King's College London, London, UK.,Lane Fox Respiratory Unit, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Nicholas Hart
- King's College London, London, UK.,Lane Fox Respiratory Unit, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | | | - Sati Sahota
- Developmental Neurosciences Section and NIHR Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Eufemia Jacob
- School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Maria Chorozoglou
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Carol Ossai
- Sickle Cell and Young Stroke Survivors Charity, London, UK
| | - Maureen Gwam
- Sickle Cell and Young Stroke Survivors Charity, London, UK
| | - Fenella J Kirkham
- Department of Child Health, University Hospital Southampton, Southampton, UK. .,Developmental Neurosciences Section and NIHR Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK. .,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
| | - Angela M Wade
- Evelina Children's Hospital, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Christina Liossi
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Psychology, University of Southampton, Southampton, UK.,Department of Psychology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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44
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Willis J, Awogbade M, Howard J, Breen C, Abbas A, Harber M, Shendi M A, Andrews P, Galliford J, Shah S, Sharpe C. SUN-053 OUTCOMES FOLLOWING KIDNEY TRANSPLANTATION IN PATIENTS WITH SICKLE CELL DISEASE WITH AND WITHOUT EXCHANGE BLOOD TRANSFUSION. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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45
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Kawadler JM, Slee A, Stotesbury H, Koelbel M, Balfour P, Saunders DE, Rees D, Howard J, Inusa B, Pelidis M, Kesse-Adu R, Chakravorty S, Awogbade M, Clark CA, Kirkham FJ, Liossi C. Index of Pain Experience in Sickle Cell Anaemia (IPESCA): development from daily pain diaries and initial findings from use with children and adults with sickle cell anaemia. Br J Haematol 2019; 186:360-363. [PMID: 30836440 DOI: 10.1111/bjh.15841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Jamie M Kawadler
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - April Slee
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Hanne Stotesbury
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Melanie Koelbel
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Philippa Balfour
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Dawn E Saunders
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - David Rees
- Department of Paediatric Haematology, King's College Hospital NHS Foundation Trust, King's College London, London, UK
| | - Jo Howard
- Department of Haematology, Guy's and St. Thomas NHS Foundation Trust, King's College London, London, UK
| | - Baba Inusa
- Department of Paediatrics, Evelina Children's Hospital, Guy's and St. Thomas' National Health Service (NHS) Foundation Trust, London, UK
| | - Maria Pelidis
- Department of Paediatrics, Evelina Children's Hospital, Guy's and St. Thomas' National Health Service (NHS) Foundation Trust, London, UK
| | - Rachel Kesse-Adu
- Department of Paediatrics, Evelina Children's Hospital, Guy's and St. Thomas' National Health Service (NHS) Foundation Trust, London, UK
| | - Subarna Chakravorty
- Department of Paediatric Haematology, King's College Hospital NHS Foundation Trust, King's College London, London, UK
| | - Moji Awogbade
- Department of Paediatric Haematology, King's College Hospital NHS Foundation Trust, King's College London, London, UK
| | - Chris A Clark
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Fenella J Kirkham
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK.,Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Christina Liossi
- School of Psychology, University of Southampton, Southampton, UK.,Psychological Services Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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46
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Charnigo RJ, Beidler D, Rybin D, Pittman DD, Tan B, Howard J, Michelson AD, Frelinger AL, Clarke N. PF-04447943, a Phosphodiesterase 9A Inhibitor, in Stable Sickle Cell Disease Patients: A Phase Ib Randomized, Placebo-Controlled Study. Clin Transl Sci 2019; 12:180-188. [PMID: 30597771 PMCID: PMC6440678 DOI: 10.1111/cts.12604] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 08/21/2018] [Accepted: 10/21/2018] [Indexed: 11/27/2022] Open
Abstract
This phase Ib study randomized patients with stable sickle cell disease (SCD) aged 18-65 years to twice-daily PF-04447943 (a phosphodiesterase 9A inhibitor; 5 or 25 mg) or placebo, with/without hydroxyurea coadministration, for up to 29 days. Blood samples were collected at baseline and various posttreatment time points for assessments of PF-04447943 pharmacokinetics (PKs)/pharmacodynamics (PDs). Change from baseline in potential SCD-related biomarkers was evaluated. Of 30 patients, 15 received hydroxyurea and 28 completed the study. PF-04447943, with/without hydroxyurea, was generally well tolerated, with no treatment-related serious adverse events. Plasma PF-04447943 exposure was dose proportional. Twice-daily PF-04447943 25 mg significantly reduced the number and size of circulating monocyte-platelet and neutrophil-platelet aggregates and levels of circulating soluble E-selectin at day 29 vs. baseline (adjusted P < 0.15). PF-04447943 demonstrated PK/PD effects suggestive of inhibiting pathways that may contribute to vaso-occlusion. This study also provides guidance regarding biomarkers for future SCD studies.
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Affiliation(s)
| | | | | | | | | | - Jo Howard
- Guy's and St. Thomas’ HospitalGreat Maze PondLondonUK
| | - Alan D. Michelson
- Center for Platelet Research StudiesDana‐Farber/Boston Children's Cancer and Blood Disorders CenterBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Andrew L. Frelinger
- Center for Platelet Research StudiesDana‐Farber/Boston Children's Cancer and Blood Disorders CenterBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
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47
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Kopeika J, Oyewo A, Punnialingam S, Reddy N, Khalaf Y, Howard J, Mononen S, Oteng-Ntim E. Ovarian reserve in women with sickle cell disease. PLoS One 2019; 14:e0213024. [PMID: 30794713 PMCID: PMC6386479 DOI: 10.1371/journal.pone.0213024] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 07/25/2018] [Accepted: 02/13/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND It has been proposed that ovarian sickling and/or iron overload in women with sickle cell disease (SCD) could contribute to gonadal dysfunction, but there are very few published studies. We hypothesised that the above phenomena might impair ovarian reserve. METHODS A total of 50 SCD patients were case-matched by age, ethnicity, and presence of regular cycles (28±5 days) with 73 patients without a known haemoglobinopathy who required anti-Müllerian hormone (AMH) assessment in a gynaecology clinic. SCD patients had AMH levels taken as part of routine care. The patients were case-controlled and matched with patients who had no haemoglobinopathy in a tertiary centre over a period of one year. RESULTS The mean AMH in the SCD case group was 7.6 pmol/l compared with 13.4 pmol/l in the control group (p<0.001). The AMH distributions were subsequently categorised. This showed that SCD patients had a significantly higher chance of having lower AMH in comparison with the control group (OR 2.6 (CI 1.1-6.5, P = 0.02). The proportion of women with AMH > 20 pmol/l was significantly lower in the SCD group (6%) in comparison with the control group (19%) (P = 0.04). CONCLUSIONS This is the first study showing that women of reproductive age with SCD are more likely to have a low ovarian reserve at a younger age in comparison with patients with no haemoglobinopathy.
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Affiliation(s)
- Julia Kopeika
- Assisted Conception Unit, Guy’s and St Thomas NHS Trust, Great Maze Pond, London, United Kingdom
- * E-mail:
| | - Adeola Oyewo
- Department of Women & Children’s Health, King’s College London, Guy’s and St Thomas NHS Trust, London, United Kingdom
| | - Sinthiya Punnialingam
- Haematology department, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Nivedita Reddy
- Assisted Conception Unit, Guy’s and St Thomas NHS Trust, Great Maze Pond, London, United Kingdom
| | - Yacoub Khalaf
- Assisted Conception Unit, Guy’s and St Thomas NHS Trust, Great Maze Pond, London, United Kingdom
| | - Jo Howard
- Haematology Department, Guy’s and St Thomas NHS Trust, Great Maze Pond, London, United Kingdom
| | - Sofia Mononen
- Department of Women & Children’s Health, King’s College London, Guy’s and St Thomas NHS Trust, London, United Kingdom
| | - Eugene Oteng-Ntim
- Department of Women & Children’s Health, King’s College London, Guy’s and St Thomas NHS Trust, London, United Kingdom
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48
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Maltecca C, Howard J, Baes C, Pryce J. 309 Beyond predictions: managing inbreeding and variability in the genomic era. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Maltecca
- NC State University,Cary, NC, United States
| | - J Howard
- University of Nebraska Lincoln,Lincoln, NE, United States
| | - C Baes
- University of Guelph,Guelph, ON, Canada
| | - J Pryce
- Department of Economic Development, Jobs, Transport and Resources,Bundorra, Vic, Australia
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49
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Cardosa D, Ridout A, Nanda S, Howard J, Robinson SE, Oteng-Ntim E. Maternal sickle cell disease and twin pregnancy: a case series and review of the literature. Hematology 2018; 24:148-158. [DOI: 10.1080/10245332.2018.1535534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Deyna Cardosa
- Department of Haematology, Southwark Wing, Guy’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Alexandra Ridout
- Women’s Health, St Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Surabhi Nanda
- Liverpool Women’s NHS Foundation Trust, University of Liverpool, Liverpool, UK
| | - Jo Howard
- Department of Haematology, Southwark Wing, Guy’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Susan E. Robinson
- Department of Haematology, Southwark Wing, Guy’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Eugene Oteng-Ntim
- Women’s Health, St. Thomas’ Hospital, King's Health Partners, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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50
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Allen SL, Samuell CM, Meyer WH, Howard J. Laser calibration of the DIII-D coherence imaging system. Rev Sci Instrum 2018; 89:10E110. [PMID: 30399797 DOI: 10.1063/1.5038739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/15/2018] [Indexed: 06/08/2023]
Abstract
In this paper, we describe an in situ calibration technique for Coherence Imaging Spectroscopy (CIS) that measures 2-D images of ion flows on DIII-D. A low power CW diode laser that is tuneable in the range 464-468 nm along with a precision wavemeter (10-5 nm resolution) is used to characterize the interferometer phase as a function of wavelength in the region of C iii (465 nm) and He ii (468 nm). The interferometer is stabilized both mechanically and thermally to minimize drift during the calibration. Optical stirring and an integration sphere are used to obtain spatially uniform calibration images. The quality of the calibration data enables a measurement of phase versus wavelength over approximately 10 fringes of the interferometer. These coefficients can also be related to the geometry of the optics and the birefringent crystal of the interferometer. On DIII-D, the integration sphere with the laser light is inserted into the CIS optical system between shots and the laser image and wavelength are automatically recorded, providing a zero velocity reference.
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Affiliation(s)
- S L Allen
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C M Samuell
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - W H Meyer
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J Howard
- Australian National Laboratory, Canberra, ACT 0200, Australia
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