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Learn how to interpret and use intracranial EEG findings. Epileptic Disord 2024; 26:1-59. [PMID: 38116690 DOI: 10.1002/epd2.20190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/21/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023]
Abstract
Epilepsy surgery is the therapy of choice for many patients with drug-resistant focal epilepsy. Recognizing and describing ictal and interictal patterns with intracranial electroencephalography (EEG) recordings is important in order to most efficiently leverage advantages of this technique to accurately delineate the seizure-onset zone before undergoing surgery. In this seminar in epileptology, we address learning objective "1.4.11 Recognize and describe ictal and interictal patterns with intracranial recordings" of the International League against Epilepsy curriculum for epileptologists. We will review principal considerations of the implantation planning, summarize the literature for the most relevant ictal and interictal EEG patterns within and beyond the Berger frequency spectrum, review invasive stimulation for seizure and functional mapping, discuss caveats in the interpretation of intracranial EEG findings, provide an overview on special considerations in children and in subdural grids/strips, and review available quantitative/signal analysis approaches. To be as practically oriented as possible, we will provide a mini atlas of the most frequent EEG patterns, highlight pearls for its not infrequently challenging interpretation, and conclude with two illustrative case examples. This article shall serve as a useful learning resource for trainees in clinical neurophysiology/epileptology by providing a basic understanding on the concepts of invasive intracranial EEG.
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Kinematic differences between left- and right-handed cricket fast bowlers during the bowling action. SOUTH AFRICAN JOURNAL OF SPORTS MEDICINE 2023; 35:v35i1a15144. [PMID: 38249757 PMCID: PMC10798611 DOI: 10.17159/2078-516x/2023/v35i1a15144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
Background Despite differences between left- and right-handed athletes in other sports, minimal evidence exists regarding biomechanical similarities and differences between left- and right-handed cricket fast bowlers performing an equivalent task. Objectives This study aimed to compare the kinematics between left and right-handed fast bowlers performing an equivalent task (i.e. bowling 'over the wicket' to a batter of the same handedness as the bowler). Methods Full body, three-dimensional kinematic data for six left-handed and 20 right-handed adolescent, male, fast bowlers were collected using the Xsens inertial measurement system. Time-normalised joint and segment angle time histories from back foot contact to follow-through ground contacts were compared between groups via statistical parametric mapping. Whole movement and subphase durations were also compared. Results Left-handed players displayed significantly more trunk flexion from 49%-56% of the total movement (ball release occurred at 54%; p = 0.037) and had shorter back foot contact durations on average (0.153 vs 0.177 s; p = 0.036) compared to right-handed players. Conclusion Left- and right-handed bowlers displayed similar sagittal plane kinematics but appeared to use non-sagittal plane movements differently around the time of ball release. The kinematic differences identified in this study can inform future research investigating the effect of hand dominance on bowling performance and injury risk.
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What to expect when you're expecting… and in recovery: Highlighting the need to develop training for perinatal mental health providers. Gen Hosp Psychiatry 2023; 83:172-178. [PMID: 37244211 DOI: 10.1016/j.genhosppsych.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 05/29/2023]
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Neurophysiology, Neuropsychology, and Epilepsy, in 2022: Hills We Have Climbed and Hills Ahead. Neurophysiology in epilepsy. Epilepsy Behav 2023; 143:109221. [PMID: 37119580 DOI: 10.1016/j.yebeh.2023.109221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 05/01/2023]
Abstract
Since the discovery of the human electroencephalogram (EEG), neurophysiology techniques have become indispensable tools in our armamentarium to localize epileptic seizures. New signal analysis techniques and the prospects of artificial intelligence and big data will offer unprecedented opportunities to further advance the field in the near future, ultimately resulting in improved quality of life for many patients with drug-resistant epilepsy. This article summarizes selected presentations from Day 1 of the two-day symposium "Neurophysiology, Neuropsychology, Epilepsy, 2022: Hills We Have Climbed and the Hills Ahead". Day 1 was dedicated to highlighting and honoring the work of Dr. Jean Gotman, a pioneer in EEG, intracranial EEG, simultaneous EEG/ functional magnetic resonance imaging, and signal analysis of epilepsy. The program focused on two main research directions of Dr. Gotman, and was dedicated to "High-frequency oscillations, a new biomarker of epilepsy" and "Probing the epileptic focus from inside and outside". All talks were presented by colleagues and former trainees of Dr. Gotman. The extended summaries provide an overview of historical and current work in the neurophysiology of epilepsy with emphasis on novel EEG biomarkers of epilepsy and source imaging and concluded with an outlook on the future of epilepsy research, and what is needed to bring the field to the next level.
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Combined Heart Liver Transplant versus Heart Transplant Alone in Failed Fontan Adult Patients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Hippo signaling instructs ectopic but not normal organ growth. Science 2022; 378:eabg3679. [DOI: 10.1126/science.abg3679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Hippo signaling pathway is widely considered a master regulator of organ growth because of the prominent overgrowth phenotypes caused by experimental manipulation of its activity. Contrary to this model, we show here that removing Hippo transcriptional output did not impair the ability of the mouse liver and
Drosophila
eyes to grow to their normal size. Moreover, the transcriptional activity of the Hippo pathway effectors Yap/Taz/Yki did not correlate with cell proliferation, and hyperactivation of these effectors induced gene expression programs that did not recapitulate normal development. Concordantly, a functional screen in
Drosophila
identified several Hippo pathway target genes that were required for ectopic overgrowth but not normal growth. Thus, Hippo signaling does not instruct normal growth, and the Hippo-induced overgrowth phenotypes are caused by the activation of abnormal genetic programs.
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ASTHMA EXACERBATIONS BEFORE AND AFTER TEZEPELUMAB TREATMENT: A POOLED ANALYSIS OF PATHWAY AND NAVIGATOR STUDIES. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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DEVELOPMENT OF THE PATIENT-IMPORTANT OUTCOMES NATIONAL DATA REPOSITORY (PIONEER) FOR HEREDITARY ANGIOEDEMA (HAE). Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mortality and major adverse cardiac events in women with breast cancer receiving radiotherapy: a 10-year cohort study of patients and population controls. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Treatment for breast cancer (BC) frequently involves radiotherapy. Guidelines recommend screening for cardiac adverse events starting 10 years after radiotherapy. The rationale for recommending this interval is unclear and informed the objective of this study.
Objectives
Study cardiovascular event rates in the first decade following curative radiotherapy for breast cancer, the time frame before guidelines recommend screening.
Methods
We performed a monocentric, retrospective study enrolling all women with unilateral BC in 2007–2008, who received radiotherapy as part of their curative treatment. We compared event rates during 10 years follow-up with an age and risk factor-matched control population (FLEMENGHO population).
Results
We included 1095 BC patients (median age 55y, IQR: 47–66y). Two hundred and eighteen (19.9%) women died. Cancer and cardiovascular mortality accounted for 107 (49.1%) and 22 (10.1%) deaths, respectively. The incidence of coronary artery disease was similar compared to age and risk-matched women [risk ratio 0.75 (95% CI 0.48–1.18)], yet heart failure (HF) [risk ratio 1.97 (95% CI 1.19–3.25)] and atrial fibrillation or flutter (AF) (risk ratio 1.82 (95% CI 1.07–3.08) occurred more often. Age [HR 1.040 (95% CI 1.012–1.069)], tumor grade [HR 1.646 (95% CI 1.103–2.458)], and neo-adjuvant treatment setting [HR 3.079 (95% CI 1.432–6.620)] were risk factors for mortality; hormonal therapy [HR 0.007 (95% CI 0.001–0.042)] proved protective. Risk factors for MACE were mean heart dose [HR 1.079 (95% CI 1.012–1.151], hormonal therapy, history of cardiovascular disease [HR 2.771 (95% CI 1.253–6.126)], and Mayo Clinic Cardiotoxicity Risk Score [HR 2.547 (95% CI 1.538–4.217)]. While mean heart dose [HR 1.141 (95% CI 1.017–1.282)] and cardiovascular history [HR 3.374 (95% CI 1.259–9.043] clearly associated with new onset HF, only a trend towards higher AF burden with increasing mean heart dose could be observed.
Conclusions
Ten-year mortality following curative treatment for unilateral BC was mainly cancer-related. HF and AF constituted significantly increased risks in the first decade following irradiation. Mean heart dose, pre-existing cardiovascular diseases, and Mayo Clinic Cardiotoxicity Risk Score were risk factors for early cardiac mortality and adverse events and should guide early dedicated cardio-oncological follow-up.
Funding Acknowledgement
Type of funding sources: None.
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Incidence of cardiovascular events in patients treated with immune checkpoint inhibitors. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In rare cases, immune checkpoint inhibitors (ICIs) cause immune-mediated myocarditis. However, the true incidence of other major adverse cardiovascular events (MACE) following ICI treatment remains unknown, mainly because late occurring side effects are rarely reported in prospective clinical trials.
Purpose
To identify the incidence and risk factors of MACE in a real-life ICI-treated cancer cohort and to compare the incidence with non-ICI-treated cancer patients and population controls.
Methods
In total, 672 ICI-treated patients were included. The primary endpoint was MACE, a composite of acute coronary syndrome, heart failure, stroke and transient ischemic attack. Secondary outcomes were acute coronary syndrome and heart failure separately. Incidence rates were compared between groups after matching according to age, sex, cardiovascular history and cancer type.
Results
Incidence of MACE was 10.3% during a median time of follow-up of 13 months (IQR 6 to 22). In multivariable analysis, a history of heart failure (hazard ratio (HR): 2.27; 95% confidence interval (CI): 1.03 to 5.04; p=0.043) and valvular heart disease (HR 3.01; 95% CI: 1.05 to 8.66; p=0.041) remained significantly associated with MACE.
Cumulative incidence rates were significantly higher in the matched ICI group (rate at full range of follow-up (rate): 8.51; 95% CI: 6.18 to 11.4) compared with the cancer cohort not exposed to ICI (rate: 5.20; 95% CI: 3.56 to 7.35; p=0.032) and the population controls (rate: 2.55; 95% CI: 2.16 to 2.99; p<0.001) mainly driven by a higher risk of heart failure events (Figure 1).
Conclusions
Cardiovascular events during and after ICI treatment are more common than currently appreciated. Patients at risk are those with a history of cardiovascular disease. Compared with matched cancer and population controls, MACE incidence rates are significantly higher, suggesting a potential harmful effect of ICI treatment besides the underlying risk.
Funding Acknowledgement
Type of funding sources: None.
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Abstract No. 520 Recanalization of complex SFA/popliteal artery CTOs utilizing rendezvous techniques from an anterior fluoroscopically guided, retrograde popliteal access. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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VAD Support of High-Risk Infants with HLHS: Comparison of Rescue VAD After Prior Palliation versus Primary VAD Insertion. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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First Report of Pediatric Outcomes from the GUARDIAN Registry: Multi-Center Analysis of Advanced Organ Preservation for Pediatric Recipients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Long-term prevention of hereditary angioedema attacks with lanadelumab: The HELP OLE Study. Allergy 2022; 77:979-990. [PMID: 34287942 PMCID: PMC9292251 DOI: 10.1111/all.15011] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/06/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023]
Abstract
Background The aim was to evaluate long‐term effectiveness and safety of lanadelumab in patients ≥12 y old with hereditary angioedema (HAE) 1/2 (NCT02741596). Methods Rollover patients completing the HELP Study and continuing into HELP OLE received one lanadelumab 300 mg dose until first attack (dose‐and‐wait period), then 300 mg q2wks (regular dosing stage). Nonrollovers (newly enrolled) received lanadelumab 300 mg q2wks from day 0. Baseline attack rate for rollovers: ≥1 attack/4 weeks (based on run‐in period attack rate during HELP Study); for nonrollovers: historical attack rate ≥1 attack/12 weeks. The planned treatment period was 33 months. Results 212 patients participated (109 rollovers, 103 nonrollovers); 81.6% completed ≥30 months on study (mean [SD], 29.6 [8.2] months). Lanadelumab markedly reduced mean HAE attack rate (reduction vs baseline: 87.4% overall). Patients were attack free for a mean of 97.7% of days during treatment; 81.8% and 68.9% of patients were attack free for ≥6 and ≥12 months, respectively. Angioedema Quality‐of‐Life total and domain scores improved from day 0 to end of study. Treatment‐emergent adverse events (TEAEs) (excluding HAE attacks) were reported by 97.2% of patients; most commonly injection site pain (47.2%) and viral upper respiratory tract infection (42.0%). Treatment‐related TEAEs were reported by 54.7% of patients. Most injection site reactions resolved within 1 hour (70.2%) or 1 day (92.6%). Six (2.8%) patients discontinued due to TEAEs. No treatment‐related serious TEAEs or deaths were reported. Eleven treatment‐related TEAEs of special interest were reported by seven (3.3%) patients. Conclusion Lanadelumab demonstrated sustained efficacy and acceptable tolerability with long‐term use in HAE patients.
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Predictability of cardiotoxicity at a Belgian cardio-oncology clinic without mandatory physician referral. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and purpose
Increased morbidity and mortality caused by side-effects of cancer treatment on cardiovascular function mandates careful monitoring and shared decision-making in cardio-oncology clinics. We report the experience of the cardio-oncology clinic at a large Belgian tertiary care center, without mandatory physician referral, and investigated the predictability of cardiotoxicity based on pre-existing cardiovascular risk factors, specific cancer treatment and existing risk scores of the American Society of Clinical Oncology (ASCO) and Mayo Clinic.
Methods
We included all patients seen at the outpatient cardio-oncology clinic between May 2018 and September 2020. We defined cardiotoxicity as a decline in ejection fraction (EF) of 10% in asymptomatic patients and 5% in symptomatic patients. Approval of the ethical committee was obtained (S65084).
Results
The majority were women (68%), with almost half (44%) having metastatic disease. Mean age was 63.4±16.0 years. The most frequent oncological diagnoses were breast cancer (33%) and haematological diseases (24%). Patients most frequently received radiation therapy (42%), anthracyclines (39%) and antimetabolites (35%). Mean follow-up was 443±245 days.
Receiver operating characteristic (ROC) analysis of predictors of cardiotoxicity showed an area under the curve (AUC) of 0.580 (CI 95% bootstrap: 0.525–0.642) for cardiovascular risk factors alone, and an AUC of 0.613 (CI 95% bootstrap: 0.550–0.676) when treatment was added to the model. The ASCO risk score poorly predicted cardiotoxicity (sensitivity 64%, specificity 52%). The Mayo Clinic cardiotoxicity risk score was the best predictor of cardiotoxicity with an AUC of 0.685 (CI 95% bootstrap: 0.625–0.743).
Discussion
Classic cardiovascular risk factors alone, or in combination with the proposed cancer treatment cannot adequately predict cardiotoxicity risk. The Mayo Clinic Cardiotoxicity Risk score outperformed the ASCO risk score but requires further refinement to enhance adequate cardiovascular risk prediction. For future model building, we hypothesize that an all-comer population of oncological patients should be used as a derivation cohort, regardless of previous or current cardiac issues, risk factors or type of therapy. Admittedly, individual susceptibility due to genetic, epigenetic and environmental predisposition cannot be adequately incorporated into a risk score and emphasizes the need for individual cardiotoxicity risk evaluation using bed to bench tools such as the use of induced pluripotent stem cell derived cardiac or vascular cells to assess the susceptibility of individual patients to cancer drug-induced cardiovascular toxicities. In the absence of adequate risk prediction tools, we advocate standardized screening of all patients before oncological treatment starts.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Cardiotoxicity
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A methodology to estimate the patient diameter and thickness from thoracic and abdominal projection radiographs of adult patients. Phys Med Biol 2021; 66. [PMID: 34157703 DOI: 10.1088/1361-6560/ac0d8c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 06/22/2021] [Indexed: 11/12/2022]
Abstract
Patient dose management systems can be part of a department's quality management tools to estimate items such as the radiation burden in specific groups or list dose outliers for further follow up. Patient size information could improve both aspects, but is not generally available. A new metric is proposed to estimate patient size for thorax and abdominal projection radiography from parameters available in thedicomheader and therefore accessible by dose management software. The tested hypothesis was that an attenuation metric, related to the ratio of detector air-kerma to incident air-kerma, inversely correlates with patient size. Such a metric was defined and then worked out for thorax and abdomen projection radiography. Input material consisted of the thorax or abdominal radiographs of 137 cases, completed with a recent CT scan as ground truth size. From the CT, the water equivalent diameter (WED) and water equivalent thickness (WET) were calculated. The correlation between the attenuation metric and the patient size was established separately for thorax and abdomen. Validation of the attenuation metric predicting the patient size was performed using extra sets of examinations on three more radiographic x-ray devices, with available CT scan. The attenuation metric had a good correlation (R2) of 0.91 and 0.84 with the WED for thorax and abdomen respectively. The corresponding values for the WET were 0.89 and 0.78. Validation of the methodology on the devices with standardized exposure index in thedicomheaders showed that the WED could be estimated within ±15% and the WET within ±30% for thorax and abdomen examinations. The ground truth and estimated size were found statistically equivalent. An attenuation metric based ondicomtags allows to estimate the patient size in projection radiography. This could now be implemented in patient dose management systems.
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Long-term ovarian hormone deprivation alters functional connectivity, brain neurochemical profile and white matter integrity in the Tg2576 amyloid mouse model of Alzheimer's disease. Neurobiol Aging 2021; 102:139-150. [PMID: 33765427 PMCID: PMC8312737 DOI: 10.1016/j.neurobiolaging.2021.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/05/2021] [Accepted: 02/16/2021] [Indexed: 01/18/2023]
Abstract
Premenopausal bilateral ovariectomy is considered to be one of the risk factors of Alzheimer's disease (AD). However, the underlying mechanisms remain unclear. Here, we aimed to investigate long-term neurological consequences of ovariectomy in a rodent AD model, TG2576 (TG), and wild-type mice (WT) that underwent an ovariectomy or sham-operation, using in vivo MRI biomarkers. An increase in osmoregulation and energy metabolism biomarkers in the hypothalamus, a decrease in white matter integrity, and a decrease in the resting-state functional connectivity was observed in ovariectomized TG mice compared to sham-operated TG mice. In addition, we observed an increase in functional connectivity in ovariectomized WT mice compared to sham-operated WT mice. Furthermore, genotype (TG vs. WT) effects on imaging markers and GFAP immunoreactivity levels were observed, but there was no effect of interaction (Genotype × Surgery) on amyloid-beta-and GFAP immunoreactivity levels. Taken together, our results indicated that both genotype and ovariectomy alters imaging biomarkers associated with AD.
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Impact of lanadelumab on health-related quality of life in patients with hereditary angioedema in the HELP study. Allergy 2021; 76:1188-1198. [PMID: 33258114 PMCID: PMC8247292 DOI: 10.1111/all.14680] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/01/2020] [Accepted: 11/14/2020] [Indexed: 01/20/2023]
Abstract
Background An objective of the phase 3 HELP Study was to investigate the effect of lanadelumab on health‐related quality of life (HRQoL) in patients with hereditary angioedema (HAE). Methods Patients with HAE‐1/2 received either lanadelumab 150 mg every 4 weeks (q4wks; n = 28), 300 mg q4wks (n = 29), 300 mg every 2 weeks (q2wks; n = 27), or placebo (n = 41) for 26 weeks (days 0–182). The Angioedema Quality of Life Questionnaire (AE‐QoL) was administered monthly, consisting of four domain (functioning, fatigue/mood, fears/shame, nutrition) and total scores. The generic EQ‐5D‐5L questionnaire was administered on days 0, 98, and 182. Comparisons were made between placebo and (a) all lanadelumab‐treated patients and (b) individual lanadelumab groups for changes in scores (day 0–182) and proportions achieving the minimal clinically important difference (MCID, −6) in AE‐QoL total score. Results Compared with the placebo group, the lanadelumab total group demonstrated significantly greater improvements in AE‐QoL total and domain scores (mean change, −13.0 to −29.3; p < 0.05 for all); the largest improvement was in functioning. A significantly greater proportion of the lanadelumab total group achieved the MCID (70% vs 37%; p = 0.001). The lanadelumab 300 mg q2wks group had the highest proportion (81%; p = 0.001) and was 7.2 times more likely to achieve the MCID than the placebo group. Mean EQ‐5D‐5L scores at day 0 were high in all groups, indicating low impairment, with no significant changes at day 182. Conclusion Patients with HAE‐1/2 experienced significant and clinically meaningful improvements in HRQoL measured by AE‐QoL following lanadelumab treatment in the HELP Study.
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Effect of breathing motion on robustness of proton therapy plans for left-sided breast cancer patients with indication for locoregional irradiation. Acta Oncol 2021; 60:222-228. [PMID: 33269958 DOI: 10.1080/0284186x.2020.1825800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To investigate the dosimetric impact of breathing motion on robustly optimized proton therapy treatment plans for left-sided breast cancer patients with an indication for locoregional irradiation. MATERIALS AND METHODS Clinical Target Volumes (CTVs) (left-sided breast, level 1 to 4 axillary lymph nodes, interpectoral and internal mammary lymph node regions) and organs at risk were delineated on 4 D-CTs of ten female patients. After treatment planning to a prescribed dose of 40.05 Gy(RBE) in 15 fractions on the time-averaged CT, the dose was calculated on all ten phases of the breathing cycle. Robustness to setup (5 mm) and range errors (3%) was evaluated for those ten phases. Correlations were evaluated between the phases of the breathing cycle and the D98% of the CTV and the Dmean of the heart. RESULTS Correlations coefficients were between -0.12 and 0.29. At the most extreme values of the 28 robustness scenarios, the clinical goals were met for all but two patients. The mean heart dose was 0.41 Gy(RBE) with a standard deviation of 0.31 Gy(RBE) of proton therapy plans. CONCLUSION The effect of breathing motion on the robustness of proton therapy treatment plans for this patient group is minor and not of clinical significance. Based on this patient group, a deep-inspiration breath hold seems to be unnecessary to improve robustness for these patients.
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Long‐term deprivation of ovarian hormones via ovariectomy alters functional connectivity, brain neurochemistry and white matter integrity in a mouse model of Alzheimer's disease. Alzheimers Dement 2020. [DOI: 10.1002/alz.037354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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P305 ANCILLARY TREATMENT NEEDS OF PATIENTS RECEIVING ORAL IMMUNOTHERAPY FOR FOOD ALLERGY IN CLINICAL PRACTICE. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lanadelumab demonstrates rapid and sustained prevention of hereditary angioedema attacks. Allergy 2020; 75:2879-2887. [PMID: 32452549 PMCID: PMC7689768 DOI: 10.1111/all.14416] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 02/06/2023]
Abstract
Background Lanadelumab demonstrated efficacy in preventing hereditary angioedema (HAE) attacks in the phase 3 HELP Study. Objective To assess time to onset of effect and long‐term efficacy of lanadelumab, based on exploratory findings from the HELP Study. Methods Eligible patients with HAE type I/II received lanadelumab 150 mg every 4 weeks (q4wks), 300 mg q4wks, 300 mg q2wks, or placebo. Ad hoc analyses evaluated day 0‐69 findings using a Poisson regression model accounting for overdispersion. Least‐squares mean monthly HAE attack rate for lanadelumab was compared with placebo. Intrapatient comparisons for days 0‐69 versus steady state (days 70‐182) used a paired t test for continuous endpoints or Kappa statistics for categorical endpoints. Results One hundred twenty‐five patients were randomized and treated. During days 0‐69, mean monthly attack rate was significantly lower with lanadelumab (0.41‐0.76) vs placebo (2.04), including attacks requiring acute treatment (0.33‐0.61 vs 1.66) and moderate/severe attacks (0.31‐0.48 vs 1.33, all P ≤ .001). More patients receiving lanadelumab vs placebo were attack free (37.9%‐48.1% vs 7.3%) and responders (85.7%‐100% vs 26.8%). During steady state, the efficacy of lanadelumab vs placebo was similar or improved vs days 0‐69. Intrapatient differences were significant with lanadelumab 300 mg q4wks for select outcomes. Lanadelumab efficacy was durable—HAE attack rate was consistently lower vs placebo, from the first 2 weeks of treatment through study end. Treatment emergent adverse events were comparable during days 0‐69 and 70‐182. Conclusion Protection with lanadelumab started from the first dose and continued throughout the entire study period.
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Diagnostic Accuracy & Pathology Revised Reports: Evidence-Based Guideline Development. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
Diagnostic errors in pathology may have adverse impact on patient outcomes and are often rectified through revised reports (RR). Improving patient outcomes with accurate RR is a tangible yet challenging benefit to assuring continuous quality improvement (CQI). Assessment and elevation of RR optimization requires counterbalance of workflow complexity in the diagnostic reporting domain. Implications inform best-practice guidelines for pathology RR and exemplify improved patient outcomes by driving down negative impacts from diagnostic errors.
Methods
A “Survey for RR in Pathology: Reality & Best Practices” was sent via email to relevant stakeholders. The 8-item survey was designed by the National Pathology Quality Registry team & ASCP’s Institute for Science, Technology & Policy. The model included quantitative and qualitative feedback to probe current experiences with RR. The survey was open April 1-30, 2019, via Key Survey and used snowball sampling.
Results
Key results illuminate necessity for RR standardization. Survey findings represent 172 respondents. Ninety- two percent of respondents indicated report accuracy as a major indication for optimizing RR practices & positively impacting patient care. Pathology practices assure appropriate RR by notifying a care provider when a change in diagnosis necessitates RR (89%) & 86% of respondents indicate delineation of RR types (e.g. addenda, amendment). Still 54% of respondents see inappropriate RR use with lack of notification to care providers and 48% indicate no delineation of RR types. This balance-counterbalance highlights deviations from optimized RR and a need for guidelines. Effects on patient care or impact to a patient’s treatment plan was indicated by 43% who affirmed stratification of diagnostic discrepancies as major vs. minor. Solely focusing on changes in diagnosis (benign vs. malignant) was heralded by 19% of respondents as a reason to categorize diagnostic discrepancies. Forty-two percent of respondents indicate data-driven CQI in the RR domain.
Conclusion
Identified RR practice gaps decrease diagnostic accuracy, confirming the need for optimal RR guidelines. RR guidelines should focus on standardized nomenclature; active dialogue between laboratory team & clinical care partners; streamlined workflows to assure accuracy; & valuing transparency to derive improved patient outcomes based on high-quality diagnostic pathology RR.
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Microbiologic Proof-Of-Concept: A Novel Device Combining UV Light And Ozone For Human Skin Antisepsis. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction/Objective
Hand hygiene (HH) decreases healthcare-associated infections (HAI). Available products include alcohol-based gels, foams, wipes, and “gold-standard” hand-washing with soap and water. We tested an investigational device (HyLuxO3; GMI, LLC, patent pending) for antimicrobial effect (AME). HyLuxO3 was engineered to deliver UV-C light energy and high velocity O3 airflow to safely achieve human skin antisepsis within OSHA and EPA regulatory limits. Combined UV and O3 has yet to be evaluated for HH and may demonstrate synergistic AME.
Methods
HyLuxO3 was tested on LB agar to titrate device variables to ascertain intensities for optimal AME; later testing was performed on VITRO-SKIN (Florida Suncare Testing, Bunnell, FL), a human skin surrogate. ATCC strains of MRSA, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Candida albicans were used to test AME vs. vegetative microbes; Bacillus atrophaeus spores were used as a surrogate for C. difficile. Tested variables included time under device, [O3], airflow velocity, 222 and/or 254 nm UV light, sample distance from UV lamp, and UV beam width. Positive controls were used to calculate log-kill curves for AME.
Results
Similar results were seen on LB agar and VITRO-SKIN. >7 log-kill and >5 log-kill were acheived vs. vegetative microbes (<30 sec) and spores (60 sec), respectively, under optimized variables. Presence of UV light and sample distance from and time under the device were the most important variables. 254 nm UV had a significantly better AME than 222 nm; combining both UV lamps had a significant synergistic AME. The narrowest UV beam (2 mm) yielded the greatest AME (total energy input kept constant). Adding O3 to UV had a modest but significant synergistic effect; optimal [O3] was 0.3-0.8 ppm. Changing airflow velocity had no significant effect on AME.
Conclusion
HyLuxO3 is a novel device that achieves >7 log-kill vs. common pathogenic vegetative microbes and >5 log-kill vs. spores using combined UV light and [O3] safe for human skin antisepsis (and surface/fomite decontamination)- and- yields such impressive AME on faster timescales than those required by bleach/other chemical products unsuitable for human skin. Future studies on human hands (using many other microbes) will determine if HyLuxO3 meets regulatory and efficacy requirements for use in and beyond healthcare settings, especially with the specter of emerging respiratory viruses.
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Aetiology of acute febrile illness in children in a high malaria transmission area in West Africa. Clin Microbiol Infect 2020; 27:590-596. [PMID: 32505586 DOI: 10.1016/j.cmi.2020.05.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Areas with declining malaria transmission in sub-Saharan Africa have recently witnessed important changes in the aetiology of childhood acute febrile illness (AFI). We describe the aetiology of AFI in a high malaria transmission area in rural Burkina Faso. METHODS In a prospective hospital-based diagnostic study, children aged 3 months to 15 years with AFI were recruited and assessed using a systematic diagnostic protocol, including blood cultures, whole blood PCR on a selection of bacterial pathogens, malaria diagnostics and a multiplex PCR on nasopharyngeal swabs targeting 21 viral and 4 bacterial respiratory pathogens. RESULTS A total of 589 children with AFI were enrolled from whom an infectious disease was considered in 575 cases. Acute respiratory tract infections, malaria and invasive bacterial infections (IBI) accounted for 179 (31.1%), 175 (30.4%) and 75 (13%) of AFI cases respectively; 16 (21.3%) of IBI cases also had malarial parasitaemia. A viral pathogen was demonstrated from the nasopharynx in 157 children (90.7%) with respiratory tract symptoms. Of all children with viral respiratory tract infections, 154 (92.4% received antibiotics, whereas no antibiotic was provided in 13 (17%) of IBI cases. CONCLUSIONS Viral respiratory infections are a common cause of childhood AFI in high malaria transmission areas, next to malaria and IBI. These findings highlight the importance of interventions to improve targeted treatment with antimicrobials. Most patients with viral infections received antibiotics unnecessarily, while a considerable number with IBI did not receive antibiotics.
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Influence of proportion of wheat in a pasture-based diet on milk yield, methane emissions, methane yield, and ruminal protozoa of dairy cows. J Dairy Sci 2019; 103:2373-2386. [PMID: 31882219 DOI: 10.3168/jds.2019-17514] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/04/2019] [Indexed: 02/05/2023]
Abstract
Wheat is the most common concentrate fed to grazing dairy cows in Australia, but no studies have examined the effects of wheat proportion in a pasture-based diet on milk production and methane emissions. In this 47-d experiment, 32 Holstein dairy cows were offered 1 of 4 diets during d 1 to 36. Cows in each of the dietary treatment groups were individually offered no wheat (W0) or wheat at 3 kg of dry matter (DM)/d (W3), 6 kg of DM/d (W6), or 9 kg of DM/d (W9). The remainder of the diet was 2.2 kg of DM of concentrate mix and freshly harvested perennial ryegrass (Lolium perenne) such that all individual cows were offered a total diet of approximately 20.2 kg of DM/d. From d 37 to 47 the diets of cows receiving treatments W0 and W3 remained unchanged, but cows in treatments W6 and W9 received the W3 diet. Individual cow feed intakes, milk yields, milk compositions, and methane emissions were measured for d 31 to 35 (period 1) and d 45 to 47 (period 2). During period 1, the mean intakes of cows offered the W0, W3, W6, and W9 diets were 19.2, 20.4, 20.2, and 19.8 kg of DM/d. Diet caused differences in energy-corrected milk, and means for W0, W3, W6, and W9 were 29.5, 32.4, 33.0, and 32.9 kg/d, respectively. Milk fat percentage differed with respective means of 3.93, 3.94, 3.69, and 3.17. Diets also caused differences in methane emissions, with means for W0, W3, W6, and W9 of 440, 431, 414, and 319 g/d. During period 1, the cows fed the W9 diet produced less methane and had lower methane yields (g/kg of DMI) and intensities (g/kg of energy-corrected milk) than cows fed the W3 diet. However, in period 2 when the wheat intake of cows in the W9 treatment was reduced to the same level as in the W3 treatment, their methane emissions, yields, and intensities were similar to those offered the W3 treatment, yet protozoa numbers in ruminal fluid were still much lower than those in cows offered the W3 treatment. Our research shows that for diets based on perennial ryegrass and crushed wheat, only the diet containing more than 30% crushed wheat resulted in substantially depressed milk fat concentration and reduced methane emissions, methane yield, and methane intensity. Thus, although feeding a diet with a high proportion of wheat can cause substantial methane mitigation, it can come at the cost of depression in milk fat concentration.
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Automated high-throughput quantification of persistent HIV-1 plasma viremia in individuals on ART. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30135-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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P305 REPORTED PRACTICE LOGISTICS FOR IMPLEMENTATION OF SUBCUTANEOUS IMMUNOTHERAPY VERSUS FOOD ORAL IMMUNOTHERAPY AMONG US-BASED ALLERGISTS/IMMUNOLOGISTS. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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P2.04-44 Combined Immune Checkpoint Blockade in Mesothelioma: In Vivo Investigation of in Vitro Data. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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P695Impact of atrial fibrillation on 10y all-cause mortality in curatively treated breast cancer patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Contemporary treatment options for breast cancer have significantly improved survival during the last two decades. To estimate cancer survival, current practice typically relies on cancer size and the presence of metastases, whereas cardiovascular comorbidities such as atrial arrhythmias are typically not taken into account.
Aim
To evaluate the incidence of atrial fibrillation and flutter among curatively treated breast cancer patients and assess its impact on survival in an all-comer population at a tertiary care centre.
Methods
In a large, single centre, retrospective study we enrolled all patients with a diagnosis of breast cancer in 2007 and 2008 who received radiation therapy as part of their curative treatment regimen. We performed Kaplan-Meier and Cox survival analyses to calculate mortality risk over 10-year follow up.
Results
We included 1338 patients, 1326 (99.1%) of whom were women. Mean age (± standard deviation) at diagnosis was 57.6±13.4 years and the distribution of left sided breast cancer versus right sided or bilateral breast cancer was 655 (49.0%) patients versus 645 (48.2%) and 38 (2.9%) patients, respectively. A total of 805 (60.1%) patients had at least one ECG recorded during the 10 year follow up. In this subgroup, atrial fibrillation or flutter was present in 70 (8.7%); 23 patients had pre-existing atrial fibrillation or flutter (32.9%), 26 patients had had radiation therapy for left sided breast cancer (37.1%) versus 21 patients for right sided breast cancer (30%; p=0.375 for left versus right sided radiation therapy). Of the total cohort, 327 (24.4%) patients died during 10 year follow-up. In the subgroup with at least a single ECG recording, mortality equaled 44.3% (31/70) in patients with one or more documented episodes of atrial fibrillation or flutter during follow-up, compared to 21.9% (161/735) in patients who remained in sinus rhythm (p<0.0001). In patients with pre-existing atrial fibrillation or flutter, mortality equaled 47.8% (11/23) versus 42.6% (20/47) in patients with atrial fibrillation or flutter manifesting after treatment initiation (p=0.683).
Survival Atrial Fibrillation/Flutter
Conclusion
Atrial fibrillation and flutter are common in patients with curative breast cancer treatment and have a significant impact on overall survival. Our study highlights the impact of cardiac comorbidities on overall survival following cancer treatment and emphasizes the importance of a dedicated cardiac follow-up in cancer survivors.
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PO471 Public Health Recommendations and the Differences In Ischaemic Heart Disease Mortality In Rural and Metropolitan Australia- the Best Case Scenario. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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THE ASSOCIATION BETWEEN POSITIVE PERSPECTIVE CONCERNING ONES FUTURE AMONG THE OLDEST OLD AND LONGEVITY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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IMPROVEMENTS WITH RESLIZUMAB TREATMENT IN PATIENT-REPORTED SLEEP QUALITY IN PATIENTS WITH INADEQUATELY CONTROLLED EOSINOPHILIC ASTHMA. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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ECONOMIC SPILLOVER EFFECTS OF INTENSIVE UNPAID CAREGIVING. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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LANADELUMAB EXPOSURE DURING STEADY STATE: ACHIEVEMENT OF EFFECTIVE CONCENTRATIONS IN PATIENTS IN THE HELP STUDY. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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P2.06-25 Combined Immune Checkpoint Blockade in Malignant Pleural Mesothelioma: In Vivo Validation of in Vitro Results. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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The effect of different anaesthetic mask shapes on the anatomical dead space using infant, child and adult part-task trainers. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2018. [DOI: 10.1080/22201181.2018.1517475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
The coordinated expression of highly related homoeologous genes in polyploid species underlies the phenotypes of many of the world's major crops. Here we combine extensive gene expression datasets to produce a comprehensive, genome-wide analysis of homoeolog expression patterns in hexaploid bread wheat. Bias in homoeolog expression varies between tissues, with ~30% of wheat homoeologs showing nonbalanced expression. We found expression asymmetries along wheat chromosomes, with homoeologs showing the largest inter-tissue, inter-cultivar, and coding sequence variation, most often located in high-recombination distal ends of chromosomes. These transcriptionally dynamic genes potentially represent the first steps toward neo- or subfunctionalization of wheat homoeologs. Coexpression networks reveal extensive coordination of homoeologs throughout development and, alongside a detailed expression atlas, provide a framework to target candidate genes underpinning agronomic traits in wheat.
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P2248Longitudinal changes in cardiac function at the extremes of aging. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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PO-423 Investigation of combined immune checkpoint blockade in human malignant pleural mesothelioma. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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PO-429 Identification of the right immunostimulatory chemotherapeutic partner for anti-CD70 immunotherapy in non-small cell lung cancer. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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PO-018 Immunogenic potential of cold atmospheric plasma for the treatment of pancreatic cancer. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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PO-306 Targeting CD70-positive cancer associated fibroblasts to tackle the immune suppressive tumour microenvironment in colorectal cancer. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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0119 Effect Of Sleep On The Brain-Heart-Gut Axis In A Mouse Model Of TBI And PTSD. Sleep 2018. [DOI: 10.1093/sleep/zsy061.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Point-of-care and point-of-'can': leveraging reference-laboratory capacity for integrated diagnosis of fever syndromes in the tropics. Clin Microbiol Infect 2018; 24:836-844. [PMID: 29649602 DOI: 10.1016/j.cmi.2018.03.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/29/2018] [Accepted: 03/30/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND There is an urgent need for integrated diagnosis of febrile syndromes able to account for multiple pathogens and to inform decisions for clinical care and public health. AIMS To reflect on the evolving roles of laboratory-based testing for non-malarial febrile illnesses (NMFIs) in low-resource settings, and to consider how advances in diagnostics, in connectivity and transport, and in implementation of quality systems may substantially enhance the capacity of reference laboratories to bridge the current gap between remote passive surveillance and clinically meaningful integrated fever diagnosis. SOURCES Iterative search of PubMed databases, organizational reports, and expert consultation. CONTENT Implementation of new technologies-such as very broad molecular panels for surveillance and mass spectrometry-may considerably diminish capability gaps in reference laboratories in low-resource settings. Although the need for clinical bacteriology diagnostics is now recognized, the lack of new simple and rapid phenotypic tests for antimicrobial resistance remains a key deficiency. Several initiatives to strengthen diagnostic preparedness for infectious disease outbreaks have highlighted the need for functional tiered laboratory networks. Recently, dramatic headway in connectivity-such as combining automated readers with the image processing and data transmission capabilities of smartphones-now allows for more complex testing and interfacing with distant laboratory information systems while reducing workload and errors. Together with connectivity to transmit and receive results, new approaches to specimen collection and transport-such as the validation of rectal swabs and the use of aerial drones to transport specimens to distant laboratories-now make remote testing feasible. The above innovations also open up the possibility of implementing quality systems through community-level diagnostic stewardship. Finally, strengthened laboratory networks actively support the feasibility of implementing quality-assured point-of-care testing where it is needed. IMPLICATIONS Recent advances offer the present-day possibility of innovations to re-invent the relationship between distant reference laboratories and end-users for integrated diagnosis of NMFIs.
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Perceptions of risk and therapy among patients with Barrett's esophagus: a patient survey study. Dis Esophagus 2018; 31:4209493. [PMID: 29036278 DOI: 10.1093/dote/dox109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 08/08/2017] [Indexed: 12/11/2022]
Abstract
Nondysplastic Barrett's esophagus has a risk of progression to esophageal adenocarcinoma as low as 0.18-0.3% per person per year, and low-grade dysplasia as low as 0.5%. While adherence to guidelines and selection of management options varies, little is known about what modifies patient decision-making. This study aims to evaluate and identify factors that influence patient perceptions of risk and decisions about management. An independently developed and piloted survey was administered to patients at an academic hospital. Risk perception and desire for therapy were assessed using a standard reference gamble paradigm, and responses were stratified based on patient and disease characteristics. Data were analyzed with Student's t and chi-squared tests. A total of 42 of 50 patients with Barrett's esophagus and no prior endoscopic therapy participated (84% response; 76% nondysplastic Barrett's esophagus, 22% low-grade dysplasia, 2% indeterminate for dysplasia; mean age 61 years, 29% female). On average, patients perceived their risk of developing esophageal adenocarcinoma in the next year, 10 years and lifetime as 6, 14, and 19%, respectively. Nearly half viewed their lifetime risk of developing esophageal adenocarcinoma to be the same or higher than diabetes, heart disease, or colon cancer. Although 92% of patients felt surveillance beneficial, only 54% believed endoscopic therapy to be effective in most or all cases. As many as 83% of patients were willing to undergo endoscopic therapy with a hypothetical success rate as low as 70%, and a majority (64%) accepted complication rates up to 30%. Compared to patients with low risk perception of developing esophageal adenocarcinoma, those with high risk perception more often believed their risk for developing esophageal adenocarcinoma was greater than diabetes (p = 0.04) or colon cancer (p = 0.002). Those with lifetime low risk perception were less likely to accept modest complication rates (<10%) of therapy (P < 0.05). Age, gender, degree of dysplasia, lifetime endoscopies and duration of symptoms had no impact on perceived effectiveness of surveillance or therapy, and did not correlate with desire for treatment at varying levels of risk and effectiveness. Patients with Barrett's esophagus overestimate their risk of developing esophageal adenocarcinoma and will accept low success rates and high risk of complications to undergo endoscopic therapy. Baseline risk perception correlates with the desire for endoscopic therapy.
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Alps to Apennines zircon roller coaster along the Adria microplate margin. Sci Rep 2018; 8:2704. [PMID: 29426906 PMCID: PMC5807382 DOI: 10.1038/s41598-018-20979-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/22/2018] [Indexed: 11/09/2022] Open
Abstract
We have traced the particle path of high-pressure metasedimentary rocks on Elba Island, Northern Apennines, with the help of a U-Pb-Hf detrital zircon study. One quarter of the analysed zircons are surprisingly young, 41-30 Ma, with a main age peak at ca. 32 Ma, indicating an unexpected early Oligocene maximum deposition age. These Oligocene ages with negative εHf indicate a volcanic source region in the central-southern Alps. Though young by geological means, these zircons record an extraordinary geodynamic history. They originated in a volcanic arc, during the convergence/collision of the the Adria microplate with Europe from ca. 65 to 30 Ma. Thereafter, the Oligocene zircons travelled ca. 400 km southward along the Adria margin and the accretionary prism to present-day Tuscany, where they were subducted to depths of at least 40 km. Shortly thereafter, they were brought to the surface again in the wake of hinge roll back of the Apennine subduction zone and the resulting rapid extensional exhumation. Such a zircon roller coaster requires a microplate that has back-to-back subduction zones with opposing polarities on two sides.
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P153 Subcutaneous C1 inhibitor prophylaxis substantially reduces the need for rescue medications in the compact study. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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OR031 Preventive effect of subcutaneous C1 inhibitor in patients with very frequent attacks of hereditary angioedema. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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