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Chen M, Parker M. Unknown Case: Enlarging Superficial Breast Mass. J Breast Imaging 2024; 6:220-222. [PMID: 38558138 DOI: 10.1093/jbi/wbad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/21/2023] [Indexed: 04/04/2024]
Affiliation(s)
- Michael Chen
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Matthew Parker
- Department of Radiology, Tulane University School of Medicine, New Orleans, LA, USA
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McColl H, Cordina R, Lal S, Parker M, Hunyor I, Medi C, Gray B. Recurrent immunosuppressive-responsive myocarditis in a patient with desmoplakin cardiomyopathy: a case report. Eur Heart J Case Rep 2024; 8:ytae129. [PMID: 38638283 PMCID: PMC11024808 DOI: 10.1093/ehjcr/ytae129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/29/2024] [Accepted: 03/08/2024] [Indexed: 04/20/2024]
Abstract
Background Desmoplakin (DSP) cardiomyopathy is a rare genetic condition characterized by repeated inflammatory myocardial injury and is associated with ventricular arrhythmia and sudden cardiac death. Diagnosis is challenging and requires a combination of genetic testing and advanced imaging techniques. Case summary We present the case of a 38-year-old woman with recurrent episodes of subclinical myocarditis. Investigation using cardiac magnetic resonance imaging (cMRI) and genetic testing revealed a diagnosis of DSP cardiomyopathy. Her disease was initially responsive to corticosteroid therapy but quickly relapsed when treatment was tapered. Management of her condition required significant immunosuppression and the subsequent insertion of an implantable cardiac defibrillator due to her risk of sudden cardiac death. Discussion Cardiac MRI and genetic testing are key diagnostic techniques in the assessment of patients with recurrent myocarditis and cardiomyopathy. The management of cardiomyopathies with an inflammatory component is not completely understood; however, there is likely a key role for immune suppression therapies. Furthermore, there are several cardiomyopathy genetic variants including DSP which require careful risk stratification due to an increased risk of sudden cardiac death.
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Affiliation(s)
- Hayden McColl
- Department of Cardiology, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, New South Wales 2050, Australia
- Faculty of Medicine and Health, The University of Sydney, Science Road, Camperdown, New South Wales 2050, Australia
| | - Rachael Cordina
- Department of Cardiology, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, New South Wales 2050, Australia
- Faculty of Medicine and Health, The University of Sydney, Science Road, Camperdown, New South Wales 2050, Australia
| | - Sean Lal
- Department of Cardiology, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, New South Wales 2050, Australia
- Faculty of Medicine and Health, The University of Sydney, Science Road, Camperdown, New South Wales 2050, Australia
| | - Matthew Parker
- Department of Cardiology, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, New South Wales 2050, Australia
- Faculty of Medicine and Health, The University of Sydney, Science Road, Camperdown, New South Wales 2050, Australia
| | - Imre Hunyor
- Department of Cardiology, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, New South Wales 2050, Australia
- Faculty of Medicine and Health, The University of Sydney, Science Road, Camperdown, New South Wales 2050, Australia
| | - Caroline Medi
- Department of Cardiology, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, New South Wales 2050, Australia
- Faculty of Medicine and Health, The University of Sydney, Science Road, Camperdown, New South Wales 2050, Australia
| | - Belinda Gray
- Department of Cardiology, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, New South Wales 2050, Australia
- Faculty of Medicine and Health, The University of Sydney, Science Road, Camperdown, New South Wales 2050, Australia
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Mathai SV, Apple SJ, Xu X, Pang L, Flatow E, Friedman A, Rios S, Benites Moya CJ, Alhuarrat MAD, Parker M, Sokol SI, Faillace RT. Differential Mortality Among Heart Failure Patients Across Different COVID-19 Surges in New York City. J Healthc Qual 2024:01445442-990000000-00058. [PMID: 38214648 DOI: 10.1097/jhq.0000000000000421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
ABSTRACT Learning from the healthcare system's response to the COVID-19 pandemic is essential to better prepare for potential future crises. We sought to assess mortality rates for patients admitted for acute decompensated heart failure (HF) and to analyze which factors demonstrated a statistically significant correlation with this primary endpoint. We performed a retrospective analysis of patients hospitalized with a primary diagnosis of acute decompensated HF within the New York City Health and Hospitals 11-hospital system across the different COVID surge periods. Mortality information was collected in 4,405 participants (mean [SD] age 70.54 [14.44] years, 1885 [42.87%] female).The highest mortality existed in the first surge (9.02%), then improved to near prepandemic levels (3.65%) in the second (3.91%) and third surges (5.94%, p < 0.0001). In-hospital mortality inversely correlated with receipt of a COVID-19 vaccination, but had no correlation with left ventricular ejection fraction or the number of vaccination doses. Mortality for acute decompensated HF patients improved after the first surge, suggesting that hospitals adequately adapted to provide quality care. As future infectious outbreaks may occur, emergency preparedness must ensure that adequate focus and resources remain for other clinical entities, such as HF, to ensure optimal care is delivered across all areas of illness.
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Fanous NA, Dang A, Andrew A, Shah J, Wilkey A, Khandekar R, Jhangiani N, Fanous AH, Parker M, Ortiz CB, Lopera J, Walker JA. Evaluation of the Catheter Clamp over Hydrophilic Guide Wire Central Venous Catheter Exchange Technique for Air Embolism Prophylaxis in an In Vitro Model. J Vasc Interv Radiol 2024; 35:122-126. [PMID: 37696430 DOI: 10.1016/j.jvir.2023.09.007] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/23/2023] [Accepted: 09/04/2023] [Indexed: 09/13/2023] Open
Abstract
PURPOSE To develop a reproducible in vitro model simulating central venous catheter (CVC) exchange with high potential for air embolization and test the hypothesis that a closed catheter clamp over hydrophilic guide wire exchange technique will significantly reduce the volume of air introduced during CVC exchange. MATERIALS AND METHODS The model consisted of a 16-F valved sheath, 240-mL container, and pressure transducer submerged in water in a 1,200-mL suction canister system. Continuous wall suction was applied to the canister to maintain negative pressure at -7 mm Hg or -11 mm Hg. Each trial consisted of 0.035-inch hydrophilic guide wire introduction, over-the-wire catheter exchange, and wire removal following clinical protocol. A total of 256 trials were performed, 128 trials at each pressure with the catheter clamp open (n = 64) or closed (n = 64) around the hydrophilic guide wire. RESULTS There was a statistically significant lower volume of air introduced with closed clamp over-the-wire exchanges than with open clamp exchanges at both pressures (2-tailed t-test, P < .001). At -7 mm Hg, a mean of 48.0 mL (SD ± 9.3) of air was introduced with open clamp and 20.6 mL (SD ± 4.7) of air was introduced with closed clamp. At -11 mm Hg, 97.8 mL (SD ± 11.9) of air was introduced with open clamp and 37.8 mL (SD ± 6.3) of air was introduced with closed clamp. CONCLUSIONS This study demonstrated the use of a reproducible in vitro model mimicking conditions causing air embolism during CVC exchange. Results showed that CVC exchange using closed catheter clamp over hydrophilic guide wire exchange technique significantly reduced the volume of air introduced per exchange.
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Affiliation(s)
- Noah A Fanous
- Long School of Medicine, the University of Texas Health Science Center at San Antonio, San Antonio, Texas.
| | - Annie Dang
- Long School of Medicine, the University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Ashley Andrew
- Long School of Medicine, the University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Jay Shah
- Long School of Medicine, the University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Andrew Wilkey
- Long School of Medicine, the University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Rahul Khandekar
- Long School of Medicine, the University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Nikita Jhangiani
- Long School of Medicine, the University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Aaron H Fanous
- Long School of Medicine, the University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Matthew Parker
- Long School of Medicine, the University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Radiology, the University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Carlos B Ortiz
- Long School of Medicine, the University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Radiology, the University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Jorge Lopera
- Long School of Medicine, the University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Radiology, the University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - John A Walker
- Long School of Medicine, the University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Radiology, the University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Borkowski P, Nazarenko N, Mangeshkar S, Borkowska N, Singh N, Garg V, Parker M, Naser AM. Atrial Flutter in the Elderly Patient: The Growing Role of Ablation in Treatment. Cureus 2023; 15:e50096. [PMID: 38186540 PMCID: PMC10770799 DOI: 10.7759/cureus.50096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
The prevalence of atrial flutter (AFL) is increasing among the elderly population, and managing this condition presents specific challenges within this demographic. As patients age, they often exhibit reduced responsiveness to conservative treatment, necessitating a more invasive approach. We present a case of a 93-year-old female who presented to the hospital with acute decompensated heart failure (ADHF) and AFL. A year prior, she was diagnosed with arrhythmia-induced cardiomyopathy. Despite recovering her ejection fraction (EF) through guideline-directed medical therapy (GDMT), her EF deteriorated again. The patient declined invasive management for her arrhythmia on multiple occasions. Managing such patients is challenging since the approach with pharmacotherapy alone often fails to maintain sinus rhythm or adequately control the ventricular rate. Growing evidence shows that invasive management, especially ablation, may be a safe and effective procedure for this patient population. Furthermore, the studies suggest that ablation may yield particular benefits for patients with simultaneous heart failure and atrial fibrillation/AFL (AF/AFL). Unfortunately, limited data exist regarding the invasive management of AFL in the elderly. Therefore, this case report aims to provide a comprehensive review of the current evidence regarding the safety and efficacy of ablation as a therapeutic option for AFL in elderly patients, with a particular focus on how patients with concomitant heart failure may benefit from ablation.
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Affiliation(s)
- Pawel Borkowski
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Natalia Nazarenko
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Shaunak Mangeshkar
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Natalia Borkowska
- Pediatrics, Samodzielny Publiczny Zakład Opieki Zdrowotnej (SPZOZ), Krotoszyn, POL
| | - Nikita Singh
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Vibhor Garg
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Matthew Parker
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
| | - Ahmad Moayad Naser
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
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Wang X, Vyas NS, Alghamdi AA, Parker M, Sapadin A, Goldberg MS, Westra W. Cutaneous Presentation of Metastatic Salivary Duct Carcinoma. Cutis 2023; 112:E13-E15. [PMID: 37988310 DOI: 10.12788/cutis.0877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Affiliation(s)
- Xintong Wang
- Drs. Wang, Vyas, Alghamdi, Sapadin, Goldberg, and Westra are from the Icahn School of Medicine, Mount Sinai, New York, New York. Drs. Wang and Westra are from the Department of Pathology, Drs. Vyas and Goldberg are from the Departments of Pathology and Dermatology, and Drs. Alghamdi and Sapadin are from the Department of Dermatology. Dr. Parker is from the Albert Einstein College of Medicine at Mount Sinai, Bronx, New York
| | - Nikki S Vyas
- Drs. Wang, Vyas, Alghamdi, Sapadin, Goldberg, and Westra are from the Icahn School of Medicine, Mount Sinai, New York, New York. Drs. Wang and Westra are from the Department of Pathology, Drs. Vyas and Goldberg are from the Departments of Pathology and Dermatology, and Drs. Alghamdi and Sapadin are from the Department of Dermatology. Dr. Parker is from the Albert Einstein College of Medicine at Mount Sinai, Bronx, New York
| | - Abdulaziz A Alghamdi
- Drs. Wang, Vyas, Alghamdi, Sapadin, Goldberg, and Westra are from the Icahn School of Medicine, Mount Sinai, New York, New York. Drs. Wang and Westra are from the Department of Pathology, Drs. Vyas and Goldberg are from the Departments of Pathology and Dermatology, and Drs. Alghamdi and Sapadin are from the Department of Dermatology. Dr. Parker is from the Albert Einstein College of Medicine at Mount Sinai, Bronx, New York
| | - Matthew Parker
- Drs. Wang, Vyas, Alghamdi, Sapadin, Goldberg, and Westra are from the Icahn School of Medicine, Mount Sinai, New York, New York. Drs. Wang and Westra are from the Department of Pathology, Drs. Vyas and Goldberg are from the Departments of Pathology and Dermatology, and Drs. Alghamdi and Sapadin are from the Department of Dermatology. Dr. Parker is from the Albert Einstein College of Medicine at Mount Sinai, Bronx, New York
| | - Allen Sapadin
- Drs. Wang, Vyas, Alghamdi, Sapadin, Goldberg, and Westra are from the Icahn School of Medicine, Mount Sinai, New York, New York. Drs. Wang and Westra are from the Department of Pathology, Drs. Vyas and Goldberg are from the Departments of Pathology and Dermatology, and Drs. Alghamdi and Sapadin are from the Department of Dermatology. Dr. Parker is from the Albert Einstein College of Medicine at Mount Sinai, Bronx, New York
| | - Matthew S Goldberg
- Drs. Wang, Vyas, Alghamdi, Sapadin, Goldberg, and Westra are from the Icahn School of Medicine, Mount Sinai, New York, New York. Drs. Wang and Westra are from the Department of Pathology, Drs. Vyas and Goldberg are from the Departments of Pathology and Dermatology, and Drs. Alghamdi and Sapadin are from the Department of Dermatology. Dr. Parker is from the Albert Einstein College of Medicine at Mount Sinai, Bronx, New York
| | - William Westra
- Drs. Wang, Vyas, Alghamdi, Sapadin, Goldberg, and Westra are from the Icahn School of Medicine, Mount Sinai, New York, New York. Drs. Wang and Westra are from the Department of Pathology, Drs. Vyas and Goldberg are from the Departments of Pathology and Dermatology, and Drs. Alghamdi and Sapadin are from the Department of Dermatology. Dr. Parker is from the Albert Einstein College of Medicine at Mount Sinai, Bronx, New York
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Apple SJ, Flomenbaum D, Parker M, Chhikara S, Stolarov A, Moser J, Mathai SV, Seo J, Ferrick N, Chudow JJ, Di Biase L, Krumerman A, Ferrick KJ. Low Utility of Short-Term Rhythm Assessment Before Long-Term Rhythm Monitoring in Patients With Cryptogenic Stroke. Am J Cardiol 2023; 202:151-159. [PMID: 37437356 DOI: 10.1016/j.amjcard.2023.06.040] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/01/2023] [Accepted: 06/11/2023] [Indexed: 07/14/2023]
Abstract
Implantable cardiac monitors are routinely placed for long-term monitoring (LTM) after a period of negative short-term monitoring (STM) to increase atrial fibrillation (AF) detection after a cryptogenic stroke or transient ischemic attack (TIA). Optimizing AF monitoring after a cryptogenic stroke is critical to improve outcomes and reduce costs. We sought to compare the diagnostic yield of STM versus LTM, assess the impact of routine STM on hospitalization length of stay, and perform a financial analysis comparing the current model to a theoretical model wherein patients can proceed directly to LTM. Our retrospective observational cohort study analyzed patients admitted to Montefiore Medical Center between May 2017 and June 2022 with a primary diagnosis of cryptogenic stroke or TIA who underwent Holter device monitoring. Of 396 subjects, STM detected AF in 10 (2.5%) compared with a diagnostic yield of 14.6% for LTM (median time to diagnosis of 76 days). Of the 386 patients with negative STM, 130 (33.7%) received an implantable cardiac monitor while an inpatient, and 256 (66.3%) did not. We calculated a point estimate of 1.67 days delay of discharge attributable to the requirement for STM to precede LTM. Our model showed that the expected cost per patient in the STM-first paradigm is $28,615.33 versus $27,111.24 in the LTM-or-STM paradigm. Considering the relatively lower diagnostic yield of STM and its association with a longer length of stay and higher costs, it may be reasonable to proceed directly to LTM to optimize AF detection after a cryptogenic stroke or TIA.
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Affiliation(s)
- Samuel J Apple
- Department of Medicine, New York City Health and Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York.
| | - David Flomenbaum
- Department of Medicine, Montefiore Medical Center, Bronx, New York
| | - Matthew Parker
- Department of Medicine, New York City Health and Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Sanya Chhikara
- Department of Medicine, New York City Health and Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Aaron Stolarov
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Jack Moser
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Sheetal Vasundara Mathai
- Department of Medicine, New York City Health and Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Jiyoung Seo
- Department of Medicine, New York City Health and Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Neal Ferrick
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Bronx, New York
| | - Jay J Chudow
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Bronx, New York
| | - Luigi Di Biase
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Bronx, New York
| | - Andrew Krumerman
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Bronx, New York
| | - Kevin J Ferrick
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Bronx, New York
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Kennedy J, Parker M, Seaborne M, Mhereeg M, Walker A, Walker V, Denaxas S, Kennedy N, Katikireddi SV, Brophy S. Healthcare use attributable to COVID-19: a propensity-matched national electronic health records cohort study of 249,390 people in Wales, UK. BMC Med 2023; 21:259. [PMID: 37468884 PMCID: PMC10354936 DOI: 10.1186/s12916-023-02897-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 05/10/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND To determine the extent and nature of changes associated with COVID-19 infection in terms of healthcare utilisation, this study observed healthcare contact 1 to 4 and 5 to 24 weeks following a COVID-19 diagnosis compared to propensity-matched controls. METHODS Two hundred forty nine thousand three hundred ninety Welsh individuals with a positive reverse transcription-polymerase chain reaction (RT-PCR) test were identified from data from national PCR test results. After elimination criteria, 98,600 positive individuals were matched to test negative and never tested controls using propensity matching. Cohorts were split on test location. Tests could be taken in either the hospital or community. Controls were those who had tested negative in their respective environments. Survival analysis was utilised for first clinical outcomes which are grouped into primary and secondary. Primary outcomes include post-viral-illness and fatigue as an indication of long-COVID. Secondary outcomes include clinical terminology concepts for embolism, respiratory conditions, mental health conditions, fit notes, or hospital attendance. Increased instantaneous risk for positive individuals was quantified using hazard ratios (HR) from Cox regression, while absolute risk (AR) and relative risk were quantified using life table analysis. RESULTS Analysis was conducted using all individuals and stratified by test location. Cases are compared to controls from the same test location. Fatigue (HR: 1.77, 95% CI: 1.34-2.25, p = < 0.001) and embolism (HR: 1.50, 95% CI: 1.15-1.97, p = 0.003) were more likely to occur in all positive individuals in the first 4 weeks; however, anxiety and depression (HR: 0.83, 95% CI: 0.73-0.95, p = 0.007) were less likely. Positive individuals continued to be more at risk of fatigue (HR: 1.47, 95% CI: 1.24-1.75, p = < 0.001) and embolism (HR: 1.51, 95% CI: 1.13-2.02, p = 0.005) after 4 weeks. All positive individuals are also at greater risk of post-viral illness (HR: 4.57, 95% CI: 1.77-11.80, p = 0.002). Despite statistical association between testing positive and several conditions, life table analysis shows that only a small minority of the study population were affected. CONCLUSIONS Community COVID-19 disease is associated with increased risks of post-viral-illness, fatigue, embolism, and respiratory conditions. Despite elevated risks, the absolute healthcare burden is low. Subsequently, either very small proportions of people experience adverse outcomes following COVID-19 or they are not presenting to healthcare.
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Affiliation(s)
- J Kennedy
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
| | - M Parker
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK.
| | - M Seaborne
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
| | - M Mhereeg
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
| | - A Walker
- Datalab, Nuffield Dept of Primary Care Health Science, Radcliffe Primary Care Building, Oxford, OX2 6GG, UK
| | - V Walker
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - S Denaxas
- Institute for Health Informatics, UCL, London, UK
| | - N Kennedy
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
| | - S V Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S Brophy
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
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Derrick K, Ortiz C, Borrego M, Parker M, Walker J. Abstract No. 525 Investigation of an Ex Vivo Perfusion Model for Teaching Angiographic Procedures to Novice Trainees. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.383] [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: 02/27/2023] Open
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Apple SJ, Stolarov A, Moser J, Chhikara S, Parker M, Seo J, Chudow J, Krumerman A, Ferrick KJ. UTILITY OF SHORT-TERM RHYTHM ASSESSMENT PRIOR TO LONG-TERM RHYTHM MONITORING IN PATIENTS WITH CRYPTOGENIC STROKE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00479-5] [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: 03/06/2023]
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Varrias D, Parker M, Pargaonkar SR, Al Deen Alhuarrat M, Khasnavis S, SAFIRIYU ISRAELA, Kharawala A, Coleman K, Villela MA, Mountantonakis SE, Faillace RT. NOT A RESPIRATORY ARRHYTHMIA: SECOND DEGREE SINOATRIAL EXIT BLOCK AS THE 1STSIGN OF A RIGHT VENTRICULAR MYOCARDIAL INFARCTION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04299-7] [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: 03/06/2023]
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Ortiz CB, Dang A, Derrick K, O'Donnell B, Bitar R, Parker M, Veraza R, Bunegin L, Borrego M, Yamaguchi S, Walker JA, Lopera J. Creation of an Ex Vivo Renal Perfusion Model to Investigate Microwave Ablation. J Vasc Interv Radiol 2023; 34:40-45.e2. [PMID: 36244634 DOI: 10.1016/j.jvir.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/20/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Abstract
This study hypothesized that an ex vivo renal perfusion model can create smaller microwave ablation (MWA) measurements during perfused states compared with nonperfused states across multiple device settings. Nine bovine kidneys, a fluoroscopic compatible perfusion model, and a commercially-available clinical MWA system were used to perform 72 ablations (36 perfused and 36 nonperfused) at 9 different device settings. Comparing perfused and nonperfused ablations at each device setting, significant differences in volume existed for 6 of 9 settings (P < .05). Collapsed across time settings, the ablation volumes by power were the following (perfused and nonperfused, P value): 60 W, 2.3 cm3 ± 1.0 and 7.2 cm3 ± 2.7, P < .001; 100 W, 5.4 cm3 ± 2.1 and 11.5 cm3 ± 5.6, P < .01; and 140 W, 11.2 cm3 ± 3.7 and 18.7 cm3 ± 6.3, P < .01. Applied power correlated with ablation volume: perfused, 0.021 cm3/W and R = 0.462, P = .004, and nonperfused, 0.029 cm3/W and R = 0.565, P < .001. These results support that an ex vivo perfused organ system can evaluate MWA systems and demonstrate heat sink perfusion effects of decreased ablation size.
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Affiliation(s)
- Carlos B Ortiz
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Division of Interventional Radiology, Department of Radiology, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas.
| | - Annie Dang
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Kade Derrick
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Barrett O'Donnell
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Division of Interventional Radiology, Department of Radiology, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Ryan Bitar
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Matthew Parker
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Division of Interventional Radiology, Department of Radiology, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | | | - Leonid Bunegin
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Vascular Perfusion Solutions, San Antonio, Texas
| | - Marina Borrego
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Division of Interventional Radiology, Department of Radiology, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Seiji Yamaguchi
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Division of Transplant Surgery, Department of Surgery, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - John A Walker
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Division of Interventional Radiology, Department of Radiology, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Jorge Lopera
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Division of Interventional Radiology, Department of Radiology, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
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13
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Wilson D, Anju A, Parker M, Meher N, Blecha J, Rosenberg O, Ohliger M, Flavell R. Cyclic [68Ga] and [18F]AlF-labeled peptides for specific detection of human angiotensin-converting enzyme 2. Nucl Med Biol 2022. [DOI: 10.1016/s0969-8051(22)02219-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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14
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Mahtani K, Parker M, Maclean E, Vyas R, Bo Wang R, Roelas M, Zemrak F, Muthumala A, Moore P, Sporton S, Chow A, Monkhouse C. Emergency pacemaker implantation in nonagenarians with complete heart block: is single chamber pacing sufficient? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In ambulatory patients with complete heart block and preserved sinus node activity (CHBs), dual chamber pacing confers well-established physiological benefits versus single chamber pacing. There is limited evidence as to whether these benefits extend to very frail patients, especially those over 90 years of age.
Purpose
In nonagenarians presenting with emergent CHBs from 2016–2019, we compared the clinical characteristics of patients selected for single versus dual chamber pacemakers (PPM), and evaluated the symptomatic and prognostic implications of these devices.
Methods
Baseline characteristics were discerned from electronic records, and physiological data extracted from serial PPM interrogations. Frailty was quantified according to the Rockwood clinical frailty scale (1–9). Cause of death was provided by the patients' General Practitioner. Cox proportional hazards analysis (HR, 95% CI) examined associations with all-cause mortality and death from congestive cardiac failure (CCF).
Results
168 consecutive patients were included (44.3% Male, Median age: 91 (2) years) and followed-up for 26.9±14.6 months. 22 patients (13.1%) were implanted with single chamber pacemakers (all programmed VVIR); when compared with patients receiving dual chamber devices, these patients had similar median age (93 (3) versus 91 (2) years, p=0.15) and LV systolic function (LVEF: 49.2% ±9.7 versus 50.7% ±10.1, p=0.71), but were more frail (Rockwood scale: 5.2±1.8 versus 4.3±1.1, p=0.004) and more likely to have severe cognitive impairment (27.3% versus 9.2%, p=0.018). Post implant, patients who received single chamber devices had higher average respiratory rates (21.3±2.4 breaths per minute versus 17.5±2.6 breaths per minute, p=0.002), lower average heart rates (65.5±10.1 bpm versus 71.9±8.6 bpm, p=0.002), and lower daily activity levels (0.57±0.3 hours of activity versus 1.5±1.1 hours of activity, p=0.016) than those with dual chamber devices. Death from CCF was more common in patients receiving single chamber devices (40.9% versus 6.2%, log rank p<0.0001); this association persisted when adjusting for age, frailty and cognitive impairment (adjusted HR: 6.2 (2.2–17.3, p=0.0005). However, in this age group, single chamber pacing was not independently associated with all-cause mortality when compared with dual chamber pacing (adjusted HR: 1.9 (0.95–3.6, p=0.07).
Conclusions
In nonagenarians with CHBs, dual chamber pacing was associated with improved symptomatic outcomes and a reduced risk of death from CCF, but did not affect all-cause mortality when compared with single chamber pacing.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Mahtani
- St Bartholomew's Hospital , London , United Kingdom
| | - M Parker
- St Bartholomew's Hospital , London , United Kingdom
| | - E Maclean
- St Bartholomew's Hospital , London , United Kingdom
| | - R Vyas
- St Bartholomew's Hospital , London , United Kingdom
| | - R Bo Wang
- St Bartholomew's Hospital , London , United Kingdom
| | - M Roelas
- St Bartholomew's Hospital , London , United Kingdom
| | - F Zemrak
- St Bartholomew's Hospital , London , United Kingdom
| | - A Muthumala
- St Bartholomew's Hospital , London , United Kingdom
| | - P Moore
- St Bartholomew's Hospital , London , United Kingdom
| | - S Sporton
- St Bartholomew's Hospital , London , United Kingdom
| | - A Chow
- St Bartholomew's Hospital , London , United Kingdom
| | - C Monkhouse
- St Bartholomew's Hospital , London , United Kingdom
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15
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Stirrup O, Blackstone J, Mapp F, MacNeil A, Panca M, Holmes A, Machin N, Shin GY, Mahungu T, Saeed K, Saluja T, Taha Y, Mahida N, Pope C, Chawla A, Cutino-Moguel MT, Tamuri A, Williams R, Darby A, Robertson DL, Flaviani F, Nastouli E, Robson S, Smith D, Laing K, Monahan I, Kele B, Haldenby S, George R, Bashton M, Witney AA, Byott M, Coll F, Chapman M, Peacock SJ, Hughes J, Nebbia G, Partridge DG, Parker M, Price JR, Peters C, Roy S, Snell LB, de Silva TI, Thomson E, Flowers P, Copas A, Breuer J. Effectiveness of rapid SARS-CoV-2 genome sequencing in supporting infection control for hospital-onset COVID-19 infection: multicenter, prospective study. eLife 2022; 11:78427. [PMID: 36098502 PMCID: PMC9596156 DOI: 10.7554/elife.78427] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Viral sequencing of SARS-CoV-2 has been used for outbreak investigation, but there is limited evidence supporting routine use for infection prevention and control (IPC) within hospital settings. Methods: We conducted a prospective non-randomised trial of sequencing at 14 acute UK hospital trusts. Sites each had a 4-week baseline data-collection period, followed by intervention periods comprising 8 weeks of 'rapid' (<48h) and 4 weeks of 'longer-turnaround' (5-10 day) sequencing using a sequence reporting tool (SRT). Data were collected on all hospital onset COVID-19 infections (HOCIs; detected ≥48h from admission). The impact of the sequencing intervention on IPC knowledge and actions, and on incidence of probable/definite hospital-acquired infections (HAIs) was evaluated. Results: A total of 2170 HOCI cases were recorded from October 2020-April 2021, corresponding to a period of extreme strain on the health service, with sequence reports returned for 650/1320 (49.2%) during intervention phases. We did not detect a statistically significant change in weekly incidence of HAIs in longer-turnaround (incidence rate ratio 1.60, 95%CI 0.85-3.01; P=0.14) or rapid (0.85, 0.48-1.50; P=0.54) intervention phases compared to baseline phase. However, IPC practice was changed in 7.8% and 7.4% of all HOCI cases in rapid and longer-turnaround phases, respectively, and 17.2% and 11.6% of cases where the report was returned. In a 'per-protocol' sensitivity analysis there was an impact on IPC actions in 20.7% of HOCI cases when the SRT report was returned within 5 days. Capacity to respond effectively to insights from sequencing was breached in most sites by the volume of cases and limited resources. Conclusion: While we did not demonstrate a direct impact of sequencing on the incidence of nosocomial transmission, our results suggest that sequencing can inform IPC response to HOCIs, particularly when returned within 5 days. Funding: COG-UK is supported by funding from the Medical Research Council (MRC) part of UK Research & Innovation (UKRI), the National Institute of Health Research (NIHR) [grant code: MC_PC_19027], and Genome Research Limited, operating as the Wellcome Sanger Institute. Clinical trial number: ClinicalTrials.gov Identifier: NCT04405934.
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Affiliation(s)
- Oliver Stirrup
- Institute for Global Health, University College London, London, United Kingdom
| | - James Blackstone
- The Comprehensive Clinical Trials Unit, University College London, London, United Kingdom
| | - Fiona Mapp
- Institute for Global Health, University College London, London, United Kingdom
| | - Alyson MacNeil
- Comprehensive Clinical Trials Unit, University College London, London, United Kingdom
| | - Monica Panca
- Comprehensive Clinical Trials Unit, University College London, London, United Kingdom
| | - Alison Holmes
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nicholas Machin
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Gee Yen Shin
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Tabitha Mahungu
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Kordo Saeed
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Tranprit Saluja
- Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Yusri Taha
- Department of Virology and Infectious Diseases, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
| | - Nikunj Mahida
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Cassie Pope
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Anu Chawla
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Asif Tamuri
- Research Computing, University College London, London, United Kingdom
| | - Rachel Williams
- Department of Genetics and Genomic Medicine, University College London, London, United Kingdom
| | - Alistair Darby
- Centre for Genomic Research, University of Liverpool, Liverpool, United Kingdom
| | - David L Robertson
- MRC-University of Glasgow Centre For Virus Research, University of Glasgow, Glasgow, United Kingdom
| | - Flavia Flaviani
- Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Eleni Nastouli
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Samuel Robson
- Centre for Enzyme Innovation, University of Portsmouth, Portsmouth, United Kingdom
| | - Darren Smith
- Department of Applied Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Kenneth Laing
- Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
| | - Irene Monahan
- Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
| | | | - Sam Haldenby
- Centre for Genomic Research, University of Liverpool, Liverpool, United Kingdom
| | - Ryan George
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Matthew Bashton
- Department of Applied Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Adam A Witney
- Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
| | - Matthew Byott
- Advanced Pathogen Diagnostics, University College London, London, United Kingdom
| | - Francesc Coll
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Sharon J Peacock
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | | | - Joseph Hughes
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, United Kingdom
| | - Gaia Nebbia
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - David G Partridge
- Directorate of Laboratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Matthew Parker
- Sheffield Bioinformatics Core, University of Sheffield, Sheffield, United Kingdom
| | | | | | - Sunando Roy
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Luke B Snell
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Thushan I de Silva
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Emma Thomson
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, United Kingdom
| | - Paul Flowers
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Andrew Copas
- Institute for Global Health, University College London, London, United Kingdom
| | - Judith Breuer
- Division of Infection and Immunity, University College London, London, United Kingdom
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16
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Polvoy I, Seo Y, Parker M, Stewart M, Siddiqua K, Manacsa HS, Ravanfar V, Blecha J, Hope TA, Vanbrocklin H, Flavell RR, Barry J, Hansen E, Villanueva-Meyer JE, Engel J, Rosenberg OS, Wilson DM, Ohliger MA. Imaging joint infections using D-methyl- 11C-methionine PET/MRI: initial experience in humans. Eur J Nucl Med Mol Imaging 2022; 49:3761-3771. [PMID: 35732972 PMCID: PMC9399217 DOI: 10.1007/s00259-022-05858-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/30/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE Non-invasive imaging is a key clinical tool for detection and treatment monitoring of infections. Existing clinical imaging techniques are frequently unable to distinguish infection from tumors or sterile inflammation. This challenge is well-illustrated by prosthetic joint infections that often complicate joint replacements. D-methyl-11C-methionine (D-11C-Met) is a new bacteria-specific PET radiotracer, based on an amino acid D-enantiomer, that is rapidly incorporated into the bacterial cell wall. In this manuscript, we describe the biodistribution, radiation dosimetry, and initial human experience using D-11C-Met in patients with suspected prosthetic joint infections. METHODS 614.5 ± 100.2 MBq of D-11C-Met was synthesized using an automated in-loop radiosynthesis method and administered to six healthy volunteers and five patients with suspected prosthetic joint infection, who were studied by PET/MRI. Time-activity curves were used to calculate residence times for each source organ. Absorbed doses to each organ and body effective doses were calculated using OLINDA/EXM 1.1 with both ICRP 60 and ICRP 103 tissue weighting factors. SUVmax and SUVpeak were calculated for volumes of interest (VOIs) in joints with suspected infection, the unaffected contralateral joint, blood pool, and soft tissue background. A two-tissue compartment model was used for kinetic modeling. RESULTS D-11C-Met was well tolerated in all subjects. The tracer showed clearance from both urinary (rapid) and hepatobiliary (slow) pathways as well as low effective doses. Moreover, minimal background was observed in both organs with resident micro-flora and target organs, such as the spine and musculoskeletal system. Additionally, D-11C-Met showed increased focal uptake in areas of suspected infection, demonstrated by a significantly higher SUVmax and SUVpeak calculated from VOIs of joints with suspected infections compared to the contralateral joints, blood pool, and background (P < 0.01). Furthermore, higher distribution volume and binding potential were observed in suspected infections compared to the unaffected joints. CONCLUSION D-11C-Met has a favorable radiation profile, minimal background uptake, and fast urinary extraction. Furthermore, D-11C-Met showed increased uptake in areas of suspected infection, making this a promising approach. Validation in larger clinical trials with a rigorous gold standard is still required.
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Affiliation(s)
- Ilona Polvoy
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
| | - Youngho Seo
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
- Department of Nuclear Engineering, University of California, Berkeley, CA USA
| | - Matthew Parker
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
| | - Megan Stewart
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
| | - Khadija Siddiqua
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
| | - Harrison S. Manacsa
- Department of Orthopedic Surgery, University of California, San Francisco, CA USA
| | - Vahid Ravanfar
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
| | - Joseph Blecha
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
| | - Thomas A. Hope
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
| | - Henry Vanbrocklin
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
| | - Robert R. Flavell
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
| | - Jeffrey Barry
- Department of Orthopedic Surgery, University of California, San Francisco, CA USA
| | - Erik Hansen
- Department of Orthopedic Surgery, University of California, San Francisco, CA USA
| | - Javier E. Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
| | - Joanne Engel
- Department of Medicine, University of California, San Francisco, CA USA
- Departments of Medicine and Microbiology and Immunology, University of California, San Francisco, CA USA
| | - Oren S. Rosenberg
- Department of Medicine, University of California, San Francisco, CA USA
- Chan Zuckerberg Biohub, San Francisco, CA USA
| | - David M. Wilson
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave., San Francisco, CA 94143 USA
| | - Michael A. Ohliger
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, San Francisco, CA 94107 USA
- Department of Radiology, Zuckerberg San Francisco General Hospital, San Francisco, CA USA
- Department of Radiology and Biomedical Imaging, University of California, 1001 Potrero Ave. 1x55D, San Francisco, CA 94110 USA
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17
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Brady SW, Roberts KG, Gu Z, Shi L, Pounds S, Pei D, Cheng C, Dai Y, Devidas M, Qu C, Hill AN, Payne-Turner D, Ma X, Iacobucci I, Baviskar P, Wei L, Arunachalam S, Hagiwara K, Liu Y, Flasch DA, Liu Y, Parker M, Chen X, Elsayed AH, Pathak O, Li Y, Fan Y, Michael JR, Rusch M, Wilkinson MR, Foy S, Hedges D, Newman S, Zhou X, Wang J, Reilly C, Sioson E, Rice SV, Loyola VP, Wu G, Rampersaud E, Reshmi SC, Gastier-Foster J, Guidry-Auvil JM, Gesuwan P, Smith MA, Winick N, Carroll AJ, Heerema NA, Harvey RC, Willman CL, Larsen E, Raetz EA, Borowitz MJ, Wood BL, Carroll WL, Zweidler-McKay PA, Rabin KR, Mattano LA, Maloney KW, Winter SS, Burke MJ, Salzer W, Dunsmore KP, Angiolillo AL, Crews KR, Downing JR, Jeha S, Pui CH, Evans WE, Yang JJ, Relling MV, Gerhard DS, Loh ML, Hunger SP, Zhang J, Mullighan C. The genomic landscape of pediatric acute lymphoblastic leukemia. Nat Genet 2022; 54:1376-1389. [PMID: 36050548 PMCID: PMC9700506 DOI: 10.1038/s41588-022-01159-z] [Citation(s) in RCA: 83] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 07/13/2022] [Indexed: 12/13/2022]
Abstract
Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. Here, using whole-genome, exome and transcriptome sequencing of 2,754 childhood patients with ALL, we find that, despite a generally low mutation burden, ALL cases harbor a median of four putative somatic driver alterations per sample, with 376 putative driver genes identified varying in prevalence across ALL subtypes. Most samples harbor at least one rare gene alteration, including 70 putative cancer driver genes associated with ubiquitination, SUMOylation, noncoding transcripts and other functions. In hyperdiploid B-ALL, chromosomal gains are acquired early and synchronously before ultraviolet-induced mutation. By contrast, ultraviolet-induced mutations precede chromosomal gains in B-ALL cases with intrachromosomal amplification of chromosome 21. We also demonstrate the prognostic significance of genetic alterations within subtypes. Intriguingly, DUX4- and KMT2A-rearranged subtypes separate into CEBPA/FLT3- or NFATC4-expressing subgroups with potential clinical implications. Together, these results deepen understanding of the ALL genomic landscape and associated outcomes.
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Affiliation(s)
- Samuel W. Brady
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Kathryn G. Roberts
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Zhaohui Gu
- Department of Computational and Quantitative Medicine & Systems Biology, Beckman Research Institute of City of Hope, Duarte CA, USA
| | - Lei Shi
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Stanley Pounds
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Deqing Pei
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Cheng Cheng
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Yunfeng Dai
- Department of Biostatistics, University of Florida, Gainesville FL, USA
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Chunxu Qu
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Ashley N. Hill
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Debbie Payne-Turner
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Xiaotu Ma
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Ilaria Iacobucci
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Pradyuamna Baviskar
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Lei Wei
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Sasi Arunachalam
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Kohei Hagiwara
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Yanling Liu
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Diane A. Flasch
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Yu Liu
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Matthew Parker
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Xiaolong Chen
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Abdelrahman H. Elsayed
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis TN, USA,Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Omkar Pathak
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Yongjin Li
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Yiping Fan
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - J. Robert Michael
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Michael Rusch
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Mark R. Wilkinson
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Scott Foy
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Dale Hedges
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Scott Newman
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Xin Zhou
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Jian Wang
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Colleen Reilly
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Edgar Sioson
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Stephen V. Rice
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Victor Pastor Loyola
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Gang Wu
- Center for Applied Bioinformatics, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Evadnie Rampersaud
- Center for Applied Bioinformatics, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Shalini C. Reshmi
- Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus OH, USA
| | | | - Jaime M. Guidry-Auvil
- Office of Cancer Genomics, National Cancer Institute, National Institutes of Health, Bethesda MD, USA
| | - Patee Gesuwan
- Office of Cancer Genomics, National Cancer Institute, National Institutes of Health, Bethesda MD, USA
| | - Malcolm A. Smith
- Cancer Therapeutics Evaluation Program, National Cancer Institute, National Institutes of Health, Bethesda MD, USA
| | - Naomi Winick
- Department of Pediatric Hematology Oncology and Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas TX, USA
| | - Andrew J. Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham AL, USA
| | | | - Richard C. Harvey
- Department of Pathology, University of New Mexico Cancer Center, Albuquerque NM, USA
| | | | - Eric Larsen
- Department of Pediatrics, Maine Children’s Cancer Program, Scarborough ME, USA
| | - Elizabeth A. Raetz
- Department of Pediatrics and Perlmutter Cancer Center, New York University Langone Medical Center, New York NY, USA
| | - Michael J. Borowitz
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore MD, USA
| | - Brent L. Wood
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, University of Southern California, CA, USA
| | - William L. Carroll
- Department of Pediatrics and Perlmutter Cancer Center, New York University Langone Medical Center, New York NY, USA
| | | | - Karen R. Rabin
- Department of Pediatrics, Baylor College of Medicine, Houston TX, USA
| | | | - Kelly W. Maloney
- Department of Pediatrics and Children’s Hospital Colorado, University of Colorado, Aurora CO, USA
| | - Stuart S. Winter
- Children’s Minnesota Research Institute and Cancer and Blood Disorders Program, Minneapolis MN, USA
| | - Michael J. Burke
- Division of Pediatric Hematology-Oncology, Medical College of Wisconsin, Milwaukee WI, USA
| | - Wanda Salzer
- Uniformed Services University, School of Medicine, Bethesda, MD, USA
| | | | | | - Kristine R. Crews
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - James R. Downing
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Sima Jeha
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - William E. Evans
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Jun J. Yang
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Mary V. Relling
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Daniela S. Gerhard
- Office of Cancer Genomics, National Cancer Institute, National Institutes of Health, Bethesda MD, USA
| | - Mignon L. Loh
- Department of Pediatrics, Benioff Children’s Hospital and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco CA, USA
| | - Stephen P. Hunger
- Department of Pediatrics and the Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA, USA
| | - Jinghui Zhang
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Charles Mullighan
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis TN, USA
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18
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Mahtani K, Parker M, Wang RB, Maclean E. 1051 EMERGENCY PACEMAKER IMPLANTATION IN NONAGENARIANS: IMPACT OF FRAILTY ON OPERATOR DECISION-MAKING AND PATIENT OUTCOMES. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Complete heart block (CHB) is a time-critical emergency. In frail patients with CHB, the absence of test results or a comprehensive history can challenge operator decision-making; in particular, minimal data exists as to the prognostic impact of single versus dual chamber pacing in this group. In patients over 90 years of age presenting with CHB, we examined the prognostic value of parameters obtained from bedside examination, and analysed the impact of single versus dual chamber pacemakers on mortality.
Method
Data were extracted from 2016–2019. Bedside covariates were age, sex, previous cardiac surgery, atrial rhythm, LV systolic function, syncope at presentation, QRS duration, and Rockwood frailty score. Cox-proportional hazards regression examined associations with all-cause mortality and cardiac death, determined from electronic records and death certificates (adjusted HR, 95% CI).
Results
205 patients were included (age 92.3 ± 2.3 years, 45.4% male). Mortality was 13.8% at 90 days and 27.2% at 27.1 ± 16.7 months. The independent predictors of mortality were pre-procedural QRS duration >130 ms (HR 2.4 (1.4–4.1) p = 0.001), age (HR 1.07 (1.02–1.15) p = 0.004), AF (HR 2.0 (1.1–3.6) p = 0.02), and Rockwood score (HR 1.2 (1.02–2.6), p = 0.043). Sex, syncope at presentation, LV function or previous cardiac surgery did not predict mortality (all p > 0.1). In a subset of 168 patients without AF, 30 (17.8%) received single chamber pacemakers. Whilst these patients were more frail than those receiving dual chamber pacemakers (Rockwood scores: 5.2 ± 1.7 vs 4.3 ± 1.1, p = 0.025), implantation of a single chamber pacemaker was independently associated with cardiac death when adjusting for frailty and co-morbidities (HR 6 (1.4–26.4), p = 0.018).
Conclusion
Nonagenarians undergoing emergency pacemaker implantation have a reasonable prognosis. Data ascertained at the bedside can help predict survival, however—when adjusting for frailty and co-morbidities—dual chamber pacing may confer an independent mortality benefit over single chamber pacing in this group.
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Affiliation(s)
- K Mahtani
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London
| | - M Parker
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London
| | - R B Wang
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London
| | - E Maclean
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London
- Barts Heart Centre, St. Bartholomew’s Hospital
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19
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Joseph A, Clothier W, Hernandez J, Madsen C, Kouam J, Ortiz C, Parker M, Walker J, Lopera J. Abstract No. 86 Distal glue splenic artery embolization versus other embolics: a single-center analysis. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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20
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Derrick K, Ortiz C, Funk P, Dang A, Fanous N, Lugosi S, Bunegin L, Borrego M, Parker M, Walker J, Lopera J. Abstract No. 61 Assessing probe orientation and renal collecting system injury during microwave ablation in a perfused ex vivo porcine model. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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21
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Parker M, Carr B. Electroconvulsive Therapy’s use in Idiopathic Intracranial Hypertension with Mood Disorder: caution, promise, and progress. Eur Psychiatry 2022. [PMCID: PMC9564714 DOI: 10.1192/j.eurpsy.2022.769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Idiopathic Intracranial Hypertension (IIH) is a condition characterized by an increase of intracranial pressure (ICP) with no identifiable cause to date. One-half of patients who suffer from IIH have co-morbid mood disorders, such as Major Depressive Disorder (MDD), that can be refractory to pharmacologic treatment. Electroconvulsive Therapy (ECT) is a safe and effective treatment for treatment-refractory mood disorder, but possesses a relative contra-indication for IIH due to its theoretical increase in ICP. Can ECT become the gold-standard treatment modality for mood disorder from IIH? Objectives We aim to synthesize and summarize the state of the literature surrounding the intersection of ECT and IIH. We will present notable findings and propose avenues for future investigation. Methods We conducted a literature review using PubMed’s search function. Key terms that were queried are as follows: Idiopathic Intracranial Hypertension, Pseudotumor Cerebri, Benign Intracranial Hypertension, Mood Disorder, Major Depressive Disorder, ECT, Electroconvulsive Therapy. Results The prevailing theory of IIH and mood disorder centers around HPA axis dysfunction, which has been heavily theorized to be positively impacted with ECT. ECT itself may not increase the ICP, but the anesthesia might. The only two case reports in the literature presented safe and successful use of ECT’s in patients with IIH and MDD. Conclusions More data is needed to draw conclusions, as the literature surrounding ECT’s use in patients with IIH remains sparse. Further studies must explore whether ECT’s use in IIH remains effective. Through this, we may understand more about both IIH and ECT itself. Disclosure No significant relationships.
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22
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Alanizi A, Parker M, Sorlin A, Wilson D. Utilizing click chemistry for PET infection imaging by fluorine-18 labeling of azide-modified bacteria. Nucl Med Biol 2022. [DOI: 10.1016/s0969-8051(22)00157-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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23
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Bredeson JV, Lyons JB, Oniyinde IO, Okereke NR, Kolade O, Nnabue I, Nwadili CO, Hřibová E, Parker M, Nwogha J, Shu S, Carlson J, Kariba R, Muthemba S, Knop K, Barton GJ, Sherwood AV, Lopez-Montes A, Asiedu R, Jamnadass R, Muchugi A, Goodstein D, Egesi CN, Featherston J, Asfaw A, Simpson GG, Doležel J, Hendre PS, Van Deynze A, Kumar PL, Obidiegwu JE, Bhattacharjee R, Rokhsar DS. Chromosome evolution and the genetic basis of agronomically important traits in greater yam. Nat Commun 2022; 13:2001. [PMID: 35422045 PMCID: PMC9010478 DOI: 10.1038/s41467-022-29114-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 02/08/2022] [Indexed: 12/14/2022] Open
Abstract
The nutrient-rich tubers of the greater yam, Dioscorea alata L., provide food and income security for millions of people around the world. Despite its global importance, however, greater yam remains an orphan crop. Here, we address this resource gap by presenting a highly contiguous chromosome-scale genome assembly of D. alata combined with a dense genetic map derived from African breeding populations. The genome sequence reveals an ancient allotetraploidization in the Dioscorea lineage, followed by extensive genome-wide reorganization. Using the genomic tools, we find quantitative trait loci for resistance to anthracnose, a damaging fungal pathogen of yam, and several tuber quality traits. Genomic analysis of breeding lines reveals both extensive inbreeding as well as regions of extensive heterozygosity that may represent interspecific introgression during domestication. These tools and insights will enable yam breeders to unlock the potential of this staple crop and take full advantage of its adaptability to varied environments.
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Affiliation(s)
- Jessen V Bredeson
- Department of Molecular & Cell Biology, University of California, Berkeley, CA, 94720, USA
| | - Jessica B Lyons
- Department of Molecular & Cell Biology, University of California, Berkeley, CA, 94720, USA
- Innovative Genomics Institute, Berkeley, CA, USA
| | - Ibukun O Oniyinde
- International Institute of Tropical Agriculture, PMB 5320, Oyo Road, Ibadan, Nigeria
| | - Nneka R Okereke
- National Root Crops Research Institute (NRCRI), Umudike, Nigeria
| | - Olufisayo Kolade
- International Institute of Tropical Agriculture, PMB 5320, Oyo Road, Ibadan, Nigeria
| | - Ikenna Nnabue
- National Root Crops Research Institute (NRCRI), Umudike, Nigeria
| | | | - Eva Hřibová
- Institute of Experimental Botany of the Czech Academy of Sciences, Centre of the Region Haná for Biotechnological and Agricultural Research, Šlechtitelů 31, CZ-77900, Olomouc, Czech Republic
| | - Matthew Parker
- School of Life Sciences, University of Dundee, Dundee, UK
| | - Jeremiah Nwogha
- National Root Crops Research Institute (NRCRI), Umudike, Nigeria
| | | | | | - Robert Kariba
- World Agroforestry (CIFOR-ICRAF), Nairobi, Kenya
- African Orphan Crops Consortium, Nairobi, Kenya
| | - Samuel Muthemba
- World Agroforestry (CIFOR-ICRAF), Nairobi, Kenya
- African Orphan Crops Consortium, Nairobi, Kenya
| | - Katarzyna Knop
- School of Life Sciences, University of Dundee, Dundee, UK
| | | | - Anna V Sherwood
- School of Life Sciences, University of Dundee, Dundee, UK
- Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Antonio Lopez-Montes
- International Institute of Tropical Agriculture, PMB 5320, Oyo Road, Ibadan, Nigeria
- International Trade Center, Accra, Ghana
| | - Robert Asiedu
- International Institute of Tropical Agriculture, PMB 5320, Oyo Road, Ibadan, Nigeria
| | - Ramni Jamnadass
- World Agroforestry (CIFOR-ICRAF), Nairobi, Kenya
- African Orphan Crops Consortium, Nairobi, Kenya
| | - Alice Muchugi
- World Agroforestry (CIFOR-ICRAF), Nairobi, Kenya
- African Orphan Crops Consortium, Nairobi, Kenya
| | | | - Chiedozie N Egesi
- International Institute of Tropical Agriculture, PMB 5320, Oyo Road, Ibadan, Nigeria
- National Root Crops Research Institute (NRCRI), Umudike, Nigeria
- Cornell University, Ithaca, NY, 14850, USA
| | | | - Asrat Asfaw
- International Institute of Tropical Agriculture, PMB 5320, Oyo Road, Ibadan, Nigeria
| | - Gordon G Simpson
- School of Life Sciences, University of Dundee, Dundee, UK
- James Hutton Institute, Dundee, UK
| | - Jaroslav Doležel
- Institute of Experimental Botany of the Czech Academy of Sciences, Centre of the Region Haná for Biotechnological and Agricultural Research, Šlechtitelů 31, CZ-77900, Olomouc, Czech Republic
| | - Prasad S Hendre
- World Agroforestry (CIFOR-ICRAF), Nairobi, Kenya
- African Orphan Crops Consortium, Nairobi, Kenya
| | | | - Pullikanti Lava Kumar
- International Institute of Tropical Agriculture, PMB 5320, Oyo Road, Ibadan, Nigeria
| | - Jude E Obidiegwu
- National Root Crops Research Institute (NRCRI), Umudike, Nigeria.
| | - Ranjana Bhattacharjee
- International Institute of Tropical Agriculture, PMB 5320, Oyo Road, Ibadan, Nigeria.
| | - Daniel S Rokhsar
- Department of Molecular & Cell Biology, University of California, Berkeley, CA, 94720, USA.
- Innovative Genomics Institute, Berkeley, CA, USA.
- DOE Joint Genome Institute, Berkeley, CA, USA.
- Okinawa Institute of Science and Technology, Onna, Okinawa, Japan.
- Chan-Zuckerberg BioHub, 499 Illinois St., San Francisco, CA, 94158, USA.
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24
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Berman M, Ali A, Macklam D, Garcia Saez D, Jothidasan A, Husain M, Stock U, Mehta V, Venkateswaran R, Curry P, Messer S, Mukadam M, Mascaro J, Clarke S, Baxter J, Tsui S, Large S, Osman M, Kaul P, Boda G, Jenkins D, Simmonds J, Quigley R, Whitney J, Gardiner D, Watson C, Rubino A, Currie I, Foley J, Macleod A, Slater C, Marley F, Downward L, Rushton S, Armstrong L, Ayton L, Ryan M, Parker M, Gibson S, Spence S, Quinn K, Watson S, Forsythe J. UK National DCD Heart Transplant Program - First Year Experience. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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25
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Boshier FAT, Pang J, Penner J, Parker M, Alders N, Bamford A, Grandjean L, Grunewald S, Hatcher J, Best T, Dalton C, Bynoe PD, Frauenfelder C, Köeglmeier J, Myerson P, Roy S, Williams R, de Silva TI, Goldstein RA, Breuer J. Evolution of viral variants in remdesivir-treated and untreated SARS-CoV-2-infected pediatrics patients. J Med Virol 2022; 94:161-172. [PMID: 34415583 PMCID: PMC8426849 DOI: 10.1002/jmv.27285] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/04/2021] [Accepted: 08/18/2021] [Indexed: 11/07/2022]
Abstract
Detailed information on intrahost viral evolution in SARS-CoV-2 with and without treatment is limited. Sequential viral loads and deep sequencing of SARS-CoV-2 from the upper respiratory tract of nine hospitalized children, three of whom were treated with remdesivir, revealed that remdesivir treatment suppressed viral load in one patient but not in a second infected with an identical strain without any evidence of drug resistance found. Reduced levels of subgenomic RNA during treatment of the second patient, suggest an additional effect of remdesivir on viral replication. Haplotype reconstruction uncovered persistent SARS-CoV-2 variant genotypes in four patients. These likely arose from within-host evolution, although superinfection cannot be excluded in one case. Although our dataset is small, observed sample-to-sample heterogeneity in variant frequencies across four of nine patients suggests the presence of discrete viral populations in the lung with incomplete population sampling in diagnostic swabs. Such compartmentalization could compromise the penetration of remdesivir into the lung, limiting the drugs in vivo efficacy, as has been observed in other lung infections.
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Affiliation(s)
- Florencia A. T. Boshier
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Juanita Pang
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
- Division of Infection and ImmunityUniversity College LondonLondonUK
| | - Justin Penner
- Department of Infectious DiseaseGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Matthew Parker
- Department of Infection, Immunity and Cardiovascular Diseases, The Florey InstituteUniversity of SheffieldSheffieldUK
| | - Nele Alders
- Department of Infectious DiseaseGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Alasdair Bamford
- Department of Infectious DiseaseGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Louis Grandjean
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Stephanie Grunewald
- Department of Metabolic MedicineUCL Great Ormond Street Institute of Child HealthLondonUK
| | - James Hatcher
- Department of MicrobiologyGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Timothy Best
- Department of MicrobiologyGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Caroline Dalton
- Department of PharmacyGreat Ormond Street Hospital for Children NHS TrustLondonUK
| | - Patricia Dyal Bynoe
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Claire Frauenfelder
- Department of EarsNose and Throat, Great Ormond Street Hospital for Children NHS Foundation TrustLondonUK
- Division of SurgeryUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Jutta Köeglmeier
- Department of GastroenterologyGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Phoebe Myerson
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Sunando Roy
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Rachel Williams
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Thushan I. de Silva
- Department of Infection, Immunity and Cardiovascular Diseases, The Florey InstituteUniversity of SheffieldSheffieldUK
| | | | - Judith Breuer
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
- Department of MicrobiologyGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
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26
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Boshier FAT, Venturini C, Stirrup O, Guerra-Assunção JA, Alcolea-Medina A, Becket AH, Byott M, Charalampous T, Filipe ADS, Frampton D, Glaysher S, Khan T, Kulasegara-Shylini R, Kele B, Monahan IM, Mollett G, Parker M, Pelosi E, Randell P, Roy S, Taylor JF, Weller SJ, Wilson-Davies E, Wade P, Williams R, Copas AJ, Cutino-Moguel T, Freemantle N, Hayward AC, Holmes A, Hughes J, Mahungu TW, Nebbia G, Nastouli E, Partridge DG, Pope CF, Price JR, Robson SC, Saeed K, Shin GY, de Silva TI, Snell LB, Thomson EC, Witney AA, Breuer J. The Alpha variant was not associated with excess nosocomial SARS-CoV-2 infection in a multi-centre UK hospital study. J Infect 2021; 83:693-700. [PMID: 34610391 PMCID: PMC8487101 DOI: 10.1016/j.jinf.2021.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/12/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Recently emerging SARS-CoV-2 variants have been associated with an increased rate of transmission within the community. We sought to determine whether this also resulted in increased transmission within hospitals. METHODS We collected viral sequences and epidemiological data of patients with community and healthcare associated SARS-CoV-2 infections, sampled from 16th November 2020 to 10th January 2021, from nine hospitals participating in the COG-UK HOCI study. Outbreaks were identified using ward information, lineage and pairwise genetic differences between viral sequences. RESULTS Mixed effects logistic regression analysis of 4184 sequences showed healthcare-acquired infections were no more likely to be identified as the Alpha variant than community acquired infections. Nosocomial outbreaks were investigated based on overlapping ward stay and SARS-CoV-2 genome sequence similarity. There was no significant difference in the number of patients involved in outbreaks caused by the Alpha variant compared to outbreaks caused by other lineages. CONCLUSIONS We find no evidence to support it causing more nosocomial transmission than previous lineages. This suggests that the stringent infection prevention measures already in place in UK hospitals contained the spread of the Alpha variant as effectively as other less transmissible lineages, providing reassurance of their efficacy against emerging variants of concern.
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Affiliation(s)
- Florencia A T Boshier
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Cristina Venturini
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Oliver Stirrup
- Institute for Global Health, University College London, London, United Kingdom
| | - José Afonso Guerra-Assunção
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom; Department of Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Adela Alcolea-Medina
- Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Infection Sciences, Viapath, London, United Kingdom
| | - Angela H Becket
- Centre for Enzyme Innovation, University of Portsmouth, Portsmouth PO1 2DT, United Kingdom; School of Biological Sciences, University of Portsmouth, Portsmouth PO1 2DY, United Kingdom
| | - Matthew Byott
- Advanced Pathogen Diagnostics Unit, University College London Hospitals NHS Foundation Trust, London, United Kingdom; The Francis Crick Institute, London, United Kingdom
| | - Themoula Charalampous
- Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
| | - Ana da Silva Filipe
- MRC-University of Glasgow Centre for Virus Research, Glasgow, United Kingdom
| | - Dan Frampton
- Advanced Pathogen Diagnostics Unit, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Division of Infection and Immunity, University College London, London, United Kingdom
| | - Sharon Glaysher
- Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Portsmouth PO6 3LY, United Kingdom
| | - Tabassum Khan
- Division of Infection, The Royal London Hospital, Barts Health, United Kingdom
| | | | - Beatrix Kele
- Division of Infection, The Royal London Hospital, Barts Health, United Kingdom
| | - Irene M Monahan
- Institute for Infection and Immunity, St George's University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
| | - Guy Mollett
- MRC-University of Glasgow Centre for Virus Research, Glasgow, United Kingdom
| | - Matthew Parker
- Sheffield Bioinformatics Core, The University of Sheffield, Sheffield, United Kingdom; Sheffield Institute for Translational Neuroscience, The University of Sheffield, Sheffield, United Kingdom; Sheffield Biomedical Research Centre, The University of Sheffield, Sheffield, United Kingdom
| | - Emanuela Pelosi
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Paul Randell
- Department of Infection and Immunity, North West London Pathology, London, United Kingdom
| | - Sunando Roy
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Joshua F Taylor
- Department of Microbiology, South West London Pathology, Jenner Wing, St. George's Hospital, Blackshaw Road, London SW17 0QT, United Kingdom
| | - Sophie J Weller
- Department of Virology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Eleri Wilson-Davies
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Phillip Wade
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The Florey Institute for Host-Pathogen Interactions and Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Rachel Williams
- Department of Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Andrew J Copas
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Nick Freemantle
- Institute for Clinical Trials and Methodology, University College London, London, United Kingdom
| | - Andrew C Hayward
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Alison Holmes
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, United Kingdom; Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Joseph Hughes
- MRC-University of Glasgow Centre for Virus Research, Glasgow, United Kingdom
| | - Tabitha W Mahungu
- Department of Virology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Gaia Nebbia
- Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Department of Infectious Diseases, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Eleni Nastouli
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom; Advanced Pathogen Diagnostics Unit, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Department of Clinical Virology, University College London Hospitals NHS Foundation Trust, London, United Kingdom; The Francis Crick Institute, London, United Kingdom
| | - David G Partridge
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The Florey Institute for Host-Pathogen Interactions and Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Cassie F Pope
- Institute for Infection and Immunity, St George's University of London, Cranmer Terrace, London SW17 0RE, United Kingdom; Infection Care Group, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, United Kingdom
| | - James R Price
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Samuel C Robson
- Centre for Enzyme Innovation, University of Portsmouth, Portsmouth PO1 2DT, United Kingdom; School of Biological Sciences, University of Portsmouth, Portsmouth PO1 2DY, United Kingdom; School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth PO1 2DT, United Kingdom
| | - Kordo Saeed
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, United Kingdom; Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, Tremona Road, Southampton, United Kingdom
| | - Gee Yen Shin
- Department of Clinical Virology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Thushan I de Silva
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The Florey Institute for Host-Pathogen Interactions and Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Luke B Snell
- Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Department of Infectious Diseases, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Emma C Thomson
- MRC-University of Glasgow Centre for Virus Research, Glasgow, United Kingdom
| | - Adam A Witney
- Institute for Infection and Immunity, St George's University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
| | - Judith Breuer
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom; Department of Microbiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
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27
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Odedra A, Allchorne P, Parker M, Lee J, Moyo-Gnahui S, Green J. 564 Freedom from Urethral Catherisation – Using QI Methodology to Improve Patient Outcome and Experiences. Br J Surg 2021. [DOI: 10.1093/bjs/znab258.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
To reduce catheter burden on patients who could instead be free of urethral catheter and taught intermittent self-catheterisation (ISC).
Method
2 PDSA (Plan, Do, Study, Act) cycles were performed over a 21-month period from February 2018 to November 2020. Using multiple nurse-led TWOC clinics, data was extracted using nurse-completed proformas and electronic patient records to determine: TWOC rate; urethral catheter-free rate; and ISC rate. Following baseline measurement, interventions were made, such as centralisation of TWOC services, emphasis on ISC teaching and the introduction of industry-nurse led clinics.
Results
At baseline, TWOC rate, urethral catheter-free rate and ISC rate were 55.7%, 68% and 28.2%, respectively. Following centralisation of TWOC services and emphasis on ISC teaching in Cycle 1, urethral catheter-free rate rose to 77.8% whilst ISC rate fell to 25%. Cycle 2 followed the introduction of industry-nurse led clinics. Following this, urethral catheter-free rate rose further to 81.6%, with ISC rate rising dramatically to 56.3%
Conclusions
To those capable, ISC frees patients of catheter burden and its sequalae. Evidently, a greater onus on ISC training will increase the number of patients left catheter-free.
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Affiliation(s)
- A Odedra
- Whipps Cross University Hospital, Barts Health NHS Trust, London, United Kingdom
| | - P Allchorne
- Whipps Cross University Hospital, Barts Health NHS Trust, London, United Kingdom
| | - M Parker
- Whipps Cross University Hospital, Barts Health NHS Trust, London, United Kingdom
| | - J Lee
- Whipps Cross University Hospital, Barts Health NHS Trust, London, United Kingdom
| | - S Moyo-Gnahui
- Whipps Cross University Hospital, Barts Health NHS Trust, London, United Kingdom
| | - J Green
- Whipps Cross University Hospital, Barts Health NHS Trust, London, United Kingdom
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Emtenani S, Ghorbanalipoor S, Parker M, Kamaguchi M, Osterloh C, Pigors M, Patzelt S, Chakievska L, Bieber K, Osman I, Izumi K, Smith P, Schmidt E, Ludwig R. 018 Cutaneous kinase activity correlates with treatment outcomes following PI3K delta inhibition in mice with experimental pemphigoid diseases. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.08.019] [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: 11/15/2022]
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Stirrup O, Boshier F, Venturini C, Guerra-Assunção JA, Alcolea-Medina A, Beckett A, Charalampous T, da Silva Filipe A, Glaysher S, Khan T, Kulasegaran Shylini R, Kele B, Monahan I, Mollett G, Parker M, Pelosi E, Randell P, Roy S, Taylor J, Weller S, Wilson-Davies E, Wade P, Williams R, Copas A, Cutino-Moguel MT, Freemantle N, Hayward AC, Holmes A, Hughes J, Mahungu T, Nebbia G, Partridge D, Pope C, Price J, Robson S, Saeed K, de Silva T, Snell L, Thomson E, Witney AA, Breuer J. SARS-CoV-2 lineage B.1.1.7 is associated with greater disease severity among hospitalised women but not men: multicentre cohort study. BMJ Open Respir Res 2021; 8:e001029. [PMID: 34544733 PMCID: PMC8453594 DOI: 10.1136/bmjresp-2021-001029] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 06/21/2021] [Accepted: 08/08/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND SARS-CoV-2 lineage B.1.1.7 has been associated with an increased rate of transmission and disease severity among subjects testing positive in the community. Its impact on hospitalised patients is less well documented. METHODS We collected viral sequences and clinical data of patients admitted with SARS-CoV-2 and hospital-onset COVID-19 infections (HOCIs), sampled 16 November 2020 to 10 January 2021, from eight hospitals participating in the COG-UK-HOCI study. Associations between the variant and the outcomes of all-cause mortality and intensive therapy unit (ITU) admission were evaluated using mixed effects Cox models adjusted by age, sex, comorbidities, care home residence, pregnancy and ethnicity. FINDINGS Sequences were obtained from 2341 inpatients (HOCI cases=786) and analysis of clinical outcomes was carried out in 2147 inpatients with all data available. The HR for mortality of B.1.1.7 compared with other lineages was 1.01 (95% CI 0.79 to 1.28, p=0.94) and for ITU admission was 1.01 (95% CI 0.75 to 1.37, p=0.96). Analysis of sex-specific effects of B.1.1.7 identified increased risk of mortality (HR 1.30, 95% CI 0.95 to 1.78, p=0.096) and ITU admission (HR 1.82, 95% CI 1.15 to 2.90, p=0.011) in females infected with the variant but not males (mortality HR 0.82, 95% CI 0.61 to 1.10, p=0.177; ITU HR 0.74, 95% CI 0.52 to 1.04, p=0.086). INTERPRETATION In common with smaller studies of patients hospitalised with SARS-CoV-2, we did not find an overall increase in mortality or ITU admission associated with B.1.1.7 compared with other lineages. However, women with B.1.1.7 may be at an increased risk of admission to intensive care and at modestly increased risk of mortality.
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Affiliation(s)
- Oliver Stirrup
- Institute for Global Health, University College London, London, UK
| | - Florencia Boshier
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Cristina Venturini
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - José Afonso Guerra-Assunção
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Genetics & Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Adela Alcolea-Medina
- Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King's College London, London, UK
- Infection Sciences, Viapath, London, UK
| | - Angela Beckett
- Centre for Enzyme Innovation, University of Portsmouth, Portsmouth, UK
- School of Biological Sciences, University of Portsmouth, Portsmouth, UK
| | - Themoula Charalampous
- Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King's College London, London, UK
| | | | - Sharon Glaysher
- Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
| | - Tabassum Khan
- Division of Infection, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | - Beatrix Kele
- Division of Infection, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Irene Monahan
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Guy Mollett
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Matthew Parker
- Sheffield Bioinformatics Core, The University of Sheffield, Sheffield, UK
- Sheffield Institute for Translational Neuroscience, The University of Sheffield, Sheffield, UK
- Sheffield Biomedical Research Centre, The University of Sheffield, Sheffield, UK
| | - Emanuela Pelosi
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paul Randell
- Department of Infection and Immunity, North West London Pathology, London, UK
| | - Sunando Roy
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Joshua Taylor
- Department of Microbiology, South West London Pathology, St. George's Hospital, London, UK
| | - Sophie Weller
- Department of Virology, Royal Free London NHS Foundation Trust, London, UK
| | - Eleri Wilson-Davies
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Phillip Wade
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- The Florey Institute for Host-Pathogen Interactions & Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, UK
| | - Rachel Williams
- Department of Genetics & Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | | | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Andrew C Hayward
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Alison Holmes
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Joseph Hughes
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Tabitha Mahungu
- Department of Virology, Royal Free London NHS Foundation Trust, London, UK
| | - Gaia Nebbia
- Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King's College London, London, UK
- Department of Infectious Diseases, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - David Partridge
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- The Florey Institute for Host-Pathogen Interactions & Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, UK
| | - Cassie Pope
- Institute for Infection and Immunity, St George's University of London, London, UK
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK
| | - James Price
- Imperial College Healthcare NHS Trust, London, UK
| | - Samuel Robson
- Centre for Enzyme Innovation, University of Portsmouth, Portsmouth, UK
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Kordo Saeed
- Microbiology Innovation and Research Unit (MIRU), Department of Microbiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Thushan de Silva
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- The Florey Institute for Host-Pathogen Interactions & Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, UK
| | - Luke Snell
- Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King's College London, London, UK
- Department of Infectious Diseases, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Emma Thomson
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Adam A Witney
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Judith Breuer
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Microbiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Loarce-Martos J, Lilleker JB, Parker M, McHugh N, Chinoy H. Polymyositis: is there anything left? A retrospective diagnostic review from a tertiary myositis centre. Rheumatology (Oxford) 2021; 60:3398-3403. [PMID: 33367878 DOI: 10.1093/rheumatology/keaa801] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 08/16/2020] [Revised: 11/03/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The current classification criteria for idiopathic inflammatory myopathy (IIM) retain PM as a major disease subgroup. However, evolution in the understanding of IIM has suggested that many of these patients could be better described as having an alternative diagnosis. In the present study, we apply the latest understanding of IIM subtyping to retrospectively review PM diagnoses in a large cohort of IIM patients. METHODS Within a previously reported cohort of 255 patients from a UK tertiary myositis clinic, 37 patients classified as PM according to both the EULAR/ACR IIM criteria and expert opinion were identified. Clinical data and complementary tests were reviewed, and consensus decisions regarding final classification were reached in each case. RESULTS Nine (9/37, 24.3%) patients remained classified as PM, 3.5% (9/255) of the original cohort; these PM patients were seronegative for myositis antibodies, responsive to immunosuppression, and in 4/7 (57.1%) patients where muscle biopsy was performed had HLA-1 upregulation and endomysial inflammatory infiltrates. Immune-mediated necrotizing myopathy (5/37, 13.5%) and connective tissue disease overlap myositis (7/37, 19%) were the main alternative diagnoses. The remaining patients were diagnosed as: unspecified myopathy (6/37, 16%), dermatomyositis (2/37, 5%), cancer-associated myopathy (3/37, 8.1%), and non-inflammatory myopathy (1/37, 3%, myofibrillar myopathy). Four patients (4/37, 10%) had insufficient data available to confidently reclassify. CONCLUSION Our study confirms that PM can now be considered a rare IIM subgroup. A thorough examination, complete myositis autoantibody panel, and careful interpretation of the biopsy results is recommended to confirm the correct IIM sub-type.
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Affiliation(s)
- Jesus Loarce-Martos
- Rheumatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - James B Lilleker
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Manchester Centre for Clinical Neuroscience, Salford Royal NHS Foundation Trust, Salford, UK
| | - Matthew Parker
- Department of Rheumatology, RPA Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Neil McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
- Royal National Hospital for Rheumatic Disease, Bath, UK
| | - Hector Chinoy
- National Institute for Health Research Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
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Stirrup O, Hughes J, Parker M, Partridge DG, Shepherd JG, Blackstone J, Coll F, Keeley A, Lindsey BB, Marek A, Peters C, Singer JB, Tamuri A, de Silva TI, Thomson EC, Breuer J. Rapid feedback on hospital onset SARS-CoV-2 infections combining epidemiological and sequencing data. eLife 2021; 10:e65828. [PMID: 34184637 PMCID: PMC8285103 DOI: 10.7554/elife.65828] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 12/16/2020] [Accepted: 06/25/2021] [Indexed: 12/29/2022] Open
Abstract
Background Rapid identification and investigation of healthcare-associated infections (HCAIs) is important for suppression of SARS-CoV-2, but the infection source for hospital onset COVID-19 infections (HOCIs) cannot always be readily identified based only on epidemiological data. Viral sequencing data provides additional information regarding potential transmission clusters, but the low mutation rate of SARS-CoV-2 can make interpretation using standard phylogenetic methods difficult. Methods We developed a novel statistical method and sequence reporting tool (SRT) that combines epidemiological and sequence data in order to provide a rapid assessment of the probability of HCAI among HOCI cases (defined as first positive test >48 hr following admission) and to identify infections that could plausibly constitute outbreak events. The method is designed for prospective use, but was validated using retrospective datasets from hospitals in Glasgow and Sheffield collected February-May 2020. Results We analysed data from 326 HOCIs. Among HOCIs with time from admission ≥8 days, the SRT algorithm identified close sequence matches from the same ward for 160/244 (65.6%) and in the remainder 68/84 (81.0%) had at least one similar sequence elsewhere in the hospital, resulting in high estimated probabilities of within-ward and within-hospital transmission. For HOCIs with time from admission 3-7 days, the SRT probability of healthcare acquisition was >0.5 in 33/82 (40.2%). Conclusions The methodology developed can provide rapid feedback on HOCIs that could be useful for infection prevention and control teams, and warrants further prospective evaluation. The integration of epidemiological and sequence data is important given the low mutation rate of SARS-CoV-2 and its variable incubation period. Funding COG-UK HOCI funded by COG-UK consortium, supported by funding from UK Research and Innovation, National Institute of Health Research and Wellcome Sanger Institute.
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Affiliation(s)
- Oliver Stirrup
- Institute for Global Health, University College LondonLondonUnited Kingdom
| | - Joseph Hughes
- MRC-University of Glasgow Centre for Virus ResearchGlasgowUnited Kingdom
| | - Matthew Parker
- Sheffield Bioinformatics Core, The University of SheffieldSheffieldUnited Kingdom
- Sheffield Institute for Translational Neuroscience, The University of SheffieldSheffieldUnited Kingdom
- Sheffield Biomedical Research Centre, The University of SheffieldSheffieldUnited Kingdom
| | - David G Partridge
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUnited Kingdom
- The Florey Institute for Host-Pathogen Interactions & Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of SheffieldSheffieldUnited Kingdom
| | - James G Shepherd
- MRC-University of Glasgow Centre for Virus ResearchGlasgowUnited Kingdom
| | - James Blackstone
- The Comprehensive Clinical Trials Unit at UCL , University College LondonLondonUnited Kingdom
| | - Francesc Coll
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | - Alexander Keeley
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUnited Kingdom
- The Florey Institute for Host-Pathogen Interactions & Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of SheffieldSheffieldUnited Kingdom
| | - Benjamin B Lindsey
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUnited Kingdom
- The Florey Institute for Host-Pathogen Interactions & Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of SheffieldSheffieldUnited Kingdom
| | - Aleksandra Marek
- Clinical Microbiology, NHS Greater Glasgow and ClydeGlasgowUnited Kingdom
| | - Christine Peters
- Clinical Microbiology, NHS Greater Glasgow and ClydeGlasgowUnited Kingdom
| | - Joshua B Singer
- MRC-University of Glasgow Centre for Virus ResearchGlasgowUnited Kingdom
| | | | - Asif Tamuri
- Research Computing, University College LondonLondonUnited Kingdom
| | - Thushan I de Silva
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUnited Kingdom
- The Florey Institute for Host-Pathogen Interactions & Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of SheffieldSheffieldUnited Kingdom
| | - Emma C Thomson
- MRC-University of Glasgow Centre for Virus ResearchGlasgowUnited Kingdom
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of GlasgowGlasgowUnited Kingdom
- Department of Infectious Diseases, Queen Elizabeth University HospitalGlasgowUnited Kingdom
| | - Judith Breuer
- Division of Infection and Immunity, University College LondonLondonUnited Kingdom
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Ortiz C, Bitar R, Garza L, Parker M, Hyman C, Suri R, Song H, Walker J, Lopera J. Abstract No. 171 Validating an ex-vivo bovine kidney pulsatile perfusion model with micro-CT evaluation of distal angioembolization. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.177] [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: 10/21/2022] Open
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Parker M. Repurposing the CRISPR‐Cas9 System for Targeted Chromatin
O
‐linked β‐
N
‐acetylglucosamine Editing. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.03709] [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: 11/11/2022]
Affiliation(s)
- Matthew Parker
- Biochemistry and Molecular BiologyKansas University Medical CenterKansas CityKS
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34
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Smith M, Quirarte J, Seiber J, Hyman C, Parker M, Ortiz C, Walker J, Kroma G. Abstract No. 224 Evaluation of integrated interventional radiology residency websites: comparative cross-sectional analysis from 2017 to 2020. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Bitar R, Ortiz C, Garza L, Parker M, Lopera J, Walker J, Phillips W. Abstract No. 36 A novel method for loading Tc-99m and R-186 into alginate microspheres for radioembolization. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.452] [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: 10/21/2022] Open
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36
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Mahagaokar K, Wong C, Balsam L, Rade J, Parker M. SYMPTOMATIC ANGINA IN A PATIENT WITH CORONARY ARTERY ANEURYSMS AND MULTIVESSEL CORONARY ARTERY DISEASE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03797-9] [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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Garza L, Ding E, Krishnakumar H, Parker M, Hyman C, Ortiz C, Walker J. Abstract No. 154 Medical crowdfunding for interventional oncology treatments. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.160] [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: 10/21/2022] Open
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Garza L, Bitar R, O'Donnell B, Parker M, Ortiz C, Hyman C, Walker J, Song HY, Lopera J. Creation of an ex-vivo bovine kidney flow model for testing embolic agents: work in progress. CVIR Endovasc 2021; 4:20. [PMID: 33534088 PMCID: PMC7859154 DOI: 10.1186/s42155-021-00210-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/27/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives To develop an ex- vivo perfusion flow model using a bovine kidney for future testing of embolic agents in an inexpensive and easy way. Methods Six bovine adult kidneys were used for this study. Kidneys were cannulated and perfused via a roller pump. Three embolic agents, coils, Gelfoam, and a glue mixture of Histoacryl + Lipiodol, were deployed by targeting three secondary segmental arteries per kidney via a 5Fr catheter under fluoroscopic guidance. Cannulation time, success rate of segmental artery selection and embolic agent deployment, total operational time, and fluoroscopy dose were recorded. Results Average kidney weight was 0.752 +/− 0.094 kg. All six bovine kidneys were successfully cannulated in 21.6 min +/− 3.0 min. Deployment of coils and glue was achieved in every case (12/12); however, Gelfoam injection was not successful in one instance (5/6, 83%). Coil deployment demonstrated no embolic effect while Gelfoam and glue injections demonstrated decreased distal contrast filling post-embolization. Mean dose area product was 12.9 ± 1.8 Gy·cm2, fluoroscopy time was 10 ± 4 min and operational time was 27 ± 8 min. Conclusions We describe the creation of an ex vivo bovine kidney flow model for the preclinical evaluation of different embolic materials. The flow model can be modified to provide extensive bench testing and it is a promising tool for hands -on training in basic and advanced embolization techniques .
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Affiliation(s)
- Luis Garza
- Long School of Medicine, University of Texas Health Science Center, 7703 Floyd Curl Drive San Antonio, San Antonio, TX, 78229, USA
| | - Ryan Bitar
- Long School of Medicine, University of Texas Health Science Center, 7703 Floyd Curl Drive San Antonio, San Antonio, TX, 78229, USA
| | - Barrett O'Donnell
- Department of Radiology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Matthew Parker
- Department of Radiology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Carlos Ortiz
- Department of Radiology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Charles Hyman
- Department of Radiology, University of Texas Health Science Center, San Antonio, TX, USA
| | - John Walker
- Department of Radiology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Ho-Young Song
- Department of Radiology, University of Texas Health Science Center, San Antonio, TX, USA.,Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jorge Lopera
- Long School of Medicine, University of Texas Health Science Center, 7703 Floyd Curl Drive San Antonio, San Antonio, TX, 78229, USA. .,Department of Radiology, University of Texas Health Science Center, San Antonio, TX, USA.
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Qureshi WT, Parker M, Walker J, Kakouros N. Equipment entrapment during redo-TAVR with successful BASILICA procedure. Catheter Cardiovasc Interv 2021; 98:E320-E323. [PMID: 33484070 DOI: 10.1002/ccd.29485] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/08/2021] [Indexed: 11/08/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) for transcatheter heart valve failure has been suggested for high-risk patients. TAVR-in-TAVR, however, may lead to complex leaflet interactions causing coronary ostial obstruction, which is a devastating complication. Coronary protection with provisional stent placement may be challenging. We describe the first percutaneous transaxillary case of TAVR-in-TAVR with Bioprosthetic Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction (BASILICA) where guide catheters used for coronary protection were entrapped between the valve frames. We describe anatomical predictors and management considerations. Operators should be aware of this important complication during TAVR-in-TAVR valve placement.
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Affiliation(s)
- Waqas T Qureshi
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Matthew Parker
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jennifer Walker
- Division of Cardiothoracic Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Nikolaos Kakouros
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Thirion P, Dunne M, Parker I, Small C, Shannon A, Clayton-Lea A, Parker M, Collins C, Coffey J, Elbeltagi N, Fitzpatrick D, McArdle O, Stevenson M, Alvarez-Iglesias A, Moriarty M, Salib O, Gillham C, Armstrong J. CTRIAL-IE (ICORG) 07-11: Phase II Trial Evaluating Radiobiological Based Reirradiation Strategy for Patients with Malignant Spinal Cord Compression. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Fergus CA, Allen T, Parker M, Pearson G, Storer L, Dawson K. Localising evidence for decision-making: participatory approach to inform schistosomiasis control. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The linear theories of change which ground many interventions do not account for the complex processes and systems in which they are implemented. This reductionist approach prioritises statistical methods which do not accommodate the stochastic, non-linear, dynamic interactions between humans and their environment. The inclusion of practitioners in the process of evidence development and utilisation of complex systems methods mitigates these issues and results in locally relevant, timely evidence for decision-making.
Methods
The aim of this work was to develop localised evidence for decision-making for schistosomiasis control in Uganda, Malawi, and Tanzania. Workshops were conducted with practitioners from the Ministries of Health at various levels and partner organisations to identify evidence needs for their decision-making processes and perceptions of disease transmission and control activities. Participatory systems mapping was used to identify factors directly and indirectly related to transmission. The maps were synthesised to a master complex systems map, which served as the blueprint for a generalised spatial agent-based model and specific ABMs tailored to the evidence needs of decision-makers.
Results
There was a gap in available evidence for practitioners to advocate for resources within the MoH and government budgets, as well as intervention efficacy and resource allocation. The adaptable and data-inclusive characteristics of the AMBs made them well-suited to produce localised outputs. Converted to NetLogo with a tailored user interface, these models were appropriate and responsive to the needs of decision-makers from village to national levels and across country contexts.
Conclusions
Used together, participatory and agent-based modelling resulted in the development of responsive and relevant evidence for practitioner decision-making. This process is generalisable and transferable to other diseases and locations outside of those in this study.
Key messages
The use of participatory systems mapping to develop agent-based models resulted in relevant and timely evidence for practitioner decision-making. The approach used here is transferable and generalisable outside schistosomiasis control and the contexts in this study.
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Affiliation(s)
- C A Fergus
- Firoz Lalji Centre for Africa, London School of Economics and Political Science, London, UK
- Department of International Development, London School of Economics and Political Science, London, UK
| | - T Allen
- Firoz Lalji Centre for Africa, London School of Economics and Political Science, London, UK
- Department of International Development, London School of Economics and Political Science, London, UK
| | - M Parker
- Department of Global Health and Development, LSHTM, London, UK
| | - G Pearson
- Firoz Lalji Centre for Africa, London School of Economics and Political Science, London, UK
| | - L Storer
- Firoz Lalji Centre for Africa, London School of Economics and Political Science, London, UK
| | - K Dawson
- Firoz Lalji Centre for Africa, London School of Economics and Political Science, London, UK
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Pearson G, Parker M, Storer E, Allen T, Fergus C. Participatory systems mapping for localised evidence and decision-making: helminth control, SSA. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Evidence-informed decision-making to assist public health practitioners in local-level programme implementation requires adaptive approaches to research, policy and practice. To address these needs there is focus on using participatory methods. Adopting such methods, this research asks: what are the evidence needs of local public health practitioners? How do evidence and decision-making processes interact? We reflect on the process of using Participatory Systems Mapping (PSM) and implications for localising evidence-informed decision-making.
Methods
We conducted workshops with district and national-level MoH personnel in Uganda and Malawi using PSM to elicit insights into local modes of schistosomiasis transmission and control, and group discussions on evidence needs and use in implementing control programmes. PSM maps are analysed, triangulated with thematic analysis of group discussion transcripts.
Results
Analysing PSM outputs alongside discussions on evidence provides critical methodological and policy insights with implications for localised evidence and decision-making. Further insights into the local dynamics of public health decision-making are gained by triangulating PSM with discussions on the meanings and importance of 'factors' identified. Information which is accessible and useful for local practitioner's decision-making in implementing disease control measures does not always align with academic production and dissemination of evidence, nor across levels where policy is produced or implemented.
Conclusions
An array of factors influence local decision-making with implications for global health policies and practices such as for schistosomiasis control. Processes of decision-making and evidence needs of local practitioners need to be better understood within broader context. Evidence and knowledge production on health interventions rarely feedback or respond to local implementation needs, decision-making practices and public health practitioners.
Key messages
Processes of decision-making and evidence needs of local practitioners need to be better understood within broader context. Evidence and knowledge production on health interventions rarely feedback or respond to local implementation needs, decision-making practices and public health practitioners.
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Affiliation(s)
- G Pearson
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
- Firoz Lalji Centre for Africa, London School of Economics and Political Science, London, UK
| | - M Parker
- Department of Global Health and Development, LSHTM, London, UK
| | - E Storer
- Firoz Lalji Centre for Africa, London School of Economics and Political Science, London, UK
| | - T Allen
- Firoz Lalji Centre for Africa, London School of Economics and Political Science, London, UK
| | - C Fergus
- Firoz Lalji Centre for Africa, London School of Economics and Political Science, London, UK
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O'Connor A, Krucien N, Cantillon P, Parker M, McCurtin A. Investigating physiotherapy stakeholders' preferences for the development of performance-based assessment in practice education. Physiotherapy 2020; 108:46-54. [PMID: 32711227 DOI: 10.1016/j.physio.2020.04.003] [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: 05/23/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Discrete choice experiments (DCEs) are used in healthcare to measure the relative importance that stakeholders give to different features (or attributes) of medical treatments or services. They may also help to address research questions in health professional education. Several challenges exist regarding the performance-based assessment process (PBA) employed in physiotherapy practice-based education, a process which determines students' readiness for independent practice. Evidence highlights many commonalities among these challenges, but it is unknown which factors are the most important to stakeholders. The use of DCE methodology may provide answers and help to prioritise areas for development. Thus, this study employed DCE to identify clinical educators', practice tutors and physiotherapy students' preferences for developing the PBA process in physiotherapy. DESIGN Attributes (aspects of the PBA process known to be important to stakeholders) were derived from focus group interviews conducted with three groups; physiotherapy students, clinical educators (practising clinicians) and practice tutors (dedicated educational roles in the workplace). These attributes included the PBA tool, grading mechanisms, assessors involved, and, feedback mechanisms. Preferences for each group were calculated using a logistic regression model. RESULTS Seventy-two students, 124 clinical educators and 49 practice tutors (n=245) participated. Priorities identified centred primarily on the mandatory inclusion of two assessors in the PBA process and on refinement of the PBA tool. CONCLUSION Employment of DCE enabled the prioritisation of stakeholder-informed challenges related to PBA in physiotherapy practice-based education. This corroborates findings from previous qualitative work and facilitates a prioritised pathway for development of this process.
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Affiliation(s)
- A O'Connor
- School of Allied Health, Health Sciences Building, University of Limerick, Castletroy, Limerick V94 T9PX, Ireland; Health Research Institute, University of Limerick, Castletroy, Limerick V94 T9PX, Ireland.
| | - N Krucien
- Health Economics Research Unit, University of Aberdeen, Aberdeen, Scotland AB25 2ZD, United Kingdom.
| | - P Cantillon
- Discipline of General Practice, Clinical Science Institute, National University of Ireland, Galway H91 TK33, Ireland.
| | - M Parker
- Department of Physical Education and Sports Sciences, University of Limerick, Castletroy, Limerick V94 T9PX, Ireland.
| | - A McCurtin
- School of Allied Health, Health Sciences Building, University of Limerick, Castletroy, Limerick V94 T9PX, Ireland; Health Research Institute, University of Limerick, Castletroy, Limerick V94 T9PX, Ireland.
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Colton H, Ankcorn M, Yavuz M, Tovey L, Cope A, Raza M, Keeley AJ, State A, Poller B, Parker M, de Silva TI, Evans C. Improved sensitivity using a dual target, E and RdRp assay for the diagnosis of SARS-CoV-2 infection: Experience at a large NHS Foundation Trust in the UK. J Infect 2020; 82:159-198. [PMID: 32474037 PMCID: PMC7255707 DOI: 10.1016/j.jinf.2020.05.061] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Hayley Colton
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Michael Ankcorn
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
| | - Mehmet Yavuz
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Leeanne Tovey
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Alison Cope
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Mohammad Raza
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Alexander J Keeley
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Amy State
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Bozena Poller
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Matthew Parker
- Sheffield Biomedical Research Centre, Sheffield Bioinformatics Core, The Medical School, The University of Sheffield, United Kingdom
| | - Thushan I de Silva
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The Department of Infection, Immunity and Cardiovascular Disease, The Medical School, The University of Sheffield, United Kingdom
| | - Cariad Evans
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
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Lessard PA, Parker M, Bougri O, Shen B, Samoylov V, Broomhead J, Li X, Raab RM. Improved performance of Eimeria-infected chickens fed corn expressing a single-domain antibody against interleukin-10. Nat Food 2020; 1:119-126. [PMID: 37127989 DOI: 10.1038/s43016-020-0029-6] [Citation(s) in RCA: 4] [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: 06/12/2019] [Accepted: 01/08/2020] [Indexed: 05/03/2023]
Abstract
Antimicrobial resistance is a significant challenge for human and animal health, and developing effective antibiotic-free treatments is a strategy to help mitigate microbial resistance. The global poultry industry faces growing challenges from Eimeria-induced coccidiosis, a serious enteric disease of chickens that currently requires treatment using ionophore antibiotics. Eimeria stimulates interleukin-10 (IL-10) expression in the small intestine and caecum of infected chickens, suppressing their immune response and facilitating disease progression. Single-domain antibodies raised from llamas immunized with chicken IL-10 (cIL-10) were developed that bind cIL-10 in vitro, block cIL-10 receptor binding and induce interferon gamma (IFN-γ) secretion from cIL-10-repressed primary chicken splenocytes. Single-domain antibodies expressed in transgenic corn demonstrated significant accumulation in phenotypically normal plants. When fed to Eimeria-challenged chickens, the transgenic corn significantly improved body weight gain (equal to that of salinomycin-treated animals), normalized the feed conversion ratio (to the same level as uninfected control animals), lowered E. tenella lesion scores to those of salinomycin-treated control animals, and reduced oocyst counts below those of infected untreated control animals. Here, we propose that transgenic corn may have a role in reducing the use of antibiotics in poultry production and maintaining animal health and productivity, and may contribute to efforts against global antimicrobial resistance.
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Affiliation(s)
| | | | | | - Binzhang Shen
- Agrivida, Inc., Woburn, MA, USA
- Unum Therapeutics, Cambridge, MA, USA
| | | | - Jon Broomhead
- Agrivida, Inc., Woburn, MA, USA
- Perstop US, St Louis, MO, USA
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Scuron M, Fay B, Parker M, Collins R, Huarte E, Yao W, Smith P. 385 Ruxolitinib cream ameliorates a preclinical model of skin dermatitis via modulation of inflammatory T-cell subsets. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ghorbanalipoor S, Emtenani S, Izumi K, Ibrahim O, Hobusch J, Bieber K, Parker M, Smith P, Schmidt E, Ludwig R. 372 Inhibition of phosphatidylinositol-3-kinase δ improves tissue destruction in pemphigoid diseases by impairing neutrophil function. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Fay B, Parker M, Yao W, Smith P. 391 Ruxolitinib cream is highly effective at modulating a humanised rodent model of psoriasis vulgaris. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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McKee M, LeCompte M, Blackstock A, Frizzell B, Chung S, Marshall T, Parker M, Farris M. Simple and Rapid Creation of Customized 3D Printed Bolus Utilizing iPhone X True Depth Camera. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tran KV, Tanriverdi K, Aurigemma GP, Lessard D, Sardana M, Parker M, Shaikh A, Gottbrecht M, Milstone Z, Tanriverdi S, Vitseva O, Keaney JF, Kiefe CI, McManus DD, Freedman JE. Circulating extracellular RNAs, myocardial remodeling, and heart failure in patients with acute coronary syndrome. J Clin Transl Res 2019; 5:33-43. [PMID: 31579840 PMCID: PMC6765153] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/02/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Given high on-treatment mortality in heart failure (HF), identifying molecular pathways that underlie adverse cardiac remodeling may offer novel biomarkers and therapeutic avenues. Circulating extracellular RNAs (ex-RNAs) regulate important biological processes and are emerging as biomarkers of disease, but less is known about their role in the acute setting, particularly in the setting of HF. METHODS We examined the ex-RNA profiles of 296 acute coronary syndrome (ACS) survivors enrolled in the Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education Cohort. We measured 374 ex-RNAs selected a priori, based on previous findings from a large population study. We employed a two-step, mechanism-driven approach to identify ex-RNAs associated with echocardiographic phenotypes (left ventricular [LV] ejection fraction, LV mass, LV end-diastolic volume, left atrial [LA] dimension, and LA volume index) then tested relations of these ex-RNAs with prevalent HF (N=31, 10.5%). We performed further bioinformatics analysis of microRNA (miRNAs) predicted targets' genes ontology categories and molecular pathways. RESULTS We identified 44 ex-RNAs associated with at least one echocardiographic phenotype associated with HF. Of these 44 exRNAs, miR-29-3p, miR-584-5p, and miR-1247-5p were also associated with prevalent HF. The three microRNAs were implicated in the regulation p53 and transforming growth factor-β signaling pathways and predicted to be involved in cardiac fibrosis and cell death; miRNA predicted targets were enriched in gene ontology categories including several involving the extracellular matrix and cellular differentiation. CONCLUSIONS Among ACS survivors, we observed that miR-29-3p, miR-584-5p, and miR-1247-5p were associated with both echocardiographic markers of cardiac remodeling and prevalent HF. RELEVANCE FOR PATIENTS miR-29c-3p, miR-584-5p, and miR-1247-5p were associated with echocardiographic phenotypes and prevalent HF and are potential biomarkers for adverse cardiac remodeling in HF.
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Affiliation(s)
- Khanh-Van Tran
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA,Corresponding author: Khanh-Van Tran Cardiovascular Fellow, Department of Medicine, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01655, USA
| | - Kahraman Tanriverdi
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - Gerard P. Aurigemma
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - Darleen Lessard
- 2Population and Quantitative Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - Mayank Sardana
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - Matthew Parker
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - Amir Shaikh
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - Matthew Gottbrecht
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Selim Tanriverdi
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - Olga Vitseva
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - John F. Keaney
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - Catarina I. Kiefe
- 2Population and Quantitative Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - David D. McManus
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA,2Population and Quantitative Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
| | - Jane E. Freedman
- 1Department of Medicine, Health Sciences University of Massachusetts Medical School, Worcester, MA, USA
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