1
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Kumar R, Kumar S, Mickael C, Fonseca Balladares D, Nolan K, Lee MH, Sanders L, Nilsson J, Molofsky AB, Tuder RM, Stenmark KR, Graham BB. Interstitial macrophage phenotypes in Schistosoma-induced pulmonary hypertension. Front Immunol 2024; 15:1372957. [PMID: 38779688 PMCID: PMC11109442 DOI: 10.3389/fimmu.2024.1372957] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Background Schistosomiasis is a common cause of pulmonary hypertension (PH) worldwide. Type 2 inflammation contributes to the development of Schistosoma-induced PH. Specifically, interstitial macrophages (IMs) derived from monocytes play a pivotal role by producing thrombospondin-1 (TSP-1), which in turn activates TGF-β, thereby driving the pathology of PH. Resident and recruited IM subpopulations have recently been identified. We hypothesized that in Schistosoma-PH, one IM subpopulation expresses monocyte recruitment factors, whereas recruited monocytes become a separate IM subpopulation that expresses TSP-1. Methods Mice were intraperitoneally sensitized and then intravenously challenged with S. mansoni eggs. Flow cytometry on lungs and blood was performed on wildtype and reporter mice to identify IM subpopulations and protein expression. Single-cell RNA sequencing (scRNAseq) was performed on flow-sorted IMs from unexposed and at day 1, 3 and 7 following Schistosoma exposure to complement flow cytometry based IM characterization and identify gene expression. Results Flow cytometry and scRNAseq both identified 3 IM subpopulations, characterized by CCR2, MHCII, and FOLR2 expression. Following Schistosoma exposure, the CCR2+ IM subpopulation expanded, suggestive of circulating monocyte recruitment. Schistosoma exposure caused increased monocyte-recruitment ligand CCL2 expression in the resident FOLR2+ IM subpopulation. In contrast, the vascular pathology-driving protein TSP-1 was greatest in the CCR2+ IM subpopulation. Conclusion Schistosoma-induced PH involves crosstalk between IM subpopulations, with increased expression of monocyte recruitment ligands by resident FOLR2+ IMs, and the recruitment of CCR2+ IMs which express TSP-1 that activates TGF-β and causes PH.
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Affiliation(s)
- Rahul Kumar
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Lung Biology Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Sushil Kumar
- Department of Pediatrics and Cardiovascular Pulmonary Research Laboratory, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Claudia Mickael
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Dara Fonseca Balladares
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Lung Biology Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Kevin Nolan
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Lung Biology Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Michael H. Lee
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Lung Biology Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Linda Sanders
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Julia Nilsson
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Ari B. Molofsky
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Rubin M. Tuder
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kurt R. Stenmark
- Department of Pediatrics and Cardiovascular Pulmonary Research Laboratory, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Brian B. Graham
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Lung Biology Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
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2
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Sakai K, Fuke H, Yoshimura K, Sasaki M, Abe K, Haino S, Hams T, Hasegawa M, Kim KC, Lee MH, Makida Y, Mitchell JW, Nishimura J, Nozaki M, Orito R, Ormes JF, Seo ES, Streitmatter RE, Thakur N, Yamamoto A, Yoshida T. Search for Antideuterons of Cosmic Origin Using the BESS-Polar II Magnetic-Rigidity Spectrometer. Phys Rev Lett 2024; 132:131001. [PMID: 38613296 DOI: 10.1103/physrevlett.132.131001] [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] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 10/21/2023] [Accepted: 01/10/2024] [Indexed: 04/14/2024]
Abstract
We searched for antideuterons (d[over ¯]'s) in the 4.7×10^{9} cosmic-ray events observed during the BESS-Polar II flight at solar minimum in 2007-2008 but found no candidates. The resulting 95% C.L. upper limit on the d[over ¯] flux is 6.7×10^{-5} (m^{2} s sr GeV/n)^{-1} in an energy range from 0.163 to 1.100 GeV/n. The result has improved by more than a factor of 14 from the upper limit of BESS97, which had a potential comparable to that of BESS-Polar II in the search for cosmic-origin d[over ¯]'s and was conducted during the former solar minimum. The upper limit of d[over ¯] flux from BESS-Polar II is the first result achieving the sensitivity to constrain the latest theoretical predictions.
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Affiliation(s)
- K Sakai
- NASA-Goddard Space Flight Center (NASA-GSFC), Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Science and Technology (CRESST)
| | - H Fuke
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (ISAS/JAXA), Sagamihara, Kanagawa 252-5210, Japan
| | - K Yoshimura
- Okayama University, Okayama, Okayama 700-8530, Japan
| | - M Sasaki
- NASA-Goddard Space Flight Center (NASA-GSFC), Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Science and Technology (CRESST)
| | - K Abe
- Kobe University, Kobe, Hyogo 657-8501, Japan
| | - S Haino
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - T Hams
- NASA-Goddard Space Flight Center (NASA-GSFC), Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Science and Technology (CRESST)
| | - M Hasegawa
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - K C Kim
- IPST, University of Maryland, College Park, Maryland 20742, USA
| | - M H Lee
- IPST, University of Maryland, College Park, Maryland 20742, USA
| | - Y Makida
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - J W Mitchell
- NASA-Goddard Space Flight Center (NASA-GSFC), Greenbelt, Maryland 20771, USA
| | - J Nishimura
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (ISAS/JAXA), Sagamihara, Kanagawa 252-5210, Japan
- The University of Tokyo, Bunkyo, Tokyo 113-0033, Japan
| | - M Nozaki
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - R Orito
- Kobe University, Kobe, Hyogo 657-8501, Japan
| | - J F Ormes
- University of Denver, Denver, Colorado 80208, USA
| | - E S Seo
- IPST, University of Maryland, College Park, Maryland 20742, USA
| | - R E Streitmatter
- NASA-Goddard Space Flight Center (NASA-GSFC), Greenbelt, Maryland 20771, USA
| | - N Thakur
- NASA-Goddard Space Flight Center (NASA-GSFC), Greenbelt, Maryland 20771, USA
| | - A Yamamoto
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - T Yoshida
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (ISAS/JAXA), Sagamihara, Kanagawa 252-5210, Japan
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3
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Kassa B, Fonseca‐Balladares DC, Kumar R, Lee MH, Mickael C, Sanders L, Nolan K, Graham BB. Experimental Schistosoma haematobium pulmonary hypertension. Pulm Circ 2024; 14:e12336. [PMID: 38312832 PMCID: PMC10835079 DOI: 10.1002/pul2.12336] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 02/06/2024] Open
Abstract
Whether all Schistosoma species cause pulmonary hypertension (PH) is unclear. Experimentally exposing mice to Schistosoma haematobium eggs caused PH, which was less severe than that induced by S. mansoni exposure. These findings align with the relatively uncommon reports of pulmonary arterial hypertension associated with S. haematobium.
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Affiliation(s)
- Biruk Kassa
- Department of MedicineLung Biology Center, Zuckerberg San Francisco General HospitalSan FranciscoCaliforniaUSA
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Dara C. Fonseca‐Balladares
- Department of MedicineLung Biology Center, Zuckerberg San Francisco General HospitalSan FranciscoCaliforniaUSA
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Rahul Kumar
- Department of MedicineLung Biology Center, Zuckerberg San Francisco General HospitalSan FranciscoCaliforniaUSA
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Michael H. Lee
- Department of MedicineLung Biology Center, Zuckerberg San Francisco General HospitalSan FranciscoCaliforniaUSA
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Claudia Mickael
- Department of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Linda Sanders
- Department of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Kevin Nolan
- Department of MedicineLung Biology Center, Zuckerberg San Francisco General HospitalSan FranciscoCaliforniaUSA
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Brian B. Graham
- Department of MedicineLung Biology Center, Zuckerberg San Francisco General HospitalSan FranciscoCaliforniaUSA
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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4
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Adhikari G, Carlin N, Choi JJ, Choi S, Ezeribe AC, França LE, Ha C, Hahn IS, Hollick SJ, Jeon EJ, Jo JH, Joo HW, Kang WG, Kauer M, Kim BH, Kim HJ, Kim J, Kim KW, Kim SH, Kim SK, Kim WK, Kim YD, Kim YH, Ko YJ, Lee DH, Lee EK, Lee H, Lee HS, Lee HY, Lee IS, Lee J, Lee JY, Lee MH, Lee SH, Lee SM, Lee YJ, Leonard DS, Luan NT, Manzato BB, Maruyama RH, Neal RJ, Nikkel JA, Olsen SL, Park BJ, Park HK, Park HS, Park KS, Park SD, Pitta RLC, Prihtiadi H, Ra SJ, Rott C, Shin KA, Cavalcante DFFS, Scarff A, Spooner NJC, Thompson WG, Yang L, Yu GH. Search for Boosted Dark Matter in COSINE-100. Phys Rev Lett 2023; 131:201802. [PMID: 38039466 DOI: 10.1103/physrevlett.131.201802] [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] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/30/2023] [Indexed: 12/03/2023]
Abstract
We search for energetic electron recoil signals induced by boosted dark matter (BDM) from the galactic center using the COSINE-100 array of NaI(Tl) crystal detectors at the Yangyang Underground Laboratory. The signal would be an excess of events with energies above 4 MeV over the well-understood background. Because no excess of events are observed in a 97.7 kg·yr exposure, we set limits on BDM interactions under a variety of hypotheses. Notably, we explored the dark photon parameter space, leading to competitive limits compared to direct dark photon search experiments, particularly for dark photon masses below 4 MeV and considering the invisible decay mode. Furthermore, by comparing our results with a previous BDM search conducted by the Super-Kamionkande experiment, we found that the COSINE-100 detector has advantages in searching for low-mass dark matter. This analysis demonstrates the potential of the COSINE-100 detector to search for MeV electron recoil signals produced by the dark sector particle interactions.
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Affiliation(s)
- G Adhikari
- Department of Physics and Wright Laboratory, Yale University, New Haven, Connecticut 06520, USA
| | - N Carlin
- Physics Institute, University of São Paulo, 05508-090, São Paulo, Brazil
| | - J J Choi
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Republic of Korea
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - S Choi
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Republic of Korea
| | - A C Ezeribe
- Department of Physics and Astronomy, University of Sheffield, Sheffield S3 7RH, United Kingdom
| | - L E França
- Physics Institute, University of São Paulo, 05508-090, São Paulo, Brazil
| | - C Ha
- Department of Physics, Chung-Ang University, Seoul 06973, Republic of Korea
| | - I S Hahn
- Department of Science Education, Ewha Womans University, Seoul 03760, Republic of Korea
- Center for Exotic Nuclear Studies, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
| | - S J Hollick
- Department of Physics and Wright Laboratory, Yale University, New Haven, Connecticut 06520, USA
| | - E J Jeon
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - J H Jo
- Department of Physics and Wright Laboratory, Yale University, New Haven, Connecticut 06520, USA
| | - H W Joo
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Republic of Korea
| | - W G Kang
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - M Kauer
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - B H Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - H J Kim
- Department of Physics, Kyungpook National University, Daegu 41566, Republic of Korea
| | - J Kim
- Department of Physics, Chung-Ang University, Seoul 06973, Republic of Korea
| | - K W Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - S H Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - S K Kim
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Republic of Korea
| | - W K Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
| | - Y D Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
- Department of Physics, Sejong University, Seoul 05006, Republic of Korea
| | - Y H Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
- Korea Research Institute of Standards and Science, Daejeon 34113, Republic of Korea
| | - Y J Ko
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - D H Lee
- Department of Physics, Kyungpook National University, Daegu 41566, Republic of Korea
| | - E K Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - H Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
| | - H S Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
| | - H Y Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - I S Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - J Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - J Y Lee
- Department of Physics, Kyungpook National University, Daegu 41566, Republic of Korea
| | - M H Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
| | - S H Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
| | - S M Lee
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Republic of Korea
| | - Y J Lee
- Department of Physics, Chung-Ang University, Seoul 06973, Republic of Korea
| | - D S Leonard
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - N T Luan
- Department of Physics, Kyungpook National University, Daegu 41566, Republic of Korea
| | - B B Manzato
- Physics Institute, University of São Paulo, 05508-090, São Paulo, Brazil
| | - R H Maruyama
- Department of Physics and Wright Laboratory, Yale University, New Haven, Connecticut 06520, USA
| | - R J Neal
- Department of Physics and Astronomy, University of Sheffield, Sheffield S3 7RH, United Kingdom
| | - J A Nikkel
- Department of Physics and Wright Laboratory, Yale University, New Haven, Connecticut 06520, USA
| | - S L Olsen
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - B J Park
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
| | - H K Park
- Department of Accelerator Science, Korea University, Sejong 30019, Republic of Korea
| | - H S Park
- Korea Research Institute of Standards and Science, Daejeon 34113, Republic of Korea
| | - K S Park
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - S D Park
- Department of Physics, Kyungpook National University, Daegu 41566, Republic of Korea
| | - R L C Pitta
- Physics Institute, University of São Paulo, 05508-090, São Paulo, Brazil
| | - H Prihtiadi
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - S J Ra
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - C Rott
- Department of Physics, Sungkyunkwan University, Suwon 16419, Republic of Korea
- Department of Physics and Astronomy, University of Utah, Salt Lake City, Utah 84112, USA
| | - K A Shin
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - D F F S Cavalcante
- Physics Institute, University of São Paulo, 05508-090, São Paulo, Brazil
| | - A Scarff
- Department of Physics and Astronomy, University of Sheffield, Sheffield S3 7RH, United Kingdom
| | - N J C Spooner
- Department of Physics and Astronomy, University of Sheffield, Sheffield S3 7RH, United Kingdom
| | - W G Thompson
- Department of Physics and Wright Laboratory, Yale University, New Haven, Connecticut 06520, USA
| | - L Yang
- Department of Physics, University of California San Diego, La Jolla, California 92093, USA
| | - G H Yu
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- Department of Physics, Sungkyunkwan University, Suwon 16419, Republic of Korea
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5
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Graham BB, Hilton JF, Lee MH, Kumar R, Balladares DF, Rahaghi FN, Estépar RSJ, Mickael C, Lima RLB, Loureiro CM, Lucena J, Oliveira RK, Corrêa RDA. Is pulmonary arterial hypertension associated with schistosomiasis distinct from pulmonary arterial hypertension associated with portal hypertension? JHLT Open 2023; 1:100007. [PMID: 38050478 PMCID: PMC10695267 DOI: 10.1016/j.jhlto.2023.100007] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Pulmonary arterial hypertension associated with schistosomiasis (SchPAH) and pulmonary arterial hypertension associated with portal hypertension (PoPAH) are lung diseases that develop in the presence of liver diseases. However, mechanistic pathways by which the underlying liver conditions and other drivers contribute to the development and progression of pulmonary arterial hypertension (PAH) are unclear for both etiologies. In turn, these unknowns limit certainty of strategies to prevent, diagnose, and reverse the resultant PAH. Here we consider specific mechanisms that contribute to SchPAH and PoPAH, identifying those that may be shared and those that appear to be unique to each etiology, in the hope that this exploration will both highlight known causal drivers and identify knowledge gaps appropriate for future research. Overall, the key pathophysiologic differences that we identify between SchPAH and PoPAH suggest that they are not variants of a single condition.
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Affiliation(s)
- Brian B. Graham
- Lung Biology Center, University of California San Francisco, San Francisco, California
- Pulmonary Division, San Francisco General Hospital, San Francisco, California
| | - Joan F. Hilton
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Michael H. Lee
- Lung Biology Center, University of California San Francisco, San Francisco, California
- Pulmonary Division, San Francisco General Hospital, San Francisco, California
| | - Rahul Kumar
- Lung Biology Center, University of California San Francisco, San Francisco, California
- Pulmonary Division, San Francisco General Hospital, San Francisco, California
| | - Dara Fonseca Balladares
- Lung Biology Center, University of California San Francisco, San Francisco, California
- Pulmonary Division, San Francisco General Hospital, San Francisco, California
| | - Farbod N. Rahaghi
- Pulmonary Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Claudia Mickael
- Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Juliana Lucena
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Rudolf K.F. Oliveira
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Ricardo de Amorim Corrêa
- Internal Medicine/Pulmonary Division, Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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6
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Park SY, Hahn KI, Kang WG, Kazalov V, Kim GW, Kim YD, Lee EK, Lee MH, Leonard DS, Sala E, So JH, Yoon SC. Detection efficiency calibration for an array of fourteen HPGe detectors. Appl Radiat Isot 2023; 193:110654. [PMID: 36646029 DOI: 10.1016/j.apradiso.2023.110654] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
The CUP array of germanium (CAGe) is an array of fourteen high-purity germanium (HPGe) detectors. The detection efficiency of full-energy-peak emitted from the various samples assayed on the CAGe was calculated using the Monte Carlo simulation toolkit GEANT4. If the dead layer on the surface of the crystal is treated in the simulation as a continuous part of the active crystal, then the detection efficiency will be overestimated. Thus, the detection efficiency of the CAGe was adjusted using multi-nuclide source data and Monte Carlo simulations. The gamma spectra of the known activity source were obtained for each HPGe detector of the CAGe. The detection efficiency measured by the multi-source data was smaller than that of simulation data if the simulation treated the whole volume of germanium crystals as active for gamma detection. By optimizing the dead layers' thicknesses in the simulation, the detection efficiency calculated by the simulation could be matched to that of multi-source data.
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Affiliation(s)
- S Y Park
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
| | - K I Hahn
- Center for Exotic Nuclear Studies, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
| | - W G Kang
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
| | - V Kazalov
- Baksan Neutrino Observatory, Institute for Nuclear Research of the Russian Academy of Science, Kabardino-Balkaria, 361609, Russia
| | - G W Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea.
| | - Y D Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea; Department of Physics and Astronomy, Sejong University, Seoul, 05006, South Korea; IBS School, University of Science and Technology (UST), Daejeon, 34113, South Korea
| | - E K Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
| | - M H Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea; IBS School, University of Science and Technology (UST), Daejeon, 34113, South Korea
| | - D S Leonard
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
| | - E Sala
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
| | - J H So
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
| | - S C Yoon
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
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7
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Song TJ, Shin JI, Yon DK, Lee SW, Hwang SY, Hwang J, Park SH, Lee SB, Lee MH, Kim MS, Koyanagi A, Tizaoui K, Kim JH, Smith L. Cerebral venous thrombosis after ChAdOx1 nCoV-19 vaccination: a systematic review. Eur Rev Med Pharmacol Sci 2023; 27:404-410. [PMID: 36647889 DOI: 10.26355/eurrev_202301_30894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To perform a systematic review of case reports or case series regarding thrombosis with thrombocytopenia syndrome (TTS) and cerebral venous thrombosis (CVT) related to ChAdOx1 nCoV-19 vaccination to address the clinical features, laboratory findings, treatment modalities, and prognosis related with CVT. SUBJECTS AND METHODS We included 64 TTS patients from 19 articles, 6 case series and 13 case reports, in which thrombosis occurred after the first dose of ChAdOx1 nCoV-19 vaccination published up to 30 June 2021 in Embase, ePubs, Medline/PubMed, Scopus, and Web of Science databases. RESULTS Of the 64 TTS patients, 38 (59.3%) had CVT. Patients with CVT were younger (median 36.5 vs. 52.5 years, p<0.001), had lower fibrinogen levels (130 vs. 245 mg/dL, p=0.008), had more frequent history of intracerebral hemorrhage (ICH), and had higher mortality rate (48.6% vs. 19.2%, p=0.020) than that of patients without CVT. In multivariable analysis, the possibility of presence of CVT was higher in younger age groups [odd ratio (OR): 0.91, 95% confidence interval (CI): (0.86-0.97, p<0.001)] and those with accompanying intracerebral hemorrhage (ICH) (OR: 13.60, 95% CI (1.28-144.12, p=0.045). CONCLUSIONS Our study demonstrated that CVT related to ChAdOx1 nCoV-19 vaccination was associated with younger age, low levels of fibrinogen, presence of ICH and more frequent mortality compared to those of non-CVT. If TTS occurs after ChAdOx1 nCoV-19 vaccination, the presence of CVT in patients with young age or ICH should be considered.
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Affiliation(s)
- T-J Song
- Department of Neurology, Seoul Hospital, Ewha University College of Medicine, Seoul, Republic of Korea.
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8
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Choe SI, Lee Y, Habashi R, Samarasinghe Y, Lee MH, McKechnie T, Shargall Y, Finley C, Hanna W, Sur R, Agzarian J. The role of brachytherapy in treatment of stage I esophageal cancer: A systematic review. Brachytherapy 2022; 21:877-886. [PMID: 35941072 DOI: 10.1016/j.brachy.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/25/2022] [Accepted: 05/30/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Despite advancements in the early detection of esophageal cancer, optimal radiotherapy methods for treatment of early disease have not yet been determined. Moreover, the benefit of intraluminal brachytherapy on local control or survival remains controversial. We performed a systematic review to establish the role of brachytherapy as boost therapy in stage I esophageal squamous cell carcinoma, and to evaluate associated survival outcomes. METHODS AND MATERIALS A systematic search of three bibliographic databases from January 1950 to January 2019 was conducted. All studies investigating brachytherapy for curative intent were included and palliative treatment was excluded. Primary outcomes included overall survival and disease-free survival (DFS). Secondary outcomes included loco-regional control (LRC) and toxicity grades and/or complications. Two reviewers independently abstracted data and evaluated study quality using grading of recommendations assessment, development, and evaluation, pooled results were presented through risk ratios. RESULTS A total of 12 retrospective studies met inclusion criteria. The overall quality of evidence yielded a Grade 1C rating (strong recommendation, low quality evidence). Of 525 included patients, 325 patients received both external beam radiation (EBRT), and brachytherapy, 132 underwent EBRT only, and 68 received brachytherapy with and/or without chemoradiation. For patient group treated with EBRT and brachytherapy, 5-year mortality, DFS and LRC were: 43% (27-59%), 63% (49-76%) and 72% (63-80%) respectively. Rates of complications reported included 82.1% Grade 1 esophagitis for a combined external beam radiation and brachytherapy cohort, 12.3% ulcerations, and 3.3% fistulae. CONCLUSIONS Brachytherapy as a combined modality is encouraging, given its relative safety and effectiveness. Further prospective analysis using higher quality evidence is warranted to evaluate oncologic outcomes and survival advantage.
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Affiliation(s)
- Se-In Choe
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada; Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Yung Lee
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Rogeh Habashi
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Yasith Samarasinghe
- Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael H Lee
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tyler McKechnie
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Yaron Shargall
- Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Christian Finley
- Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Wael Hanna
- Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ranjan Sur
- Deparment of Radiation Oncology, McMaster University, Hamilton, Ontario, Canada
| | - John Agzarian
- Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada.
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9
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Kim SE, Chun KH, Oh J, Yu HT, Lee CJ, Kim TH, Pak HN, Lee MH, Joung B, Kang SM. Prediction of response to cardiac resynchronization therapy using cardiac magnetic resonance imaging in non-ischemic dilated cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac resynchronization therapy (CRT) is a well-established therapy for symptomatic heart failure with reduced ejection fraction, but the response is different for individuals. Although many modalities have been conducted to predict CRT response, cardiac magnetic resonance (CMR) to predict CRT response has still insufficient usefulness.
Purpose
We determine whether the parameters including late gadolinium enhancement (LGE) identified in CMR could act as predictors of CRT response.
Methods
We retrospectively investigated 124 patients with non-ischemic dilated cardiomyopathy who underwent CMR before CRT implantation between Jan 2010 and July 2021 in a single center. CRT response was defined as a decrease in left ventricular end-systolic volume (LVESV) >15% on echocardiography after at least 3 months after CRT implantation.
Results
Among the study population (mean age 65.7±11.2 years, mean EF 25±6.5%, 50% of female), 85 (69%) patients were defined as CRT responder. The CRT responders had more left bundle branch block (LBBB) compared with non-responders [79 (92.9%) vs. 23 (59.0%), p<0.001], but there was a no difference of QRS duration (158.7 vs 165.0ms, p=0.054) between two groups. CMR analysis showed that there were no significant differences in the left ventricular (LV) chamber volume and LV ejection fraction between CRT-responder and non-responder. However, the right ventricular (RV) chamber volume was smaller (RV end-diastolic volume index, 86.3 vs 103.5 ml/m2, p=0.039; RV end-systolic volume index, 49.3 vs 68.5 ml/m2, p=0.013) and the RV ejection fraction (RVEF) was higher (46.9 vs 37.6%, p=0.002) in CRT-responders compared with non-responders. The LGE on CMR was more shown in non-responders than in CRT-responders [33 (84.6%) vs 45 (52.9%), p<0.001]. In CMR parameters, RV dysfunction (RVEF <45%) [Odds ratio (OR), 0.21 (0.05–0.93), p=0.045] and LGE [OR, 0.21 (0.05–0.58), p=0.01] were significantly associated with poor CRT response.
Conclusions
The presence of LGE and RV dysfunction on CMR were associated with poor CRT response in patients with non-ischemic dilated cardiomyopathy. Further investigation with CMR for pre-CRT patients is needed to support these results.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S E Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - K H Chun
- NHIS Ilsan Hospital, Cardiology , Goyang , Korea (Republic of)
| | - J Oh
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - H T Yu
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - C J Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - T H Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - H N Pak
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - M H Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - B Joung
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - S M Kang
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
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Kim MH, Hwang I, Park JW, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Blunted atrial reverse remodeling a year after catheter ablation for atrial fibrillation and their long-term rhythm outcome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Although active rhythm control by atrial fibrillation (AF) catheter ablation (AFCA) reduces left atrial (LA) dimension, blunted atrial reverse remodeling can be observed in patients with significant atrial myopathy. We explored the characteristics and long-term outcomes of AF patients who showed blunted atrial reverse remodeling despite no AF recurrence within a year after AFCA.
Methods
Among a total of 2,756 patients with AFCA, we included 1,685 patients (74.8% male, 60.2±10.1 years old, 54.5% paroxysmal AF) who underwent both baseline and 1-year follow-up echocardiogram, baseline LA>40mm, and did not recur within a year. We divided them into tertile groups (T1–T3) based on one-year percent change of LA dimension after propensity matching for age, sex, AF type, and baseline LA dimension. We also investigated the patients' genetic characteristics with blunted LA reverse remodeling (T1) using a genome-wide association study (GWAS).
Results
Patients with blunted LA reverse remodeling (T1, n=424) were independently associated with body mass index (OR 1.082 [1.010–1.160], p=0.025), LA peak pressure (OR 1.010 [1.002–1.019], p=0.019), LA wall thickness (OR 0.448 [0.252–0.789], p=0.006), LA voltage (OR 0.651 [0.463–0.907], p=0.012), and pericardial fat volume (OR 1.004 [1.001–1.008], p=0.014). Throughout 65.9±37.4 months of follow-up, the incidence of AF recurrence a year after the procedure was significantly higher in the T1 group than in T2 or T3 groups (Log-rank p<0.001). Among 894 patients with GWAS, ATXN1, XPO7, KRR1_PHLDA1, ZFHX3, and their polygenic risk score were associated with blunted LA reverse remodeling.
Conclusions
Patients with blunted LA reverse remodeling after AFCA were independently associated with low LA voltage, thin wall thickness, high LA pressure, and fat volume, and have a genetic background. Long-term clinical recurrence a year after AFCA was higher in this patient group with suspicious atrial myopathy.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health and WelfareNational Research Foundation of Korea
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Affiliation(s)
- M H Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - I Hwang
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - J W Park
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - H T Yu
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - T H Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - J S Uhm
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - B Joung
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - M H Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - H N Pak
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
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11
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Park Y, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Effects of early recurrence and extra-PV triggers on long-term recurrence after catheter ablation for atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.594] [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
Although early recurrence (ER) within 3 months after atrial fibrillation (AF) catheter ablation (AFCA) was recently reported to be a reliable predictor of late recurrence (LR), the mechanism is not clear.
Purpose
We explored the characteristics of patients with ER and compared the long-term late recurrence (LR) pattern depending on the existence of extra-pulmonary vein trigger (ExPV-trigger).
Methods
Among 3643 patients who underwent de novo AFCA, we included 1249 patients (59.2±11.0 years old, 31.3% persistent AF) who underwent isoproterenol provocation and regular follow-up over three years after AFCA. We evaluated the risk factors for ER and compared the patients with ER alone (10.1%), LR alone (16.6%), and ER+LR (15.9%), and the outcome of repeat procedure.
Results
Overall ER (ER alone and ER+LR) was independently associated with persistent AF (OR 1.58 [1.16–2.14], p=0.003), extra-PV triggers (OR 2.80 [1.90–4.13], p<0.001), and empirical extra-PV ablation (OR 1.54 [1.15–2.07], p=0.004). Overall LR (LR alone and ER+LR) risk was significantly higher in the ER with ExPV-trigger group than in ER without ExPV-trigger or no ER groups (Log-rank p<0.001). The rhythm outcome of the second procedure did not differ between ER+LR and LR alone groups (Log-rank p=0.160), but was worse in the ER+LR ExPV-trigger than in ER+LR without ExPV-trigger or LR alone groups (Log-rank p=0.005).
Conclusion
ER was independently associated with LR after de novo AFCA. ExPV-trigger played crucial roles in ER and LR after de novo AFCA and worse rhythm outcome after redo AFCA.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Y Park
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - H T Yu
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - T H Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - J S Uhm
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - B Joung
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - M H Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - H N Pak
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
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12
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Kim D, Yu HT, Kwon OS, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Effect of the epicardial fat volume on the outcomes after a left atrial posterior wall isolation in addition to pulmonary vein isolation in patients with persistent atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
While the effect of a circumferential pulmonary vein isolation (CPVI) alone is unsatisfactory, that of an additional electrical posterior wall box isolation (POBI) is controversial in persistent atrial fibrillation (PeAF) patients. Increased epicardial adipose tissue (EAT) is associated with higher recurrence rates after AF catheter ablation (AFCA).
Purpose
We investigated the possible effects of a POBI on rhythm outcomes with varying EAT volumes.
Methods
We included 1,187 patients with PeAF undergoing a de novo AFCA (79.6% male, median age 60 years) into two groups including those receiving a CPVI alone (n=687) and those an additional POBI (n=500). The rhythm outcomes at two years post-AFCA were compared in subgroups stratified by the total EAT volume using propensity overlap weighting.
Results
A reduced total EAT volume was linearly associated with more favorable rhythm outcomes for an additional POBI treatment than for a CPVI alone (P for interaction=0.002). Among the patients with smaller EAT volumes (≤116.23 ml, the median value, n=594), an additional POBI was associated with a reduced AF recurrence risk as compared to a CPVI only (weighted hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.56–0.99; weighted log-rank P=0.039). In contrast, among the remaining 593 patients with greater EAT volumes (>116.2 3mL), there was no difference in the AF recurrence risk between an additional POBI and CPVI alone (weighted HR 1.13, 95% CI 0.84–1.52; weighted log-rank P=0.410). Among 185 patients with a repeat ablation, the POBI reconnection rate tended to be higher in the large EAT group (75.0%) than small EAT group (55.4%, P=0.060).
Conclusion
While PeAF patients with a smaller EAT volume averted AF recurrence by an additional POBI after the CPVI, no benefit of the POBI was observed in those with a greater EAT volume. The EAT volume might identify AF patients likely to benefit from linear ablation in addition to the CPVI.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Korean Ministry of Science, ICT & Future Planning (MSIP)Korean Ministry of Health and Welfare
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Affiliation(s)
- D Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - H T Yu
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - O S Kwon
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - T H Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - J S Uhm
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - B Joung
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - M H Lee
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - H N Pak
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
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13
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Mickael C, Lee MH, Graham BB. The COVID-19 pandemic and pulmonary arterial hypertension in Italy: adaptation, outcomes and valuable lessons learned. Eur Respir J 2022; 60:2200796. [PMID: 36202406 PMCID: PMC9924355 DOI: 10.1183/13993003.00796-2022] [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: 04/21/2022] [Accepted: 04/29/2022] [Indexed: 11/05/2022]
Abstract
This editorial summarises the key findings of R. Badagliacca and co-workers regarding the changes in care and clinical outcomes of PAH patients during the initial COVID-19 pandemic in Italy https://bit.ly/3ytgIjk
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Affiliation(s)
- Claudia Mickael
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael H Lee
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Brian B Graham
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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14
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Lee MH, Menezes TCF, Reisz JA, Ferreira EVM, Graham BB, Oliveira RKF. Exercise metabolomics in pulmonary arterial hypertension: Where pulmonary vascular metabolism meets exercise physiology. Front Physiol 2022; 13:963881. [PMID: 36171971 PMCID: PMC9510894 DOI: 10.3389/fphys.2022.963881] [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: 06/08/2022] [Accepted: 08/23/2022] [Indexed: 01/29/2023] Open
Abstract
Pulmonary arterial hypertension is an incurable disease marked by dysregulated metabolism, both at the cellular level in the pulmonary vasculature, and at the whole-body level characterized by impaired exercise oxygen consumption. Though both altered pulmonary vascular metabolism and abnormal exercise physiology are key markers of disease severity and pulmonary arterial remodeling, their precise interactions are relatively unknown. Herein we review normal pulmonary vascular physiology and the current understanding of pulmonary vascular cell metabolism and cardiopulmonary response to exercise in Pulmonary arterial hypertension. We additionally introduce a newly developed international collaborative effort aimed at quantifying exercise-induced changes in pulmonary vascular metabolism, which will inform about underlying pathophysiology and clinical management. We support our investigative approach by presenting preliminary data and discuss potential future applications of our research platform.
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Affiliation(s)
- Michael H. Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Thaís C. F. Menezes
- Division of Respiratory Diseases, Department of Medicine, Federal University of SP, São Paulo, Brazil
| | - Julie A. Reisz
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Eloara V. M. Ferreira
- Division of Respiratory Diseases, Department of Medicine, Federal University of SP, São Paulo, Brazil
| | - Brian B. Graham
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Rudolf K. F. Oliveira
- Division of Respiratory Diseases, Department of Medicine, Federal University of SP, São Paulo, Brazil,*Correspondence: Rudolf K. F. Oliveira,
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15
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Lee MH, Sanders L, Kumar R, Hernandez-Saavedra D, Yun X, Ford JA, Perez MJ, Mickael C, Gandjeva A, Koyanagi DE, Harral JW, Irwin DC, Kassa B, Eckel RH, Shimoda LA, Graham BB, Tuder RM. Contribution of fatty acid oxidation to the pathogenesis of pulmonary hypertension. Am J Physiol Lung Cell Mol Physiol 2022; 323:L355-L371. [PMID: 35763400 PMCID: PMC9448289 DOI: 10.1152/ajplung.00039.2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/05/2022] [Accepted: 06/25/2022] [Indexed: 11/22/2022] Open
Abstract
Dysregulated metabolism characterizes both animal and human forms of pulmonary hypertension (PH). Enzymes involved in fatty acid metabolism have previously not been assessed in human pulmonary arteries affected by pulmonary arterial hypertension (PAH), and how inhibition of fatty acid oxidation (FAO) may attenuate PH remains unclear. Fatty acid metabolism gene transcription was quantified in laser-dissected pulmonary arteries from 10 explanted lungs with advanced PAH (5 idiopathic, 5 associated with systemic sclerosis), and 5 donors without lung diseases. Effects of oxfenicine, a FAO inhibitor, on female Sugen 5416-chronic hypoxia (SuHx) rats were studied in vivo using right heart catheterization, and ex vivo using perfused lungs and pulmonary artery ring segments. The impact of pharmacologic (oxfenicine) and genetic (carnitine palmitoyltransferase 1a heterozygosity) FAO suppression was additionally probed in mouse models of Schistosoma and hypoxia-induced PH. Potential mechanisms underlying FAO-induced PH pathogenesis were examined by quantifying ATP and mitochondrial mass in oxfenicine-treated SuHx pulmonary arterial cells, and by assessing pulmonary arterial macrophage infiltration with immunohistochemistry. We found upregulated pulmonary arterial transcription of 26 and 13 FAO genes in idiopathic and systemic sclerosis-associated PAH, respectively. In addition to promoting de-remodeling of pulmonary arteries in SuHx rats, oxfenicine attenuated endothelin-1-induced vasoconstriction. FAO inhibition also conferred modest benefit in the two mouse models of PH. Oxfenicine increased mitochondrial mass in cultured rat pulmonary arterial cells, and decreased the density of perivascular macrophage infiltration in pulmonary arteries of treated SuHx rats. In summary, FAO inhibition attenuated experimental PH, and may be beneficial in human PAH.
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Affiliation(s)
- Michael H Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California
| | - Linda Sanders
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Aurora, Colorado
| | - Rahul Kumar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California
| | - Daniel Hernandez-Saavedra
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Aurora, Colorado
| | - Xin Yun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Joshay A Ford
- University of Colorado School of Medicine, Aurora, Colorado
| | - Mario J Perez
- Department of Psychiatry, University of Colorado, Aurora, Colorado
| | - Claudia Mickael
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Aurora, Colorado
| | - Aneta Gandjeva
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Aurora, Colorado
| | - Daniel E Koyanagi
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Aurora, Colorado
| | - Julie W Harral
- Cardiovascular Pulmonary Research Laboratory, Department of Pediatrics and Medicine, University of Colorado, Aurora, Colorado
| | - David C Irwin
- Cardiovascular Pulmonary Research Laboratory, Department of Pediatrics and Medicine, University of Colorado, Aurora, Colorado
| | - Biruk Kassa
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California
| | - Robert H Eckel
- Division of Endocrinology, Department of Medicine, University of Colorado, Aurora, Colorado
| | - Larissa A Shimoda
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Brian B Graham
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California
| | - Rubin M Tuder
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Aurora, Colorado
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16
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Samoutis A, Lee MH, Patel A, Jaiswal P. O099 Position and number of anchors in hip arthroscopy labrum repair: a systematic review. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.099] [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: 11/06/2022]
Abstract
Abstract
Introduction
Hip labral tears are reported in 22–55% of patients with hip or groin pain. Operative treatment is necessary for most cases, via hip arthroscopy with the use of suture anchors. This systematic review aims to determine the optimal number and position of anchors in hip labral repair.
Methods
Pubmed, Ovid & Embase were searched, and 2 researchers independently screened the 1,304 results. Outcome measures such as procedures performed, number & (clockface) position of anchors, failure & articular involvement of anchors were extracted.
Results
5 studies were included in the analysis: 1 Cross-Sectional Study (1645 Hips, mean age (MA):33.7 years), 3 Retrospective case studies (491 hips, MA:31.0) and 1 Controlled Cadaveric study (32 cadaveric hips, MA:62.7). Chi-squared statistical analysis of 323 hips found a significant difference (X2 (2, N = 323) = 17.88, p < .001) in the risk of articular involvement with the position of anchors at 11°-12° o’clock, 1°-2° and 3°-4°. There is an absolute risk reduction (ARR) of 19% with anchors positioned at 11°-12° compared to anchors positioned at 3°-4° (X2 (1, N=178) =15.79, p < .001) and an ARR of 12% with anchors at 1°-2° compared to anchors positioned at 3°-4° (X2 (1, N = 237) = 15.79, p < .0109). Additionally, by assessing 1645 operations it was found that for tears spanning >2 hours, a minimum of 2 anchors was placed.
Conclusion
Placement of anchors in the 3°-4° o’clock position carries the highest risk for articular involvement. Small diameter anchors and careful placement can be used to minimize articular injury. Preferable positions of anchors are 11°-12°, furthermore, for tears spanning over 2 hours, a minimum of 2 anchors was placed.
Take-home message
In Hip Arthroscopy labral repair, placement of anchors in the 3°-4° o’clock position carries the highest risk for articular involvement. Small diameter anchors and 2 hours. flexible anchor instrumentation can be used to minimize articular injury, furthermore, for tears spanning over 2 hours, a minimum of 2 anchors was placed.
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Lee MH, Nelms MW, Damji A. Unexpected change makers: the need for medical learner education on hospital governance. Can Med Educ J 2022; 13:116-117. [PMID: 35875439 PMCID: PMC9297236 DOI: 10.36834/cmej.75110] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Michael H Lee
- Medical Student, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Matthew W Nelms
- Medical Student, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Ali Damji
- Assistant Professor, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
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18
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Gu S, Mickael C, Kumar R, Lee MH, Sanders L, Kassa B, Harral J, Williams J, Hansen KC, Stenmark KR, Tuder RM, Graham BB. The role of macrophages in right ventricular remodeling in experimental pulmonary hypertension. Pulm Circ 2022; 12:e12105. [PMID: 35874852 PMCID: PMC9297026 DOI: 10.1002/pul2.12105] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 11/18/2022] Open
Abstract
Right ventricular (RV) failure is the primary cause of death in pulmonary hypertension (PH), but the mechanisms of RV failure are not well understood. We hypothesized macrophages in the RV contribute to the RV response in PH. We induced PH in mice with hypoxia (FiO2 10%) and Schistosoma mansoni exposure, and in rats with SU5416-hypoxia. We quantified cardiac macrophages in mice using flow cytometry. Parabiosis between congenic CD45.1/.2 mice or Cx3cr1-green fluorescent protein and wild-type mice was used to quantify circulation-derived macrophages in experimental PH conditions. We administered clodronate liposomes to Sugen hypoxia (SU-Hx) exposed rats to deplete macrophages and evaluated the effect on the extracellular matrix (ECM) and capillary network in the RV. In hypoxia exposed mice, the overall number of macrophages did not significantly change but two macrophage subpopulations increased. Parabiosis identified populations of RV macrophages that at steady state is derived from the circulation, with one subpopulation that significantly increased with PH stimuli. Clodronate treatment of SU-Hx rats resulted in a change in the RV ECM, without altering the RV vasculature, and correlated with improved RV function. Populations of RV macrophages increase and contribute to RV remodeling in PH, including through regulation of the RV ECM.
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Affiliation(s)
- Sue Gu
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine University of Colorado Anschutz Medical Campus Aurora Colorado USA
- Cardiovascular Pulmonary Research Lab University of Colorado School of Medicine Aurora Colorado USA
| | - Claudia Mickael
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine University of Colorado Anschutz Medical Campus Aurora Colorado USA
- Department of Medicine, Program in Translational Lung Research University of Colorado Anschutz Medical Campus Aurora Colorado USA
| | - Rahul Kumar
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital and Trauma Center University of California San Francisco California USA
| | - Michael H Lee
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital and Trauma Center University of California San Francisco California USA
| | - Linda Sanders
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine University of Colorado Anschutz Medical Campus Aurora Colorado USA
- Department of Medicine, Program in Translational Lung Research University of Colorado Anschutz Medical Campus Aurora Colorado USA
| | - Biruk Kassa
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital and Trauma Center University of California San Francisco California USA
| | - Julie Harral
- Cardiovascular Pulmonary Research Lab University of Colorado School of Medicine Aurora Colorado USA
| | - Jason Williams
- Biochemistry and Molecular Genetics University of Colorado Anschutz Medical Campus Aurora Colorado USA
| | - Kirk C Hansen
- Biochemistry and Molecular Genetics University of Colorado Anschutz Medical Campus Aurora Colorado USA
| | - Kurt R Stenmark
- Cardiovascular Pulmonary Research Lab University of Colorado School of Medicine Aurora Colorado USA
| | - Rubin M Tuder
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine University of Colorado Anschutz Medical Campus Aurora Colorado USA
- Department of Medicine, Program in Translational Lung Research University of Colorado Anschutz Medical Campus Aurora Colorado USA
| | - Brian B Graham
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital and Trauma Center University of California San Francisco California USA
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19
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Jang YW, Yoon Y, Maharjan R, Yi H, Jeong M, Hong SY, Lee MH, Kim SW, Kim JI, Yang JW. First Report of Pseudomonas cichorii Causing Bacterial vein necrosis on Perilla plants [ Perilla frutescens (L.) Britton.] in South Korea. Plant Dis 2022; 107:549. [PMID: 35700520 DOI: 10.1094/pdis-01-22-0143-pdn] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Perilla (Perilla frutescens L.) is the second most important upland crop and the third largest edible oil crop in Korea (Shin and Kim 1994). During a disease survey in Busan, Korea in September 2021, symptoms of vein necrosis were observed in perilla plants, with incidences of approximately 30% and 50% in two fields. Symptoms of spots on the perilla appeared as leaf dryness and spots with water-soaked blotches largely concentrated on the mid-veins of leaves. The lesions were initiated with water-soaked spots on the leaf or stem and gradually turned black or brown. Necrosis was also observed in the stems. A bacterium was isolated on Luria-Bertani (LB) agar from diseased leaf tissues that were surface-disinfected with 70% ethyl alcohol for 3-5 min and then washed with sterile water three times. Three pieces of sterilized leaf tissue (size: 0.5 × 0.5 cm) were mixed with 500 µL sterile water for 30 min, and then the suspension was serially diluted and spread on LB agar. Subsequently, isolates were cultivated on LB agar and King's Medium B agar (KMB) (Schaad et al. 2001), and they were predominantly cream-colored and circular bacterial colonies with undulated margins. The bacterial colonies on KMB displayed fluorescence under 365 nm UV light. The isolates were analyzed with the GEN III MicroPlate (Biolog, Hayward, CA, USA), and all isolates were identified as Pseudomonas cichorii, a devastating plant bacterium that damages a wide range of host plants worldwide, including in South Korea (Hikichi et al. 2013; Ramkumar et al. 2015). To identify the species of the bacterial pathogen, genomic DNA of four isolates (BS4922, BS4167, BS4345, and BS4560) was extracted, and the 16S rRNA gene and hrcRST gene were amplified with universal primers, 27F/1492R and Hcr1/Hcr2, and sequencing was then done (Patel et al. 2019). In the BLAST analysis, the 16S rRNA sequences (GenBank OM060656, OM275434, OM275435, OM275436) showed a 100% and 99% similarity to P. cichorii strains MAFF 302698 (AB724286) and P. cichorii strain Pc-Gd-4 (KU923373), respectively. Further, hrcRST gene sequences (GenBank OM143596, OM268864, OM268865, and OM268866) showed high similarity (>99%) with P. cichorii strain P16-51 (MG518230). A pathogenicity test of the four isolates was performed on 3 - 4 weeks old perilla plants by creating wounds with a needle on the lower leaves and stems, and then the plants were inoculated by spraying inoculum (108 CFU/ml). The plants that served as the negative control were wounded and sprayed with unsterilized water. The inoculated perilla plants were placed in a greenhouse at 28 ± 2oC , 80-85% relative humidity, and a natural photoperiod. The inoculation site began to show symptoms of water-soaked brown lesions. Disease symptoms such as leaf dryness, water-soaked blotches on the mid-vein of leaves, and necrosis on plant stems were observed in the inoculated plants 7-10 days after inoculation, whereas the plants of the negative control group did not show any symptoms. The bacteria were re-isolated from the diseased tissues of the plants, and DNA sequence analysis identified them as P. cichorii. Additionally, all isolates induced hypersensitivity reactions in tobacco and tomato leaves within 24 h after inoculation. To our knowledge, this is the first report of P. cichorii infecting perilla in South Korea. The findings in this study will provide the basic information for the development of diagnostic tools and management measures against P. cichorii in perilla.
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Affiliation(s)
- Yun-Woo Jang
- National Institute of Crop Science, RDA, , Southern Area Crop Science, 20, jeompiljae-ro, miryang, Korea (the Republic of), 50424;
| | - Youngnam Yoon
- National Institute of Crop Science, RDA, Corp Productiong Technology Research Division, 20th, Jeompiljaero, Miryang, Korea (the Republic of), 50424;
| | - Rameswor Maharjan
- National Institute of Crop Science, RDA, Crop Production Technology Research Division, Miryang, Gyeongsangnam-do, Korea (the Republic of);
| | - Hwijong Yi
- National Institute of Crop Science, RDA, Crop Production Technology Research Division, Miryang, Gyeongsangnam-do, Korea (the Republic of);
| | - M Jeong
- National Institute of Crop Science, RDA, Corp Productiong Technology Research Division, Miryang, Korea (the Republic of);
| | - S Y Hong
- National Institute of Crop Science, RDA, Mirayang, Korea (the Republic of);
| | - M H Lee
- National Institute of Crop Science, RDA, Miryang, Korea (the Republic of);
| | - S W Kim
- National Institute of Crop Science, RDA, Miryang, Korea (the Republic of);
| | - J I Kim
- National Institute of Crop Science, RDA, Miryang, Korea (the Republic of);
| | - Jung-Wook Yang
- National Institute of Crop Science Muan, Bioenergy crop research Institute, 199 Muanro Cheonggye, Muan, Jeonnam, Korea (the Republic of), 58545;
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20
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Yang PS, Kim DH, Jang E, Yu HT, Kim TH, Pak HN, Lee MH, Sung JH, Joung B. Comparative effectiveness of early rhythm control versus rate control for cardiovascular outcomes according to sex in patients with atrial fibrillation. Europace 2022. [DOI: 10.1093/europace/euac053.184] [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
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health & Welfare, Republic of Korea
Background
Rhythm control is associated with better cardiovascular outcomes than usual care among patients recently diagnosed with atrial fibrillation (AF). However, there are limited data on the outcomes of AF ablation according to sex. The purpose of this study was to evaluate gender differences in the effects of early rhythm control compared to rate control on the primary composite outcome of cardiovascular death, ischaemic stroke, hospitalisation for heart failure (HF), or myocardial infarction.
Methods
We conducted a retrospective population-based cohort study including 22635 patients with AF newly treated with rhythm control (antiarrhythmic drugs or ablation) or rate control in 2011-2015 from the Korean National Health Insurance Service database. Propensity overlap weighting was used.
Results
Among patients with early AF treatment (initiated within 1 year since diagnosis), compared with rate control, rhythm control was associated with a similar lower risk of the primary composite outcome both women (weighted incidence rate per 100 person-years: 8.68 in rhythm control vs. 10.3 in rate control; hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.69 to 0.90; P<0.001) and men (weighted incidence rate per 100 person-years: 6.33 in rhythm control vs. 8.32 in rate control; HR 0.77, 95% CI 0.67 to 0.88; P<0.001). However, the effective initiation time for rhythm control therapy was within 6 and 11 months after AF diagnosis in female and male patients, respectively. Moreover, the effective times for other outcomes were different between genders (hospitalization for HF; female within 2 months, male within 9 months/ ischemic stroke; female within 11 months, male immediately).
Conclusions
Early initiation of rhythm control was associated with a lower risk of primary outcome in both genders. However, the effective rhythm control treatment initiation time for primary outcome, stroke and HF-related admission was different in both genders. For rhythm control treatment to be effective, women should start treatment earlier than men.
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Affiliation(s)
- PS Yang
- CHA University, Seongnam, Korea (Republic of)
| | - DH Kim
- Yonsei University College of Medicine, Cardiology, Seoul, Korea (Republic of)
| | - E Jang
- Yonsei University College of Medicine, Cardiology, Seoul, Korea (Republic of)
| | - HT Yu
- Yonsei University College of Medicine, Cardiology, Seoul, Korea (Republic of)
| | - TH Kim
- Yonsei University College of Medicine, Cardiology, Seoul, Korea (Republic of)
| | - HN Pak
- Yonsei University College of Medicine, Cardiology, Seoul, Korea (Republic of)
| | - MH Lee
- Yonsei University College of Medicine, Cardiology, Seoul, Korea (Republic of)
| | - JH Sung
- CHA University, Seongnam, Korea (Republic of)
| | - B Joung
- Yonsei University College of Medicine, Cardiology, Seoul, Korea (Republic of)
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21
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Yu G, Kim TH, Yu HT, Joung BY, Pak HN, Lee MH. Learning curve of left bundle branch area pacing with standard stylet-driven pacing leads: a single center prospective observational study in Korea. Europace 2022. [DOI: 10.1093/europace/euac053.426] [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: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Although cardiac pacing is an essential therapy for bradycardia, conventional right ventricular pacing (CRVP) can cause electrical-mechanical dyssynchrony. Left Bundle Branch Area Pacing (LBBAP) is a new conduction system pacing strategy that includes a normal conduction system and therefore maintains synchronous ventricular contraction. Most of the experience with LBBAP is done in a lumen-less lead with fixed helix design, and this device is not available in sometimes.
Purpose
This study aimed to evaluate the learning curve of LBBAP using standard stylet-driven lead with extendable helix design.
Methods
This study enrolled patients who underwent permanent cardiac pacemaker implantation at a University Hospital in South Korea from December 2020 to October 2021. LBBAP was performed with a 5.6Fr stylet-driven pacing lead with an extendable helix. The learning curve was assessed by analyzing fluoroscopy time and procedure time.
Results
In 65 patients who underwent LBBAP during the observation period, mean fluoroscopy time and procedural time were 17.1 ± 17.2 minutes and 64.2 ± 33.5 minutes, respectively in this study. The learning curve for achieving LBBAP appears to plateau after around 24th case with a progressive reduction in procedure time. This is a significantly shorter period of time when compared to the previously reported learning curves of his bundle pacing (30-50cases), previously developed conduction system pacing strategy.
Conclusion
During initial experience with LBBAP, fluoroscopy and procedural time continue to improve with operator experience. For physicians who are experienced at cardiac pacemaker implantation, the steepest part of the learning curve of LBBAP appears to be over the first 20-25 cases.
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Affiliation(s)
- G Yu
- Yonsei University, Seoul, Korea (Republic of)
| | - TH Kim
- Yonsei University, Seoul, Korea (Republic of)
| | - HT Yu
- Yonsei University, Seoul, Korea (Republic of)
| | - BY Joung
- Yonsei University, Seoul, Korea (Republic of)
| | - HN Pak
- Yonsei University, Seoul, Korea (Republic of)
| | - MH Lee
- Yonsei University, Seoul, Korea (Republic of)
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22
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Verdugo-Paiva F, Vergara C, Ávila C, Castro J, Cid J, Contreras V, Jara I, Jiménez V, Lee MH, Muñoz M, Rojas-Gómez AM, Rosón-Rodríguez P, Serrano-Arévalo K, Silva-Ruz I, Vásquez-Laval J, Zambrano-Achig P, Zavadzki G, Rada G. COVID-19 L·OVE repository is highly comprehensive and can be used as a single source for COVID-19 studies. J Clin Epidemiol 2022; 149:195-202. [PMID: 35597369 PMCID: PMC9116966 DOI: 10.1016/j.jclinepi.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/05/2022] [Accepted: 05/04/2022] [Indexed: 11/15/2022]
Abstract
Background and Objective The coronavirus disease 2019 Living OVerview of Evidence (COVID-19 L·OVE) is a public repository and classification platform for COVID-19 articles. The repository contains more than 430,000 articles as of September 20, 2021 and intends to provide a one-stop shop for COVID-19 evidence. Considering that systematic reviews conduct high-quality searches, this study assesses the comprehensiveness and currency of the repository against the total number of studies in a representative sample of COVID-19 systematic reviews. Methods Our sample was generated from all the studies included in the systematic reviews of COVID-19 published during April 2021. We estimated the comprehensiveness of COVID-19 L·OVE repository by determining how many of the individual studies in the sample were included in the COVID-19 L·OVE repository. We estimated the currency as the percentage of studies that was available in the COVID-19 L·OVE repository at the time the systematic reviews conducted their own search. Results We identified 83 eligible systematic reviews that included 2,132 studies. COVID-19 L·OVE had an overall comprehensiveness of 99.67% (2,125/2,132). The overall currency of the repository, that is, the proportion of articles that would have been obtained if the search of the reviews was conducted in COVID-19 L·OVE instead of searching the original sources, was 96.48% (2,057/2,132). Both the comprehensiveness and the currency were 100% for randomized trials (82/82). Conclusion The COVID-19 L·OVE repository is highly comprehensive and current. Using this repository instead of traditional manual searches in multiple databases can save a great amount of work to people conducting systematic reviews and would improve the comprehensiveness and timeliness of evidence syntheses. This tool is particularly important for supporting living evidence synthesis processes.
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Affiliation(s)
| | - C Vergara
- Epistemonikos Foundation, Santiago, Chile
| | - C Ávila
- Epistemonikos Foundation, Santiago, Chile
| | - J Castro
- Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J Cid
- School of Dentistry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - I Jara
- Epistemonikos Foundation, Santiago, Chile
| | - V Jiménez
- Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M H Lee
- Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M Muñoz
- Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - A M Rojas-Gómez
- Epistemonikos Foundation, Santiago, Chile; Unidad de investigación en medicina estomatológica preventiva y social (UIMEPS), Universidad del Magdalena, Santa Marta, Colombia
| | | | | | - I Silva-Ruz
- School of Dentistry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - G Zavadzki
- School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - G Rada
- Epistemonikos Foundation, Santiago, Chile; UC Evidence Center, Cochrane Chile Associated Center, Pontificia Universidad Católica de Chile, Santiago, Chile; Internal Medicine Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Shin JI, Kim SE, Lee MH, Kim MS, Lee SW, Park S, Shin YH, Yang JW, Song JM, Moon SY, Kim SY, Park Y, Suh DI, Yang JM, Cho SH, Jin HY, Hong SH, Won HH, Kronbichler A, Koyanagi A, Jacob L, Hwang J, Tizaoui K, Lee KH, Kim JH, Yon DK, Smith L. COVID-19 susceptibility and clinical outcomes in autoimmune inflammatory rheumatic diseases (AIRDs): a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci 2022; 26:3760-3770. [PMID: 35647859 DOI: 10.26355/eurrev_202205_28873] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This meta-analysis aims to assess the susceptibility to and clinical outcomes of COVID-19 in autoimmune inflammatory rheumatic disease (AIRD) and following AIRD drug use. MATERIALS AND METHODS We included observational and case-controlled studies assessing susceptibility and clinical outcomes of COVID-19 in patients with AIRD as well as the clinical outcomes of COVID-19 with or without use of steroids and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). RESULTS Meta-analysis including three studies showed that patients with AIRD are not more susceptible to COVID-19 compared to patients without AIRD or the general population (OR: 1.11, 95% CI: 0.58 to 2.14). Incidence of severe outcomes of COVID-19 (OR: 1.34, 95% CI: 0.76 to 2.35) and COVID-19 related death (OR: 1.21, 95% CI: 0.68 to 2.16) also did not show significant difference. The clinical outcomes of COVID-19 among AIRD patients with and without csDMARD or steroid showed that both use of steroid (OR: 1.69, 95% CI: 0.96 to 2.98) or csDMARD (OR: 1.35, 95% CI: 0.63 to 3.08) had no effect on clinical outcomes of COVID-19. CONCLUSIONS AIRD does not increase susceptibility to COVID-19, not affecting the clinical outcome of COVID-19. Similarly, the use of steroids or csDMARDs for AIRD does not worsen the clinical outcome.
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Affiliation(s)
- J I Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea.
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24
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Lee KH, Li H, Lee MH, Park SJ, Kim JS, Han YJ, Cho K, Ha B, Kim SJ, Jacob L, Koyanagi A, Shin JI, Kim JH, Smith L. Clinical characteristics and treatments of multi-system inflammatory syndrome in children: a systematic review. Eur Rev Med Pharmacol Sci 2022; 26:3342-3350. [PMID: 35587087 DOI: 10.26355/eurrev_202205_28754] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Multisystem inflammatory syndrome in children (MIS-C) can occur in association with coronavirus disease 2019 (COVID-19). It is not easy to differentiate MIS-C from severe COVID-19 or Kawasaki disease based on symptoms. The aim of this study was to describe the clinical and laboratory characteristics of MIS-C. PATIENTS AND METHODS We searched PubMed/Medline for case series and reports of MIS-C published until June 20, 2020. From a total of nine articles involving 45 cases, various clinical and laboratory data were extracted. Each target case was evaluated by using different diagnostic criteria. RESULTS The average age at onset of MIS-C was 8.6 years. In 80% of cases, the age of patients ranged from 5 to 15 years. Fever (100%) and shock (82%) were the most common presenting symptoms. Sixty percent of cases met the diagnostic criteria for typical or atypical Kawasaki disease. Biomarkers indicative of inflammation, coagulopathy, or cardiac injury were characteristically elevated as follows: ferritin (mean: 1,061 ng/mL), CRP (217 mg/L), ESR (69 mm/hr), IL-6 (214.8 pg/mL), TNFα (63.4 pg/mL), D-dimer (3,220 ng/mL), PT (15.5 s), troponin I (1,006 ng/L), and BNP (12,150 pg/mL). Intravenous immunoglobulin was administered in all target cases, and inotropic agents were commonly used as well. No case of death was observed. CONCLUSIONS This study demonstrated that MIS-C is a serious condition that presents with fever, rash, as well as cardiovascular and gastrointestinal symptoms. Although it is challenging to differentiate MIS-C from Kawasaki disease or severe COVID-19, initiation of appropriate treatments through early diagnosis is warranted.
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Affiliation(s)
- K H Lee
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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25
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Mickael C, Kheyfets VO, Langouët-Astrié C, Lee MH, Sanders LA, Trentin CO, Sweatt AJ, Zamanian RT, Bull TM, Stenmark K, Graham BB, Tuder RM. Peripheral Blood Inflammation Profile of Patients with Pulmonary Arterial Hypertension Using the High-Throughput Olink Proteomics Platform. Am J Respir Cell Mol Biol 2022; 66:580-581. [PMID: 35486078 PMCID: PMC9116364 DOI: 10.1165/rcmb.2021-0369le] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | | | - Michael H. Lee
- University of California, San FranciscoSan Francisco, California
| | | | | | | | | | | | | | - Brian B. Graham
- University of California, San FranciscoSan Francisco, California
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26
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Badreddine J, Lee MH, Mishra K, Pope R, Kim JY, Hong SH, Gupta S, Song JM, Shin JI, Ghayda RA. Continuing perioperative estrogen therapy does not increase venous thromboembolic events in transgender patients: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci 2022; 26:2511-2517. [PMID: 35442466 DOI: 10.26355/eurrev_202204_28488] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The aim of this study is to compare the risk of venous thromboembolic events (VTE) between patients suspending and continuing estrogen therapy perioperatively, in male to female gender-affirming surgery (vaginoplasty). MATERIALS AND METHODS The authors conducted a systematic review and meta-analysis of existing research on male to female gender-affirming study, which compared the risk of VTE among the usage of estrogen perioperatively. RESULTS A total of 209 studies were identified as potentially eligible among PubMed, Embase, and Cochrane library databases. Among the studies, 191 studies were excluded due to their abstract inappropriateness. Out of the remaining 18 studies, only 3 articles were eligible and were finally included. Meta-analysis was performed and showed odds ratio of 0.77 (95% CI: 0.04, 14.01). CONCLUSIONS Perioperative estrogen therapy does not increase VTE risk on male to female gender-affirming surgery. Therefore, estrogen therapy may be continued perioperatively in vaginoplasty. More prospective studies are needed.
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Affiliation(s)
- J Badreddine
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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Sinkala E, Ahmed HY, Sibomana JP, Lee MH, Kassa B, Kumar R, Mazimba S, Binegdie AB, Mpisa S, Wamundila K, Graham BB, Hilton JF. Rationale and design of a screening study to detect schistosomiasis-associated pulmonary hypertension in Ethiopia and Zambia. Pulm Circ 2022; 12:e12072. [PMID: 35514775 PMCID: PMC9063961 DOI: 10.1002/pul2.12072] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/28/2022] [Accepted: 03/27/2022] [Indexed: 11/05/2022] Open
Abstract
Schistosomiasis is a major cause of pulmonary arterial hypertension (PAH) worldwide, but the prevalence and risk factors for schistosomiasis-associated PAH (SchPAH) development are not well understood. Schistosomiasis-associated hepatosplenic disease (SchHSD) is thought to be a major risk factor for PAH development. Herein, we describe our plans for prospectively screening SchHSD subjects for clinical evidence of PAH at two major academic medical centers and national referral hospitals in Addis Ababa, Ethiopia and Lusaka, Zambia. The screening study will primarily be conducted by echocardiography, in addition to clinical assessments. Plasma samples will be drawn and banked for subsequent analysis based on preclinical animal model rationale. If successful, this study will demonstrate feasibility of conducting prospective cohort studies of SchPAH screening in schistosomiasis-endemic regions of Africa, and provide initial data on clinic-based disease prevalence and potential mechanistic biomarkers underlying disease pathogenesis.
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Affiliation(s)
- Edford Sinkala
- Hepatology Clinic, Department of MedicineUniversity of Zambia Teaching HospitalLusakaZambia
| | - Hanan Yusuf Ahmed
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Tikur Anbessa Specialized Hospital, College of Health SciencesUniversity of Addis AbabaAddis AbabaEthiopia
| | - Jean Pierre Sibomana
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Tikur Anbessa Specialized Hospital, College of Health SciencesUniversity of Addis AbabaAddis AbabaEthiopia
- Department of Medicine, Butare University Teaching HospitalUniversity of RwandaButareRwanda
| | - Michael H. Lee
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Biruk Kassa
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Rahul Kumar
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Sula Mazimba
- Department of Medicine, Division of CardiologyUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | - Amsalu B. Binegdie
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Tikur Anbessa Specialized Hospital, College of Health SciencesUniversity of Addis AbabaAddis AbabaEthiopia
| | - Sydney Mpisa
- Hepatology Clinic, Department of MedicineUniversity of Zambia Teaching HospitalLusakaZambia
| | - Kawana Wamundila
- Hepatology Clinic, Department of MedicineUniversity of Zambia Teaching HospitalLusakaZambia
| | - Brian B. Graham
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Joan F. Hilton
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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Kassa B, Lee MH, Kumar R, Mickael C, Sanders L, Tuder RM, Mentink-Kane M, Graham BB. Experimental Schistosoma japonicum-induced pulmonary hypertension. PLoS Negl Trop Dis 2022; 16:e0010343. [PMID: 35417453 PMCID: PMC9037943 DOI: 10.1371/journal.pntd.0010343] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/25/2022] [Accepted: 03/19/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Schistosomiasis, a major cause of pulmonary arterial hypertension (PAH) worldwide, is most clearly described complicating infection by one species, Schistosoma mansoni. Controlled exposure of mice can be used to induce Type 2 inflammation-dependent S. mansoni pulmonary hypertension (PH). We sought to determine if another common species, S. japonicum, can also cause experimental PH. METHODS Schistosome eggs were obtained from infected mice, and administered by intraperitoneal sensitization followed by intravenous challenge to experimental mice, which underwent right heart catheterization and tissue analysis. RESULTS S. japonicum sensitized and challenged mice developed PH, which was milder than that following S. mansoni sensitization and challenge. The degree of pulmonary vascular remodeling and Type 2 inflammation in the lungs was similarly proportionate. Cross-sensitization revealed that antigens from either species are sufficient to sensitize for intravenous challenge with either egg, and the degree of PH severity depended on primarily the species used for intravenous challenge. Compared to a relatively uniform distribution of S. mansoni eggs, S. japonicum eggs were observed in clusters in the lungs. CONCLUSIONS S. japonicum can induce experimental PH, which is milder than that resulting from comparable S. mansoni exposure. This difference may result from the distribution of eggs in the lungs, and is independent of which species is used for sensitization. This result is consistent with the clearer association between S. mansoni infection and the development of schistosomiasis-associated PAH in humans.
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Affiliation(s)
- Biruk Kassa
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Michael H. Lee
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Rahul Kumar
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Claudia Mickael
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Linda Sanders
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Rubin M. Tuder
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | | | - Brian B. Graham
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
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Javidan AP, Li A, Lee MH, Forbes TL, Naji F. A Systematic Review and Bibliometric Analysis of Applications of Artificial Intelligence and Machine Learning in Vascular Surgery. Ann Vasc Surg 2022; 85:395-405. [PMID: 35339595 DOI: 10.1016/j.avsg.2022.03.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/22/2022] [Accepted: 03/12/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Artificial intelligence (AI) and machine learning (ML) have seen increasingly intimate integration with medicine and healthcare in the last two decades. The objective of this study was to summarize all current applications of AI and ML in the vascular surgery literature and to conduct a bibliometric analysis of the published studies. METHODS A comprehensive literature search was conducted through EMBASE, MEDLINE, and Ovid HealthStar from inception until February 19, 2021. Reporting of this study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Title and abstract screening, full-text screening, and data extraction were conducted in duplicate. Data extracted included study meta-data, the clinical area of study within vascular surgery, type of AI/ML method used, data set, and the application of AI/ML. Publishing journals were classified as having either a clinical scope or technical scope. Author academic background was classified as clinical, non-clinical (e.g., engineering) or both, depending on author affiliation. RESULTS The initial search identified 7434 studies, of which 249 were included for final analysis. The rate of publications is exponentially increasing, with 158 (63%) studies being published in the last 5 years. Studies were most commonly related to carotid artery disease (118, 47%), abdominal aortic aneurysms (51, 20%), and peripheral arterial disease (26, 10%). Study authors employed an average of 1.50 (range: 1-6) distinct AI methods in their studies. The application of AI/ML methods broadly related to predictive models (54, 22%), image segmentation (49, 19.4%), diagnostic methods (46, 18%), or multiple combined applications (91, 37%). The most commonly used AI/ML methods were artificial neural networks (155/378 use cases, 41%), support vector machines (64, 17%), k-nearest neighbors algorithm (26, 7%), and random forests (23, 6%). Data sets to which these AI/ML methods were applied frequently involved ultrasound images (87, 35%), CT images (42, 17%), clinical data (34, 14%) or multiple data sets (36, 14%). Overall, 22 (9%) studies were published in journals specific to vascular surgery, with the majority (147/249, 59%) being published in journals with a scope related to computer science or engineering. Among 1576 publishing authors, 46% had exclusively a clinical background, 48% a non-clinical background, and 5% had both a clinical and non-clinical background. CONCLUSION There is an exponentially growing body of literature describing the use of AI and ML in vascular surgery. There is a focus on carotid artery disease and abdominal aortic disease, with many other areas of vascular surgery underrepresented. Neural networks and support vector machines composed most AI methods in the literature. As AI/ML continues to see more expanded applications in the field, it is important that vascular surgeons appreciate its potential and limitations. Additionally, as it sees increasing use, there is a need for clinicians with expertise in AI/ML methods who can optimize its transition into daily practice.
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Affiliation(s)
- Arshia P Javidan
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Allen Li
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael H Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Thomas L Forbes
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Faysal Naji
- Department of Vascular Surgery, McMaster University, Hamilton, Ontario, Canada
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Lee MH, Leda M, Buchan T, Malik A, Rigobon A, Liu H, Daza JF, O'Brien K, Stein M, Hing NNF, Siemeiniuk R, Sekercioglu N, Evaniew N, Foroutan F, Ross H, Alba AC. Prognostic value of blood pressure in ambulatory heart failure: a meta-analysis and systematic review. Ambulatory blood pressure predicts heart failure prognosis. Heart Fail Rev 2022; 27:455-464. [PMID: 33682033 DOI: 10.1007/s10741-021-10086-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 01/14/2023]
Abstract
Previous primary studies have explored the association between blood pressure (BP) and mortality in ambulatory heart failure (HF) patients reporting varying and contrasting associations. The aim is to determine the pooled BP prognostic value and explore potential reasons for between-study inconsistency. We searched Medline, Cochrane, EMBASE and CINAHL from January 2005 to October 2018 for studies with ≥ 50 events (mortality and/or hospitalization) and included BP in a multivariable model in ambulatory HF patients. We pooled hazard ratios (random effects model) for systolic BP (SBP) or diastolic BP (DBP) effect on mortality and/or hospitalization risk. We used a priori defined sub-group analyses to explore heterogeneity and GRADE approach to assess the certainty of the evidence. Seventy-one eligible articles (239,467 screened) at low to moderate risk of bias included 235,752 participants. Higher SBP was associated with reduced all-cause mortality (HR 0.93, 95%CI 0.91-0.95, I2 = 87.13%, moderate certainty), all-cause hospitalization events (HR 0.91, 95%CI 0.88-0.93, I2 = 44.4%, high certainty) and their composite endpoint (HR 0.93 per 10 mmHg, 95%CI 0.91-0.94, I2 = 86.3%, high certainty). DBP did not demonstrate a statistically significant effect for all outcomes. The association strength was significantly weaker in studies following patients with either LVEF > 40%, higher average SBP (> 130 mmHg), increasing age and diabetes. All other a priori subgroup hypotheses did not explain between study differences. Higher ambulatory SBP is associated with reduced risk of all-cause mortality and hospitalization. Patients with lower BP and reduced LVEF are in a high-risk group of developing adverse events with moderate certainty of evidence.
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Affiliation(s)
- Michael H Lee
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
| | - Mariela Leda
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
- McMaster University, Hamilton, ON, Canada
| | - Tayler Buchan
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
| | - Abdullah Malik
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
| | - Alanna Rigobon
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
| | - Helen Liu
- University of Toronto, Toronto, ON, Canada
| | | | | | | | | | | | | | - Nathan Evaniew
- Section of Orthopedic Surgery, University of Calgary, Calgary, AB, Canada
| | - Farid Foroutan
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
- McMaster University, Hamilton, ON, Canada
| | - Heather Ross
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Ana Carolina Alba
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada.
- University of Toronto, Toronto, ON, Canada.
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Lee Y, Samarasinghe Y, Lee MH, Thiru L, Shargall Y, Finley C, Hanna W, Levine O, Juergens R, Agzarian J. Role of Adjuvant Therapy in Esophageal Cancer Patients After Neoadjuvant Therapy and Esophagectomy: A Systematic Review and Meta-analysis. Ann Surg 2022; 275:91-98. [PMID: 34596073 DOI: 10.1097/sla.0000000000005227] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to analyze esophageal cancer patients who previously underwent neoadjuvant therapy followed by a curative resection to determine whether additional adjuvant therapy is associated with improved survival outcomes. SUMMARY BACKGROUND DATA Neoadjuvant therapy followed by surgery is the standard of care for locally advanced esophageal cancer, whereas adjuvant therapy is typically employed for patients with residual disease. However, the role of adjuvant therapy after a curative resection is still uncertain. METHODS MEDLINE, EMBASE, and CENTRAL databases were searched for studies comparing patients with esophageal cancer who underwent neoadjuvant therapy and curative resection with and without adjuvant therapy. Primary outcome was overall survival (OS), and random effects meta-analysis was conducted where appropriate. Grading of recommendations, assessment, development, and evaluation was used to assess the certainty of evidence. RESULTS Ten studies involving 6462 patients were included. When compared to patients who received neoadjuvant therapy and esophagectomy alone, adjuvant therapy groups experienced a significant decrease in mortality by 48% at 1 year (Risk Ratio (RR) 0.52, 95% confidence interval [CI] 0.41-0.65, P < 0.001, moderate certainty). This reduction in mortality was carried through to 5-year follow-up (RR 0.91, 95% CI 0.86-0.96, P < 0.001, moderate certainty). The difference between the adjuvant therapy and the control group was uncertain regarding the secondary outcomes. CONCLUSION Adjuvant therapy after neoadjuvant treatment and esophagectomy with negative resection margins provide an improved OS at 1 and 5 years with moderate to high certainty of evidence, but the benefit for disease-free survival and locoregional/distal recurrence remain uncertain due to limited reporting of these outcomes.
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Affiliation(s)
- Yung Lee
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Yasith Samarasinghe
- Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael H Lee
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Luxmy Thiru
- Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Yaron Shargall
- Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Christian Finley
- Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Wael Hanna
- Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Oren Levine
- Deparment of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Rosalyn Juergens
- Deparment of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - John Agzarian
- Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
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Behnsen J, Zhi H, Aron AT, Subramanian V, Santus W, Lee MH, Gerner RR, Petras D, Liu JZ, Green KD, Price SL, Camacho J, Hillman H, Tjokrosurjo J, Montaldo NP, Hoover EM, Treacy-Abarca S, Gilston BA, Skaar EP, Chazin WJ, Garneau-Tsodikova S, Lawrenz MB, Perry RD, Nuccio SP, Dorrestein PC, Raffatellu M. Siderophore-mediated zinc acquisition enhances enterobacterial colonization of the inflamed gut. Nat Commun 2021; 12:7016. [PMID: 34853318 PMCID: PMC8636617 DOI: 10.1038/s41467-021-27297-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 06/24/2020] [Accepted: 11/09/2021] [Indexed: 11/09/2022] Open
Abstract
Zinc is an essential cofactor for bacterial metabolism, and many Enterobacteriaceae express the zinc transporters ZnuABC and ZupT to acquire this metal in the host. However, the probiotic bacterium Escherichia coli Nissle 1917 (or "Nissle") exhibits appreciable growth in zinc-limited media even when these transporters are deleted. Here, we show that Nissle utilizes the siderophore yersiniabactin as a zincophore, enabling Nissle to grow in zinc-limited media, to tolerate calprotectin-mediated zinc sequestration, and to thrive in the inflamed gut. We also show that yersiniabactin's affinity for iron or zinc changes in a pH-dependent manner, with increased relative zinc binding as the pH increases. Thus, our results indicate that siderophore metal affinity can be influenced by the local environment and reveal a mechanism of zinc acquisition available to commensal and pathogenic Enterobacteriaceae.
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Affiliation(s)
- Judith Behnsen
- Department of Microbiology & Molecular Genetics, University of California Irvine, Irvine, CA, USA
- Department of Microbiology & Immunology, University of Illinois Chicago, Chicago, IL, USA
| | - Hui Zhi
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California San Diego, La Jolla, CA, 92093, USA
| | - Allegra T Aron
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
- Collaborative Mass Spectrometry Innovation Center, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Vivekanandan Subramanian
- University of Kentucky PharmNMR Center, College of Pharmacy, University of Kentucky, Lexington, KY, 40536-0596, USA
| | - William Santus
- Department of Microbiology & Immunology, University of Illinois Chicago, Chicago, IL, USA
| | - Michael H Lee
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California San Diego, La Jolla, CA, 92093, USA
| | - Romana R Gerner
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California San Diego, La Jolla, CA, 92093, USA
| | - Daniel Petras
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
- Collaborative Mass Spectrometry Innovation Center, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Janet Z Liu
- Department of Microbiology & Molecular Genetics, University of California Irvine, Irvine, CA, USA
| | - Keith D Green
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, KY, 40536-0596, USA
| | - Sarah L Price
- Department of Microbiology and Immunology, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| | - Jose Camacho
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California San Diego, La Jolla, CA, 92093, USA
| | - Hannah Hillman
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California San Diego, La Jolla, CA, 92093, USA
| | - Joshua Tjokrosurjo
- Department of Microbiology & Molecular Genetics, University of California Irvine, Irvine, CA, USA
| | - Nicola P Montaldo
- Department of Microbiology & Molecular Genetics, University of California Irvine, Irvine, CA, USA
| | - Evelyn M Hoover
- Department of Microbiology & Molecular Genetics, University of California Irvine, Irvine, CA, USA
| | - Sean Treacy-Abarca
- Department of Microbiology & Molecular Genetics, University of California Irvine, Irvine, CA, USA
| | - Benjamin A Gilston
- Department of Biochemistry and Chemistry, and Center for Structural Biology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric P Skaar
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Walter J Chazin
- Department of Biochemistry and Chemistry, and Center for Structural Biology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sylvie Garneau-Tsodikova
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, KY, 40536-0596, USA
| | - Matthew B Lawrenz
- Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases, Department of Microbiology and Immunology, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| | - Robert D Perry
- Department of Microbiology and Immunology, University of Kentucky, Lexington, KY, 40536, USA
| | - Sean-Paul Nuccio
- Department of Microbiology & Molecular Genetics, University of California Irvine, Irvine, CA, USA
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California San Diego, La Jolla, CA, 92093, USA
| | - Pieter C Dorrestein
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
- Collaborative Mass Spectrometry Innovation Center, University of California, San Diego, La Jolla, CA, 92093, USA
- Center for Microbiome Innovation, University of California San Diego, La Jolla, CA, 92093, USA
| | - Manuela Raffatellu
- Department of Microbiology & Molecular Genetics, University of California Irvine, Irvine, CA, USA.
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California San Diego, La Jolla, CA, 92093, USA.
- Center for Microbiome Innovation, University of California San Diego, La Jolla, CA, 92093, USA.
- Chiba University-UC San Diego Center for Mucosal Immunology, Allergy, and Vaccines (CU-UCSD cMAV), La Jolla, CA, 92093, USA.
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Lee Y, Lee MH, Phillips SA, Stacey MC. Growth factors for treating chronic venous leg ulcers: A systematic review and meta-analysis. Wound Repair Regen 2021; 30:117-125. [PMID: 34783408 DOI: 10.1111/wrr.12982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/13/2021] [Accepted: 10/18/2021] [Indexed: 01/20/2023]
Abstract
Chronic venous leg ulcers (VLU) are wounds that commonly occur due to venous insufficiency. Many growth factors have been introduced over the past two decades to treat VLU. This systematic review and meta-analysis evaluates the impact of growth factor treatments of VLU in comparison to control for complete wound healing, percent reduction in wound area, time to wound healing, and adverse events. A systematic review and meta-analysis of randomised trials was conducted. MEDLINE and EMBASE were searched up to December 2020. Studies were included if they compared a growth factor versus placebo or standard care in patients with VLU. From 1645 articles, 13 trials were included (n = 991). There was a significant difference between any growth factor and placebo in complete wound healing (P = 0.04). Any growth factor compared to placebo significantly increased the likelihood of percent wound reduction by 48.80% (P = <0.00001). There was no difference in overall adverse event rate. Most comparisons have low certainty of evidence according to Grading of Recommendations, Assessment, Development, and Evaluation. This meta-analysis suggests that growth factors have a beneficial effect in complete wound healing of VLU. Growth factors may also increase percent reduction in wound area. The suggestion of benefit for growth factors identified in this review is not a strong one based on the low quality of evidence.
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Affiliation(s)
- Yung Lee
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael H Lee
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Steven A Phillips
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael C Stacey
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Lee MH, Graham BB, Bull TM. Double Trouble: Airflow and Pulmonary Vascular Obstruction. Am J Respir Crit Care Med 2021; 204:1365-1367. [PMID: 34644521 PMCID: PMC8865726 DOI: 10.1164/rccm.202109-2153ed] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Michael H Lee
- University of California San Francisco, 8785, Division of Pulmonary and Critical Care Medicine, San Francisco, California, United States
| | | | - Todd M Bull
- University of Colorado, 1878, Denver, Colorado, United States;
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35
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Wu WJ, Ma GC, Chang TY, Lee MH, Chen YN, Chen M. Hydrops in first trimester as unreported prenatal finding of dyssegmental dysplasia confirmed by exome sequencing. Ultrasound Obstet Gynecol 2021; 58:318-320. [PMID: 32936525 DOI: 10.1002/uog.23119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/31/2020] [Accepted: 09/03/2020] [Indexed: 06/11/2023]
Affiliation(s)
- W J Wu
- Department of Genomic Medicine and Department of Genomic Science and Technology, Changhua Christian Hospital Healthcare System, Changhua, Taiwan
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
- Ph.D. Programs in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - G-C Ma
- Department of Genomic Medicine and Department of Genomic Science and Technology, Changhua Christian Hospital Healthcare System, Changhua, Taiwan
- Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - T Y Chang
- Department of Genomic Medicine and Department of Genomic Science and Technology, Changhua Christian Hospital Healthcare System, Changhua, Taiwan
| | - M H Lee
- Department of Genomic Medicine and Department of Genomic Science and Technology, Changhua Christian Hospital Healthcare System, Changhua, Taiwan
| | - Y N Chen
- Taiji Fetal Medicine Center, Taipei, Taiwan
| | - M Chen
- Department of Genomic Medicine and Department of Genomic Science and Technology, Changhua Christian Hospital Healthcare System, Changhua, Taiwan
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
- Department of Medical Science, National Tsing Hua University, Hsinchu, Taiwan
- Department of Biomedical Science, Dayeh University, Changhua, Taiwan
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Lee MH, Doran J, Bang TJ, Hohsfield R, Hountras P, Boddie G, Wagh MS, Badesch D, Bull TM. Pulmonary arterial hypertension and intraductal papillary mucinous neoplasms of the pancreas: A novel association? Chest 2021; 160:2260-2265. [PMID: 34284002 DOI: 10.1016/j.chest.2021.06.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/13/2021] [Accepted: 06/18/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Michael H Lee
- University of California San Francisco, Division of Pulmonary and Critical Care Medicine
| | | | - Tami J Bang
- University of Colorado, Department of Radiology
| | - Robin Hohsfield
- University of Colorado, Division of Pulmonary Sciences and Critical Care Medicine
| | - Peter Hountras
- University of Colorado, Division of Pulmonary Sciences and Critical Care Medicine
| | - Genevieve Boddie
- University of Colorado, Division of Pulmonary Sciences and Critical Care Medicine
| | - Mihir S Wagh
- University of Colorado, Division of Gastroenterology
| | - David Badesch
- University of Colorado, Division of Pulmonary Sciences and Critical Care Medicine
| | - Todd M Bull
- University of Colorado, Division of Pulmonary Sciences and Critical Care Medicine
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Shim BJ, Lee MH, Lim JY, Gong HS. A longitudinal histologic evaluation of vitamin D receptor expression in the skeletal muscles of patients with a distal radius fracture. Osteoporos Int 2021; 32:1387-1393. [PMID: 33452895 DOI: 10.1007/s00198-020-05809-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
UNLABELLED We investigated the effect of vitamin D supplementation on the expression of muscle vitamin D receptor (VDR) and cross-sectional area (CSA) in patients with a distal radius fracture (DRF). Significant increases in VDR expression and CSA were observed, especially in vitamin D-deficient patients. PURPOSE Vitamin D supplementation is known to enhance muscle mass and function, but whether the VDR is essential in this process remains unknown. We evaluated the change in VDR expression and CSA in the forearm muscles following vitamin D supplementation in patients with a DRF. METHODS We prospectively recruited 18 women with a median age of 63.5 years who have a DRF. We obtained two biopsies of the forearm muscle, first at the time of fracture repair and then during hardware removal. We supplemented 1000 IU of vitamin D per day during a median interval of 8 months. We examined the changes in VDR expression and CSA by immunohistochemistry. RESULTS The median serum 25-hydroxyvitamin D [25(OH)D] increased from 14.3 to 32.1 ng/mL (P = 0.001). The median VDR expression increased from 0.72 to 0.78 (P = 0.002), and the median CSA increased from 1290.0 to 1685.8 μm2 (P = 0.022). Significant increases in VDR expression and CSA were observed in vitamin D-deficient patients [25(OH)D] < 20 ng/mL, but not in vitamin D-non-deficient patients. The changes in VDR expression and CSA were in the same direction in 13 patients, but in the opposite direction in 5 patients. CONCLUSION Vitamin D supplementation may increase muscle VDR expression and CSA in patients with a DRF, especially in vitamin D-deficient patients. The increase in CSA without an increase in VDR expression in some patients indicates that the effect of vitamin D supplementation on muscle mass could be mediated by indirect effect of serum vitamin D restoration and by VDR.
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Affiliation(s)
- B J Shim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gumi-ro 173, 82 Beon-gil, Bundang-gu, Seoungnam-si, Gyeonggi-do, 13620, South Korea
| | - M H Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gumi-ro 173, 82 Beon-gil, Bundang-gu, Seoungnam-si, Gyeonggi-do, 13620, South Korea
| | - J Y Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Gumi-ro 173, 82 Beon-gil, Bundang-gu, Seoungnam-si, 13620, Gyeonggi-do, South Korea
| | - H S Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gumi-ro 173, 82 Beon-gil, Bundang-gu, Seoungnam-si, Gyeonggi-do, 13620, South Korea.
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Lee MH, Kang BY, Wong CC, Li AW, Naseer N, Ibrahim SA, Keimig EL, Poon E, Alam M. A systematic review of autologous adipose-derived stromal vascular fraction (SVF) for the treatment of acute cutaneous wounds. Arch Dermatol Res 2021; 314:417-425. [PMID: 34047823 DOI: 10.1007/s00403-021-02242-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/27/2021] [Accepted: 05/11/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Stromal vascular fraction (SVF), derived enzymatically or mechanically from adipose tissue, contains a heterogenous population of cells and stroma, including multipotent stem cells. The regenerative capacity of SVF may potentially be adapted for a broad range of clinical applications, including the healing of acute cutaneous wounds. OBJECTIVE To evaluate the available literature on the efficacy and safety of autologous adipose-derived stromal vascular fraction (SVF) for the treatment of acute cutaneous wounds in humans. METHODS A systematic review of the literature utilizing MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was performed to identify published clinical trials of autologous adipose-derived SVF or similar ADSC-containing derivatives for patients with acute cutaneous wounds. This was supplemented by searches for ongoing clinical trials through ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. RESULTS 872 records were initially retrieved. Application of inclusion and exclusion criteria yielded 10 relevant studies: two completed non-randomized controlled trials and eight ongoing clinical trials. Both completed studies reported a statistically significant benefit in percentage re-epithelialization and time to healing for the SVF treatment arms. Safety information for SVF was not provided. Ongoing clinical trials were assessing outcomes such as safety, patient and observer reported scar appearance, wound healing rate, and wound epithelization. CONCLUSION In the context of substantial limitations in the quantity and quality of available evidence, the existing literature suggests that SVF may be a useful treatment for acute cutaneous wounds in humans. More clinical trials with improved outcome measures and safety assessment are needed.
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Affiliation(s)
- M H Lee
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA
| | - B Y Kang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA
| | - C C Wong
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA
| | - A W Li
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA
| | - N Naseer
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA
| | - Sarah A Ibrahim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA
| | - E L Keimig
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA
| | - E Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA
| | - M Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair Street, Suite 1600, Chicago, IL, 60611, USA.
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Park Y, Yu H, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Antiarrhythmic drug responders among patients with recurrent atrial fibrillation after catheter ablation. Europace 2021. [DOI: 10.1093/europace/euab116.185] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): The Ministry of Health and Welfare The National Research Foundation of Korea (NRF)
Backgroud
Sinus rhythm (SR) can be maintained with antiarrhythmic drugs (AADs) in a considerable number of patients with recurrent atrial fibrillation (AF) after AF catheter ablation (AFCA).
Purpose
We explored the characteristics and long-term outcomes of patients who maintained clinically acceptable rhythm control with AADs for 2 years.
Methods
Among 2,935 consecutive AAD-resistant patients who underwent a de novo AFCA, we included 512 recurrent patients (73.0% men, 59.2 ± 10.5 years old, 56.4% paroxysmal AF) who were followed up for over 2 years under AAD medications.
Results
In total, 218 patients remained in SR (AAD-responders[2-yrs], 42.6%) and 294 had recurrent AF among whom, 162 underwent repeat procedures (redo-AFCA[AAD failure-2-yrs]). We also compared the AAD-responders[2-yrs] with 40 patients who underwent AFCA before AADs (redo-AFCA[Before AAD]). AAD-responders[2-yrs] were independently associated with an old age (odds ratio [OR] 1.02 [1.00-1.04] p = 0.037), paroxysmal AF (OR 1.51 [1.04-2.19] p = 0.003), and a delayed recurrence timing of > 18 months (OR 1.52 [1.04-2.22] p = 0.032). When comparing the AAD-responder[2-yrs] and redo-AFCA[AAD failure-2-yrs] groups, the recurrence pattern showed a convergence after 7 years. The overall rhythm outcome was better in the redo-AFCA[Before AAD] group than AAD group (log rank p = 0.013).
Conclusion
Among the patients with recurrent AF after AFCA, over 40% remained in SR with AADs for 2 years, especially those who were old, those with a paroxysmal type, and those who had a delayed recurrence timing of >18 months after the de novo procedure. UnivariateMultivariateOdds Ratio(95% CI)p valueOdds Ratio(95% CI)p valueAge1.02 (1.00-1.04)0.0231.02 (1.00-1.04)0.037Female1.64 (1.11-2.42)0.0141.29 (0.85-1.95)0.236PAF1.58 (1.11-2.26)0.0121.51 (1.04-2.19)0.030Time to recurrence after the initial AFCA >18mo*1.59 (1.11-2.30)0.0131.52 (1.04-2.22)0.032LA dimension, mm0.99 (0.96-1.02)0.360LV ejection fraction, %1.03 (1.01-1.06)0.0111.02 (0.997-1.046)0.081Heart failure0.65 (0.34-1.24)0.192Hypertension1.18 (0.83-1.67)0.358Diabetes1.01 (0.65-1.71)0.844Stroke or TIA0.96 (0.56-1.66)0.879Vascular disease1.43 (0.88-2.31)0.151Logistic regression analysis for AAD responders Abstract Figure. K-M analysis of AF-free survival rate
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Affiliation(s)
- Y Park
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - H Yu
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - TH Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - JS Uhm
- Yonsei University, Seoul, Korea (Republic of)
| | - B Joung
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - MH Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - HN Pak
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
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Lee MH, Mickael C, Graham BB. Two Birds With One Stone: Helping the Pulmonary Arteries and the Right Ventricle by Targeting BMPR2 Signaling. Am J Respir Cell Mol Biol 2021; 65:233-235. [PMID: 34029508 PMCID: PMC8485994 DOI: 10.1165/rcmb.2021-0143ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Michael H Lee
- University of California San Francisco, 8785, San Francisco, California, United States
| | - Claudia Mickael
- University of Colorado, 1878, Denver, Colorado, United States
| | - Brian B Graham
- University of California San Francisco, 8785, Department of Medicine, San Francisco, California, United States;
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Kim D, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Malnutrition and risk of procedural complication in patients with atrial fibrillation undergoing catheter ablation. Europace 2021. [DOI: 10.1093/europace/euab116.226] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health and Welfare of Korea Ministry of Science, ICT & Future Planning of Korea
Background
Malnutrition is common in the elderly, even in developed countries, and increases mortality.
Purpose
To investigate the prevalence and prognostic value of malnutrition among patients with atrial fibrillation (AF) which is a type of metabolic disease.
Methods
We included 3,239 patients (age 58.5 ± 10.8 years, 73.2% male, 67.7% paroxysmal type) undergoing de novo AF catheter ablation (AFCA) between 2009 and 2020. Nutritional status was assessed using controlling nutritional status (CONUT) score. The associations between malnutrition and the risk of AFCA complications or long-term rhythm outcome were evaluated by multivariable logistic regression.
Results
Among 3,239 patients, 1,005 (31.0%) patients had malnutrition; 991 (30.6%) with mild (CONUT scores 2-4) and 14 (0.4%) with moderate-to-severe (CONUT scores ≥5) malnutrition. Overall complication rates after AFCA were 3.3% in normal nutrition, 4.2% in mild malnutrition, and 21.4% in moderate to severe malnutrition, respectively (P for trend = 0.031). Major complication rates were 1.9%, 2.6%, and 14.3% in normal nutrition, mild malnutrition, and moderate to severe malnutrition (P for trend = 0.042). After multivariable adjustment, moderate-to-severe malnutrition status was associated with increased risks of overall (OR 8.215 [2.199-30.691], P = 0.002) and major (OR 7.392 [1.568-34.837], P = 0.011) complications compared with normal nutrition. However, CONUT score did not affect the long-term rhythm outcome during the mean follow-up of 40 (interquartile range 18-74) months (log-rank P = 0.760).
Conclusion
Malnutrition is common in patients undergoing AFCA. Those with moderate-to-severe malnutrition status were at substantially higher risk of complications after AFCA. Abstract Figure. Overall and major complication rates
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Affiliation(s)
- D Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - HT Yu
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - TH Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - JS Uhm
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - B Joung
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - MH Lee
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - HN Pak
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
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Pak HN, Park JW, Yang SY, Kim M, Yu HT, Kim TH, Uhm JS, Joung BY, Lee MH. Sex differences in mapping and rhythm outcomes of a repeat atrial fibrillation ablation. Europace 2021. [DOI: 10.1093/europace/euab116.209] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
The risk of procedure-related complications and rhythm outcomes differ between men and women after atrial fibrillation catheter ablation (AFCA). We evaluated whether consistent sex differences existed in mapping and rhythm outcomes in repeat ablation procedures.
Methods
Among 3,282 patients in the registry, we analysed 443 consecutive patients (24.6% female, 58.5 ± 10.3 years old, 61.5% paroxysmal AF) who underwent a second AFCA. We compared the clinical factors, mapping, left atrial (LA) pressure, complications, and long-term clinical recurrences after propensity score matching.
Results
The LA volume index (43.1 ± 18.6 vs. 35.8 ± 11.6 ml/m2, p < 0.001) was higher, but LA dimension (40.0 ± 6.8 vs. 41.6 ± 6.3mm, p = 0.018), LA voltage (0.94 ± 0.55 vs. 1.20 ± 0.68 mV, p = 0.002), and pericardial fat volume (89.5 ± 43.1 vs. 122.1 ± 53.9 cm3, p < 0.001) lower in women with a repeat ablation than in their male counterparts. The pulmonary vein (PV) reconnections were lower (58.7% vs. 74.9%, p = 0.001), but the proportion of extra-PV triggers (27.5% vs. 17.0%, p = 0.026) and elevated LA pulse pressures (79.7% vs. 63.7%, p = 0.019) was significantly higher in women than men. There was no significant sex difference in the procedure-related complication rate (4.6% vs. 4.2%, p = 0.791). During a 31(8∼60) month median follow-up, clinical recurrences were significantly higher in women after both the de novo procedure (log rank p = 0.039, antiarrhythmic drug [AAD]-free log rank p < 0.001) and second procedure (log rank p = 0.006, AAD-free log rank p = 0.093). A female sex (HR 1.51 [1.06-2.15], p = 0.023), non-paroxysmal AF (HR 1.78 [1.30-2.34], p < 0.010), and extra-PV triggers (HR 1.88 [1.28-2.75], p = 0.001) were independently associated with clinical recurrences after repeat procedures.
Conclusions
During the repeat AFCA procedures, PV reconnections were lower in women than men, and the existence of extra-PV triggers and an LA pressure elevation was more significant, which resulted in poor rhythm outcomes.
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Affiliation(s)
- HN Pak
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - JW Park
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - SY Yang
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - M Kim
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - HT Yu
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - TH Kim
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - JS Uhm
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - BY Joung
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - MH Lee
- Yonsei University Health system, Seoul, Korea (Republic of)
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Park JW, Kwon OS, Shim JM, Yu HT, Kim TH, Uhm JS, Kim JY, Choi JI, Joung BY, Lee MH, Kim YH, Pak HN. Artificial intelligence-predicted poor responders to catheter ablation for atrial fibrillation. Europace 2021. [DOI: 10.1093/europace/euab116.228] [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
Funding Acknowledgements
Type of funding sources: None.
Introduction
Although atrial fibrillation (AF) catheter ablation is effective for rhythm control, in some patients it is hard to maintain sinus rhythm in spite of repeated AF catheter ablation (AFCA) procedures and anti-arrhythmic drugs (AADs). We explored the pre-procedural predictors for poor responders to AFCA and tested whether artificial intelligence (AI) assists the prediction of poor responders in the independent cohort by determining the invasive parameters.
Methods
Among 1,214 patients who underwent AFCA and regular rhythm follow-up for 56.2 ± 33.8 months (59 ± 11 years, 73.5% male, 68.6% paroxysmal AF), we differentiated 92 poor responders defined as those with sustained AF despite repeat AFCAs, AADs, or electrical cardioversion. Using the Youden index, we identified advanced LA remodeling with lower LA voltage under 1.109mV. AI model, which was derived from development cohort using medical record, was applied to predict LA voltage <1.109mV in the independent cohort (n = 634, poor responders = 24) using a grad-cam score.
Results
The patients with lower LA voltage under 1.109mV showed significantly poorer rhythm outcomes (Log-rank p < 0.001). We determined invasive parameter LA voltage by using the multiple variables (age, female sex, AF type, CHA2DS2VASc score, LA dimension, E/em, hemoglobin, PR interval) and achieved relatively good prediction power of AI for LA voltage <1.109mV (AUC = 0.734, sensitivity 0.729, specificity 0.643) in the test cohort. In the independent cohort, the AI model showed good discrimination power for poor responders (AUC 0.751, p < 0.001) by estimating LA voltage, which is an invasive variable. The patients with predicted lower LA voltage (grad-cam score <0) showed poorer rhythm outcome after active rhythm control (Log-rank p < 0.001)
Conclusions
The patients with advanced atrial remodeling with low LA voltage, which can be predicted by an AI, showed significantly higher recurrence of AF after AFCA with AADs or cardioversion. AI may assist to select these poor responder patients before the AFCA procedure. Abstract Figure.
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Affiliation(s)
- JW Park
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - OS Kwon
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - JM Shim
- Korea University, Cardiovascular Center, Seoul, Korea (Republic of)
| | - HT Yu
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - TH Kim
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - JS Uhm
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - JY Kim
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - JI Choi
- Korea University, Cardiovascular Center, Seoul, Korea (Republic of)
| | - BY Joung
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - MH Lee
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - YH Kim
- Korea University, Cardiovascular Center, Seoul, Korea (Republic of)
| | - HN Pak
- Yonsei University Health system, Seoul, Korea (Republic of)
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Lee J, Kwon OS, Lee JS, Yu HT, Kim TH, Uhm JS, Joung BY, Lee MH, Pak HN. Left atrial wall stress and the outcome of catheter ablation for atrial fibrillation: artificial intelligence-based prediction of clinical outcome. Europace 2021. [DOI: 10.1093/europace/euab116.296] [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: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction: Left atrial (LA) wall stress (LAW-str) may contribute to the mechanism of atrial fibrillation (AF).
Purpose
We explored the clinical characteristics and the rhythm outcome of AF depending on LAW-str among the patients who underwent AF catheter ablation (AFCA). We also tested whether artificial intelligence (AI) properly estimate LAW-str without invasive parameters.
Methods
We included 2223 patients (72.8% male, 59.0 [52.0–67.0] years old, 28.7% with persistent AF [PeAF]) who underwent radiofrequency catheter ablation (RFCA). LAW-str was calculated by the Law of Laplace using LA diameter (echocardiogram), peak LA pressure, and mean LA wall thickness (computed tomography) measured by customized software. Based on the quartile (Q1–4) or AI-estimated values of LAW-str, we compared clinical characteristics and rhythm outcome.
Results
LAW-str was independently associated with PeAF (p < 0.001), diabetes (p = 0.012) and vascular disease (p = 0.002), body mass index (p < 0.001), E/Em (p < 0.001), and mean LA voltage (p < 0.001). During 26.0 (12.0–52.0) months follow-up, clinical recurrence of AF was significantly higher in the Q4 of LAW-str group (log rank p = 0.001). LAW-str was independently associated with clinical recurrence after AFCA (HR 1.001 [1.000–1.002], p = 0.013). AI-based model using non-invasive parameters predicted Q4 of LAW-str with area under the curve (AUC) 0.734, which was similar to logistic regression based predictive model using all data including invasive parameters (AUC 0.726). Patients in Q4 of LAW-str showed consistently worse rhythm outcome regardless of the type of AF, sex, or AI-based prediction (p = 0.039).
Conclusions
The LAW-str seems to be associated with rhythm outcome of AFCA and AI can predict this complex parameter with moderate accuracy. TableMultivariateβ (95% CI)PPersistent AF31.08 (21.77-40.39)<0.001Diabetes mellitus15.36 (3.35-27.38)0.012Vascular disease22.27 (8.4-36.14)0.002Body mass index2.91 (1.53-4.29)<0.001E/Em4.95 (3.87-6.02)<0.001Mean LA voltage-22.24 (-27.96–16.52)<0.001Linear regression analysis for clinical variables predictive of LA wall stress (10^3 dyn/cm2).Abstract Figure. AF recurrence by LAW-str, AI-prediction
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Affiliation(s)
- J Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - OS Kwon
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - JS Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - HT Yu
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - TH Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - JS Uhm
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - BY Joung
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - MH Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - HN Pak
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
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Park JW, Yang PS, Yu HT, Kim TH, Jang ES, Pak HN, Lee MH, Joung BY. The reduction of body mass index and risk of incidence of cardiovascular events in the elderly population. Europace 2021. [DOI: 10.1093/europace/euab116.152] [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: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Obesity is known to be risk factor for incidence of cardiovascular (CV) events. However, the association between the reduction of body mass index (BMI) and incidence of cardiovascular event is not well established in elderly Asian population.
Methods
From the National Health Insurance Service-Senior (≥60 years) cohort from 2002 to 2013, 13,038 participants over 75 years old without baseline comorbidities (mean age: 78.4 ± 3.2 years 5243 (40.2%) male) were included in this study. We measured the change of BMI from first to second visit for health check-up within mean 23.6 ± 5.8months of follow-up. We categorized the reduction of BMI as five group according to the amount of change in BMI in overall patients (group 1: BMI change <-10%, group 2: -10%≤BMI change<-3%, group 3: -3% ≤ BMI change < 3%, group 4: 3% ≤BMI change < 10%, group 5: 10% ≤BMI change). We investigated the influence of change in BMI on the incidence of new-onset AF, stroke, acute myocardial infarction (MI), and CV mortality
Results
In the overall patients, new-onset AF, stroke, acute MI, and CV death was occurred in the 494 patients (3.5%), 775 patients (5.9%), 16 patients (0.1%), and 458 patients (3.5%) respectively. The Kaplan-Meier curve showed significant cumulative incidence rate of CV death in group 1 (Log rank p < 0.001). The multivariate cox regression after adjusting for compound clinical covariates showed the risk of stroke (HR 1.43, 95% CI [1.09-1.89], p = 0.01) and CV death (HR 2.06, 95% CI [1.49-2.84] were significant higher in the group 1 as compared with group 3. In the high BMI (≥25) group, the risk of AF was significant higher in the group 5 as compared with group 3 (HR 2.38, 95% CI [1.02-5.54], p = 0.04). In contrast, the risk of stroke (HR 1.70, 95% CI [1.07-2.71], p = 0.02) and CV death (HR 3.27, 95% CI [1.66-6.41], p < 0.001) was significant higher in the group 1 than in group 3.
Conclusions
In the elderly Asian population over 75 years old, the reduction of body weight affected worse effect on the incidence of stroke and CV death in overall patient and high BMI (≥25) group. It needs careful consideration to reduce BMI in the elderly Asian population even with high BMI (≥25) for purpose of CV events.
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Affiliation(s)
- JW Park
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - PS Yang
- Bundang CHA General Hospital, Seongnam, Korea (Republic of)
| | - HT Yu
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - TH Kim
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - ES Jang
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - HN Pak
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - MH Lee
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - BY Joung
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
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Lee Y, Samarasinghe Y, Lee MH, Thiru L, Shargall Y, Finley C, Hanna W, Levine OH, Juergens RA, Agzarian J. Role of adjuvant therapy in esophageal cancer patients after neoadjuvant therapy and curative esophagectomy: A systematic review and meta-analysis. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e16083] [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: 11/20/2022] Open
Abstract
e16083 Background: While neoadjuvant therapy followed by esophagectomy is the standard of care for locally advanced esophageal cancer, the role of adjuvant therapy is uncertain. As such, this review aims to analyze esophageal cancer patients who previously underwent neoadjuvant therapy followed by a curative resection (negative margins) to determine whether additional adjuvant therapy is associated with improved survival outcomes. Methods: MEDLINE, EMBASE, and CENTRAL databases were searched up to August 2020 for studies comparing patients with esophageal cancer who underwent neoadjuvant therapy and curative resection with and without adjuvant therapy. Primary outcome was overall survival (OS), and secondary outcomes were disease-free survival (DFS), locoregional recurrence, and distant recurrence at 1 and 5-years. Random effects meta-analysis was conducted where appropriate. Grading of recommendations, assessment, development, and evaluation (GRADE) was used to assess the certainty of evidence. Results: Ten studies involving 6,462 patients were included. 6,162 (95.36%) patients from 7 studies received adjuvant chemotherapy, whereas 296 (4.58%) patients from 3 studies underwent either adjuvant radiotherapy or chemoradiotherapy. When compared to patients who received neoadjuvant therapy and esophagectomy alone, adjuvant therapy groups experienced a significant overall survival benefit by 48% at 1-year (RR 0.52, 95%CI 0.41-0.65, P < 0.001, moderate certainty). This reduction in mortality was consistent at long-term 5-year follow-up (RR 0.91, 95%CI 0.87-0.96, P < 0.001, moderate certainty). Subgroup analysis on pathologic node positive patients demonstrated a consistent survival benefit at 1-year (RR 0.57, 95% CI 0.42-0.77, P < 0.001, moderate certainty) and 5-year (RR 0.89 95%CI 0.84-0.95, P < 0.001, moderate certainty). While adjuvant therapy presented no benefit for the T0-2 stage subgroup, patients with T3-4 disease experienced a significant reduction in mortality with the addition of adjuvant therapy at both 1-year (RR 0.51, 95% CI 0.41-0.63, P < 0.001, moderate certainty), and 5-years (RR 0.91, 95% CI 0.85-0.97, P = 0.005, moderate certainty). Due to incomplete reporting, the added benefit of adjuvant therapy was uncertain regarding DFS, locoregional recurrence, and distant recurrence. Conclusions: Adjuvant therapy after neoadjuvant treatment and curative esophagectomy provides improved OS at 1 and 5 years, but the benefit for DFS and locoregional/distant recurrence was uncertain due to limited reporting of these outcomes.
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Affiliation(s)
- Yung Lee
- McMaster University, Hamilton, ON, Canada
| | | | | | | | | | | | - Wael Hanna
- McMaster University, Hamilton, ON, Canada
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Koh JWH, Ng CH, Lee MH, Chin YH, Ong ZH, Tham HY, Chong CS, Shim HH, Fo FJ. 19 Colectomy Rate for Moderate to Severe Ulcerative Colitis with Biologics. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.188] [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: 11/13/2022]
Abstract
Abstract
Introduction
Biologics are recommended by both the ACG and ECCO community for the treatment of ulcerative colitis. Yet, current literature has yet to estimate the rate of colectomies after biologic therapy, and thus a pooled meta-analysis was conducted the rate of colectomies in 1month, 6 months, 1 year, 2years and five years after biologics.
Method
Medline and Embase were searched for articles examining biologics use in moderate to severe UC or acute severe UC (ASUC) from inception to 21st May 2020. Analysis of proportions were undertaken after a freeman-tukey double arcsine transformation.
Results
The pooled overall colectomy rates of ASUC and moderate to severe UC were 9% (CI: 4% - 14%) at one month, 18% (CI: 13% - 25%) at six months, 21% (CI:16% - 27%) at one year, 29% (CI:24% - 34%) at two years and 38% (CI:30% - 45%) at five years. Additionally, colectomy rates were consistently lower comparing between articles before and after 2010. At one-year, overall colectomy rate following infliximab use was at 25%, golimumab at 15%, vedolizumab at 14%, and adalimumab at 3%.
Conclusions
Colectomy rates in the era of biologics ranged from 8% to 38% and lower post-2010 showing significant improvement in management and supporting the utility of biologics in Ulcerative colitis management.
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Affiliation(s)
- J W H Koh
- National University Singapore, Singapore, Singapore
| | - C H Ng
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - M H Lee
- National University Singapore, Singapore, Singapore
| | - Y H Chin
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Z H Ong
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - H Y Tham
- National University Hospital, Singapore, Singapore
| | - C S Chong
- National University Hospital, Singapore, Singapore
| | - H H Shim
- Singapore General Hospital, Singapore, Singapore
| | - F J Fo
- Sengkang General Hospital, Singapore, Singapore
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Rahaghi FN, Hilton JF, Corrêa RA, Loureiro C, Ota-Arakaki JS, Verrastro CGY, Lee MH, Mickael C, Nardelli P, Systrom DA, Waxman AB, Washko GR, San José Estépar R, Graham BB, Oliveira RKF. Arterial vascular volume changes with haemodynamics in schistosomiasis-associated pulmonary arterial hypertension. Eur Respir J 2021; 57:2003914. [PMID: 33446601 PMCID: PMC8106660 DOI: 10.1183/13993003.03914-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/19/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joan F Hilton
- Dept of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Ricardo A Corrêa
- Internal Medicine/Pulmonary Division, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Jaquelina S Ota-Arakaki
- Division of Respiratory Diseases, Dept of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Michael H Lee
- Pulmonary Sciences and Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Claudia Mickael
- Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz medical campus, Aurora, CO, USA
| | - Pietro Nardelli
- Applied Chest Imaging Laboratory, Dept of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David A Systrom
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aaron B Waxman
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, Dept of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian B Graham
- Pulmonary Sciences and Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Rudolf K F Oliveira
- Division of Respiratory Diseases, Dept of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Abstract
Infections with Salmonella enterica pose a challenge for antibiotic treatment. In this issue of Cell Chemical Biology, Tsai et al. use a chemical genomics approach to identify dephostatin as an inhibitor of intracellular Salmonella virulence in vitro and in vivo by targeting the two-component systems SsrA-SsrB and PmrB-PmrA.
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Affiliation(s)
- Michael H Lee
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA
| | - Sean-Paul Nuccio
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA
| | - Manuela Raffatellu
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA; Center for Microbiome Innovation, University of California San Diego, La Jolla, CA 92093, USA; Chiba University-UC San Diego Center for Mucosal Immunology, Allergy, and Vaccines (CU-UCSD cMAV), La Jolla, CA 92093, USA.
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50
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Lee MH, Cool CD, Maloney JP. Histopathological Correlation of Acute on Chronic Eosinophilic Pneumonitis Caused by Vaporized Cannabis Oil Inhalation. Chest 2021; 159:e137-e139. [PMID: 33678280 DOI: 10.1016/j.chest.2020.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/21/2020] [Accepted: 10/05/2020] [Indexed: 11/17/2022] Open
Abstract
Whether eosinophilic pneumonitis represents a true manifestation of e-cigarette, or vaping, product use-associated lung injury remains uncertain, and this ambiguity stems from a lack of histopathological data. We present a previously healthy young woman whose asthma-like symptoms and histopathologic finding of eosinophilic pneumonitis were caused by inhalation of vaporized cannabis hash oil concentrates. This report provides compelling evidence that eosinophilic pneumonitis can result from cannabis hash oil inhalation.
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Affiliation(s)
- Michael H Lee
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California San Francisco.
| | | | - James P Maloney
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver
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