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Kidder BL, Ruden X, Singh A, Marben TA, Rass L, Chakravarty A, Xie Y, Puscheck EE, Awonuga AO, Harris S, Ruden DM, Rappolee DA. Novel high throughput screen reports that benzo(a)pyrene overrides mouse trophoblast stem cell multipotency, inducing SAPK activity, HAND1 and differentiated trophoblast giant cells. Placenta 2024:S0143-4004(23)00644-6. [PMID: 38245404 DOI: 10.1016/j.placenta.2023.12.020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
INTRODUCTION Cultured mouse trophoblast stem cells (mTSC) maintain proliferation/normal stemness (NS) under FGF4, which when removed, causes normal differentiation (ND). Hypoxic, or hyperosmotic stress forces trophoblast giant cells (TGC) differentiate. Hypoxic, hyperosmotic, and genotoxic benzo(a)pyrene (BaP), which is found in tobacco smoke, force down-regulation of inhibitor of differentiation (Id)2, enabling TGC differentiation. Hypoxic and hyperosmotic stress induce TGC by SAPK-dependent HAND1 increase. Here we test whether BaP forces mTSC-to-TGC while inducing SAPK and HAND1. METHODS Hand1 and SAPK activity were assayed by immunoblot, mTSC-to-TGC growth and differentiation were assayed at Tfinal after 72hr exposure of BaP, NS, ND, Retinoic acid (RA), or sorbitol. Nuclear-stained cells were micrographed automatically by a live imager, and assayed by ImageJ/FIJI, Biotek Gen 5, AIVIA proprietary artificial intelligence (AI) software or open source, CellPose artificial intelligence/AI software. RESULTS BaP (0.05-1μM) activated SAPK and HAND1 without diminishing growth. TSC-to-TGC differentiation was assayed with increasingly accuracy for 2-4 N cycling nuclei and >4 N differentiating TGC nuclei, using ImageJ/FIJI, Gen 5, AIVIA, or CellPose AI software. The AIVIA and Cellpose AI software matches human accuracy. The lowest BaP effects on SAPK activation/HAND1 increase are >10-fold more sensitive than similar effects for mESC. RA induces 44-47% 1st lineage TGC differentiation, but the same RA dose induces only 1% 1st lineage mESC differentiation. DISCUSSION First, these pilot data suggest that mTSC can be used in high throughput screens (HTS) to predict toxicant exposures that force TGC differentiation. Second, mTSC differentiated more cells than mESC for similar stress exposures, Third, open source AI can replace human micrograph quantitation and enable a miscarriage-predicting HTS.
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Affiliation(s)
- B L Kidder
- Department of Oncology, Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, MI, USA
| | - X Ruden
- CS Mott Center/WSU Ob/gyn Department, USA; Reproductive Stress Inc, Grosse Pointe Farms, MI, USA
| | - A Singh
- CS Mott Center/WSU Ob/gyn Department, USA; WSU CMMG, USA
| | - T A Marben
- University of Detroit, Mercy (NIH Build Fellow), USA
| | - L Rass
- Barber Foundation Fellows/WSU, USA
| | | | - Y Xie
- Western Fertility, Los Angeles, CA, USA
| | - E E Puscheck
- CS Mott Center/WSU Ob/gyn Department, USA; Invia Infertility, Chicago, IL, USA
| | | | - S Harris
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - D M Ruden
- CS Mott Center/WSU Ob/gyn Department, USA; IEHS, WSU, USA
| | - D A Rappolee
- CS Mott Center/WSU Ob/gyn Department, USA; Reproductive Stress Inc, Grosse Pointe Farms, MI, USA; Dept of Physiology, WSU, USA.
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Kozhimala M, Chan SM, Weininger G, Sumpio BJ, Levine LJ, Harris S, Zheng S, Longo WE, Ochoa Chaar C, Guzman RJ, Sumpio BE. Prevalence and Characteristics of Patients with Median Arcuate Ligament Syndrome in a Cohort Diagnosed with Celiac Artery Compression. J Am Coll Surg 2023; 236:1085-1091. [PMID: 36476640 DOI: 10.1097/xcs.0000000000000500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Median arcuate ligament syndrome (MALS) is a frequent differential diagnosis in patients with postprandial abdominal symptoms, but diagnosis remains challenging. The aim of this study was to identify characteristics of patients who had MALS compared with non-MALS patients among a cohort of patients diagnosed with celiac artery compression (CAC). STUDY DESIGN An IRB-approved retrospective chart review (2000 to 2021) of patients at our institution with a discharge diagnosis of CAC was performed. Medical record review for clinical symptoms and findings consistent with MALS was performed. RESULTS Two hundred ninety-three patients with a diagnosis of CAC were identified; 59.7% were women, and average age was 63.9 ± 20.2 years. Sixty-nine (23.5%) patients with CAC had MALS. There were no significant differences in sex or race between MALS and non-MALS patients, but MALS patients were younger (55.7 vs 68.1, p < 0.001). There was no significant difference in gastrointestinal comorbidities between the 2 groups. Patients with MALS were less likely to have diabetes (12.5% vs 26.9%), renal disease (4.6% vs 8.2%), hypertension (41.5% vs 70.3%), mesenteric atherosclerotic disease (14% vs 61.9%), and peripheral artery disease (15.0% vs 39.7%). CONCLUSIONS We demonstrate a novel observation that MALS patients tend to have fewer atherosclerotic characteristics than non-MALS patients with CAC. Patients in our study with MALS were more likely to be younger, women, and presenting with epigastric pain. MALS patients had a significantly lower incidence of diabetes, hypertension, renal disease, mesenteric artery disease, and peripheral arterial disease compared with the non-MALS group. An important clinically relevant feature of MALS patients may be their lack of atherosclerotic phenotype compared with non- MALS patients with CAC.
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Affiliation(s)
- Meagan Kozhimala
- From the Division of Vascular and Endovascular Surgery (Kozhimala, Harris, Chaar, Guzman, BE Sumpio), New Haven, CT
- Department of Surgery, Waterbury Hospital, CT (Kozhimala)
| | - Shin Mei Chan
- Yale University School of Medicine (Chan, Weininger, Zheng), New Haven, CT
| | - Gabe Weininger
- Yale University School of Medicine (Chan, Weininger, Zheng), New Haven, CT
| | - Brandon J Sumpio
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston (BJ Sumpio)
| | | | - Sean Harris
- From the Division of Vascular and Endovascular Surgery (Kozhimala, Harris, Chaar, Guzman, BE Sumpio), New Haven, CT
| | - Sijin Zheng
- Yale University School of Medicine (Chan, Weininger, Zheng), New Haven, CT
| | | | - Cassius Ochoa Chaar
- From the Division of Vascular and Endovascular Surgery (Kozhimala, Harris, Chaar, Guzman, BE Sumpio), New Haven, CT
| | - Raul J Guzman
- From the Division of Vascular and Endovascular Surgery (Kozhimala, Harris, Chaar, Guzman, BE Sumpio), New Haven, CT
| | - Bauer E Sumpio
- From the Division of Vascular and Endovascular Surgery (Kozhimala, Harris, Chaar, Guzman, BE Sumpio), New Haven, CT
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Thorsen ML, Harris S, Palacios JF, McGarvey RG, Thorsen A. American Indians travel great distances for obstetrical care: Examining rural and racial disparities. Soc Sci Med 2023; 325:115897. [PMID: 37084704 PMCID: PMC10164064 DOI: 10.1016/j.socscimed.2023.115897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/20/2023] [Accepted: 04/06/2023] [Indexed: 04/23/2023]
Abstract
Rural, American Indian/Alaska Native (AI/AN) people, a population at elevated risk for complex pregnancies, have limited access to risk-appropriate obstetric care. Obstetrical bypassing, seeking care at a non-local obstetric unit, is an important feature of perinatal regionalization that can alleviate some challenges faced by this rural population, at the cost of increased travel to give birth. Data from five years (2014-2018) of birth certificates from Montana, along with the 2018 annual survey of the American Hospital Association (AHA) were used in logistic regression models to identify predictors of bypassing, with ordinary least squares regression models used to predict factors associated with the distance (in miles) birthing people drove beyond their local obstetric unit to give birth. Logit analyses focused on hospital-based births to Montana residents delivered during this time period (n = 54,146 births). Distance analyses focused on births to individuals who bypassed their local obstetric unit to deliver (n = 5,991 births). Individual-level predictors included maternal sociodemographic characteristics, location, perinatal health characteristics, and health care utilization. Facility-related measures included level of obstetric care of the closest and delivery hospitals, and distance to the closest hospital-based obstetric unit. Findings suggest that birthing people living in rural areas and on American Indian reservations were more likely to bypass to give birth, with bypassing likelihood depending on health risk, insurance, and rurality. AI/AN and reservation-dwelling birthing people traveled significantly farther when bypassing. Findings highlight that distance traveled was even farther for AI/AN people facing pregnancy health risks (23.8 miles farther than White people with pregnancy risks) or when delivering at facilities offering complex care (14-44 miles farther than White people). While bypassing may connect rural birthing people to more risk-appropriate care, rural and racial inequities in access persist, with rural, reservation-dwelling AI/AN birthing people experiencing greater likelihood of bypassing and traveling greater distances when bypassing.
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Affiliation(s)
- Maggie L Thorsen
- Department of Sociology and Anthropology, Montana State University, USA.
| | - Sean Harris
- Jake Jabs College of Business and Entrepreneurship, Montana State University, USA
| | - Janelle F Palacios
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland, California, 94611, USA
| | - Ronald G McGarvey
- IESEG School of Management, Univ. Lille, CNRS, UMR 9221 - LEM - Lille Economie Management, F-59000, Lille, France
| | - Andreas Thorsen
- Jake Jabs College of Business and Entrepreneurship, Montana State University, USA
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Chan SM, Weininger G, Kozhimala M, Sumpio BJ, Levine LJ, Harris S, Zheng S, Ochoa Chaar CI, Guzman RJ, Sumpio BE. Utility of Hook Sign in the Diagnosis of Median Arcuate Ligament Syndrome. Ann Vasc Surg 2023:S0890-5096(23)00186-3. [PMID: 37023920 DOI: 10.1016/j.avsg.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/18/2023] [Accepted: 03/19/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE Median arcuate ligament syndrome (MALS) is a clinical syndrome caused by compression of the celiac artery by the median arcuate ligament (MAL) that often manifests with non-specific abdominal pain. Identification of this syndrome is often dependent on imaging of compression and upward bending of the celiac artery by lateral CTA, the so-called "hook sign." The purpose of this study was to assess the relationship of radiologic characteristicss of the celiac artery to clinically relevant MALS. DESIGN Single-center retrospective study METHODS: An IRB-approved retrospective chart review from 2000-2021 of 293 patients at a tertiary academic center diagnosed with celiac artery compression (CAC) was performed. Patient demographics and symptoms of 69 patients who were diagnosed with symptomatic MALS were compared to 224 patients without MALS (but with CAC) per electronic medical record review. CTA images were reviewed and the fold angle (FA) was measured. The presence of a hook sign (defined as a visual fold angle < 135 degrees) was recorded as well as stenosis (defined as >50% of luminal narrowing on imaging). Wilcoxon rank sum test and Chi-squared were utilized for comparative analysis. Logistic model was run to relate the presence of MALS with comorbidities and radiographic findings. RESULTS Imaging was available in 59 patients (25 males, 34 females) and 157 patients (60 males, 97 females) with and without MALS respectively. Patients with MALS were more likely to have a more severe FA (120.7 ± 33.6 vs. 134.8 ± 27.9, P = 0.002). Males with MALS were also more likely to have a more severe FA compared with males without MALS (111.1 ± 33.7 vs. 130.4 ± 30.4, P = 0.015). In patients with BMI > 25, MALS patients also had narrower FA compared with patients without MALS (112.6 ± 30.5 vs. 131.7 ± 30.3, P = 0.001). The FA was negatively correlated with BMI in patients with CAC . The hook sign and stenosis were associated with diagnosis of MALS (59.3% vs. 28.7%, P < 0.001, and 75.7% vs. 45.2%, P < 0.001, respectively). In logistic regression, pain, stenosis and a narrow FA were statistically significant predictors of the presence of MALS. CONCLUSIONS The upward deflection of the celiac artery in patients with MALS is more severe compared with patients without MALS. Consistent with prior literature, this bending of the celiac artery is negatively correlated with BMI in patients with and without MALS. When demographic variables and comorbidities are considered, a narrow FA is a statistically significant predictor of MALS. Regardless of MALS diagnosis, a hook sign was associated with narrower FA. While demographics and imaging findings may inform MALS diagnosis, clinicians should not rely on a visual assessment of a hook sign but should quantitatively measure the anatomic bending angle of the celiac artery to assist with the diagnosis and understand the outcomes.
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Affiliation(s)
- Shin Mei Chan
- Yale University School of Medicine, New Haven, CT, 06511
| | - Gabe Weininger
- Yale University School of Medicine, New Haven, CT, 06511
| | - Meagan Kozhimala
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, 06511
| | - Brandon J Sumpio
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, 02114
| | - Louis J Levine
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 06511
| | - Sean Harris
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, 06511
| | - Sijin Zheng
- Yale University School of Medicine, New Haven, CT, 06511
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, 06511
| | - Raul J Guzman
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, 06511
| | - Bauer E Sumpio
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, 06511.
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Wegner S, Workman T, Park JJ, Harris S, Wallace J, Stanaway I, Hong S, Hansen B, Griffith WC, Faustman EM. A Dynamic In vitro developing testis model reflects structures and functions of testicular development in vivo. Reprod Toxicol 2023; 118:108362. [PMID: 37011698 DOI: 10.1016/j.reprotox.2023.108362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 04/03/2023]
Abstract
To better define appropriate applications of our 3-dimensional testicular co-culture as a model for reproductive toxicology, we evaluated the ability of the model to capture structural and functional elements that can be targeted by reproductive toxicants. Testicular co-cultures were prepared from postnatal day 5 male rats and cultured with a Matrigel overlay. Following a 2-day acclimation period, we characterized functional pathway dynamics by evaluating morphology, protein expression, testosterone concentrations, and global gene expression at a range of timepoints from experimental days 0 to 21. Western blotting confirmed expression of Sertoli cell, Leydig cell, and spermatogonial cell-specific protein markers. Testosterone detected in cell culture media indicates active testosterone production. Quantitative pathway analysis identified Gene Ontology biological processes enriched among genes significantly changing over the course of 21 days. Processes enriched among genes significantly increasing through time include general developmental processes (morphogenesis, tissue remodeling, etc.), steroid regulation, Sertoli cell development, immune response, and stress and apoptosis. Processes enriched among genes significantly decreasing over time include several related to male reproductive development (seminiferous tubule development, male gonad development, Leydig cell differentiation, Sertoli cell differentiation), all of which appear to peak in expression between days 1 and 5 before decreasing at later timepoints. This analysis provides a temporal roadmap for specific biological process of interest for reproductive toxicology in the model and anchors the model to sensitive phases of in vivo development, helping to define the relevance of the model for in vivo processes.
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Affiliation(s)
- Susanna Wegner
- Institute for Risk Analysis and Risk Communication, University of Washington School of Public Health, Seattle, WA, USA
| | - Tomomi Workman
- Institute for Risk Analysis and Risk Communication, University of Washington School of Public Health, Seattle, WA, USA
| | - Julie Juyoung Park
- Institute for Risk Analysis and Risk Communication, University of Washington School of Public Health, Seattle, WA, USA
| | - Sean Harris
- Institute for Risk Analysis and Risk Communication, University of Washington School of Public Health, Seattle, WA, USA
| | - James Wallace
- Institute for Risk Analysis and Risk Communication, University of Washington School of Public Health, Seattle, WA, USA
| | - Ian Stanaway
- Institute for Risk Analysis and Risk Communication, University of Washington School of Public Health, Seattle, WA, USA
| | - Sungwoo Hong
- Institute for Risk Analysis and Risk Communication, University of Washington School of Public Health, Seattle, WA, USA
| | - Brad Hansen
- Institute for Risk Analysis and Risk Communication, University of Washington School of Public Health, Seattle, WA, USA
| | - William C Griffith
- Institute for Risk Analysis and Risk Communication, University of Washington School of Public Health, Seattle, WA, USA
| | - Elaine M Faustman
- Institute for Risk Analysis and Risk Communication, University of Washington School of Public Health, Seattle, WA, USA.
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Vassallo J, Cowburn P, Park C, Bull D, Harris S, Moran C, Smith J. Ten second triage: A novel and pragmatic approach to major incident triage. Trauma 2023. [DOI: 10.1177/14604086231156219] [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: 03/09/2023]
Abstract
Triage is a key principle in the effective management of major incidents and has traditionally been performed using an assessment of a casualty's physiology. However, it has become apparent from recent experiences of major incidents that physiological triage may practically not be possible, especially in the early stages of an incident. A key factor is the speed with which it is possible to perform triage, and subsequently, the speed at which key life-saving interventions (e.g., management of external haemorrhage and airway opening manoeuvres) are able to be performed simultaneously as part of the triage process. Addressing this issue was a priority for the review of major incident triage undertaken by NHS England and culminated in the development of the Ten Second Triage (TST) tool.
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Affiliation(s)
- J. Vassallo
- Institute of Naval Medicine, Gosport, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - P. Cowburn
- Emergency Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- South Western Ambulance Service NHS Foundation Trust, North Bristol Operations Centre, Bristol, UK
- National Ambulance Resilience Unit (NARU), College of Policing, UK
| | - C. Park
- Academic Department of Military Anaesthesia & Critical Care, Royal Centre for Defence Medicine, Birmingham, UK
- Department of Anaesthesia and Critical Care, Kings College Hospital, London, UK
| | - D. Bull
- National Ambulance Resilience Unit (NARU), College of Policing, UK
| | - S. Harris
- London Ambulance Service, London, UK
| | - C.G. Moran
- NHS England London, London, UK
- Department of Trauma and Orthopaedics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J.E. Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
- Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
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DeCarlo C, Woo K, van Petersen AS, Geelkerken RH, Chen AJ, Yeh SL, Kim GY, Henke PK, Tracci MC, Schneck MB, Grotemeyer D, Meyer B, DeMartino RR, Wilkins PB, Iranmanesh S, Rastogi V, Aulivola B, Korepta LM, Shutze WP, Jett KG, Sorber R, Abularrage CJ, Long GW, Bove PG, Davies MG, Miserlis D, Shih M, Yi J, Gupta R, Loa J, Robinson DA, Gombert A, Doukas P, de Caridi G, Benedetto F, Wittgen CM, Smeds MR, Sumpio BE, Harris S, Szeberin Z, Pomozi E, Stilo F, Montelione N, Mouawad NJ, Lawrence P, Dua A. Factors associated with successful median arcuate ligament release in an international, multi-institutional cohort. J Vasc Surg 2023; 77:567-577.e2. [PMID: 36306935 DOI: 10.1016/j.jvs.2022.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Prior research on median arcuate ligament syndrome has been limited to institutional case series, making the optimal approach to median arcuate ligament release (MALR) and resulting outcomes unclear. In the present study, we compared the outcomes of different approaches to MALR and determined the predictors of long-term treatment failure. METHODS The Vascular Low Frequency Disease Consortium is an international, multi-institutional research consortium. Data on open, laparoscopic, and robotic MALR performed from 2000 to 2020 were gathered. The primary outcome was treatment failure, defined as no improvement in median arcuate ligament syndrome symptoms after MALR or symptom recurrence between MALR and the last clinical follow-up. RESULTS For 516 patients treated at 24 institutions, open, laparoscopic, and robotic MALR had been performed in 227 (44.0%), 235 (45.5%), and 54 (10.5%) patients, respectively. Perioperative complications (ileus, cardiac, and wound complications; readmissions; unplanned procedures) occurred in 19.2% (open, 30.0%; laparoscopic, 8.9%; robotic, 18.5%; P < .001). The median follow-up was 1.59 years (interquartile range, 0.38-4.35 years). For the 488 patients with follow-up data available, 287 (58.8%) had had full relief, 119 (24.4%) had had partial relief, and 82 (16.8%) had derived no benefit from MALR. The 1- and 3-year freedom from treatment failure for the overall cohort was 63.8% (95% confidence interval [CI], 59.0%-68.3%) and 51.9% (95% CI, 46.1%-57.3%), respectively. The factors associated with an increased hazard of treatment failure on multivariable analysis included robotic MALR (hazard ratio [HR], 1.73; 95% CI, 1.16-2.59; P = .007), a history of gastroparesis (HR, 1.83; 95% CI, 1.09-3.09; P = .023), abdominal cancer (HR, 10.3; 95% CI, 3.06-34.6; P < .001), dysphagia and/or odynophagia (HR, 2.44; 95% CI, 1.27-4.69; P = .008), no relief from a celiac plexus block (HR, 2.18; 95% CI, 1.00-4.72; P = .049), and an increasing number of preoperative pain locations (HR, 1.12 per location; 95% CI, 1.00-1.25; P = .042). The factors associated with a lower hazard included increasing age (HR, 0.99 per increasing year; 95% CI, 0.98-1.0; P = .012) and an increasing number of preoperative diagnostic gastrointestinal studies (HR, 0.84 per study; 95% CI, 0.74-0.96; P = .012) Open and laparoscopic MALR resulted in similar long-term freedom from treatment failure. No radiographic parameters were associated with differences in treatment failure. CONCLUSIONS No difference was found in long-term failure after open vs laparoscopic MALR; however, open release was associated with higher perioperative morbidity. These results support the use of a preoperative celiac plexus block to aid in patient selection. Operative candidates for MALR should be counseled regarding the factors associated with treatment failure and the relatively high overall rate of treatment failure.
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Affiliation(s)
- Charles DeCarlo
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
| | - Karen Woo
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | | | - Robert H Geelkerken
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, Netherlands; Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, Netherlands
| | - Alina J Chen
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Savannah L Yeh
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Gloria Y Kim
- Division of Vascular Surgery, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Peter K Henke
- Division of Vascular Surgery, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Margaret C Tracci
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA
| | - Matthew B Schneck
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA
| | - Dirk Grotemeyer
- Department of Vascular Surgery, Hôpitaux Robert Schuman - Hopital Kirchberg, Luxembourg, MN
| | - Bernd Meyer
- Department of Vascular Surgery, Hôpitaux Robert Schuman - Hopital Kirchberg, Luxembourg, MN
| | - Randall R DeMartino
- Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Parvathi B Wilkins
- Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Sina Iranmanesh
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Vinamr Rastogi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Bernadette Aulivola
- Division of Vascular and Endovascular Surgery, Department of Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL
| | - Lindsey M Korepta
- Division of Vascular and Endovascular Surgery, Department of Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL
| | - William P Shutze
- Division of Vascular Surgery, Department of Surgery, The Heart Hospital Plano, Plano, TX
| | - Kimble G Jett
- Division of Vascular Surgery, Department of Surgery, The Heart Hospital Plano, Plano, TX
| | - Rebecca Sorber
- Division of Vascular and Endovascular Surgery, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Christopher J Abularrage
- Division of Vascular and Endovascular Surgery, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Graham W Long
- Division of Vascular Surgery, Department of Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Paul G Bove
- Division of Vascular Surgery, Department of Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Mark G Davies
- Division of Vascular and Endovascular Surgery, Long School of Medicine, University of Texas Health Sciences Center at San Antonio, San Antonio, TX
| | - Dimitrios Miserlis
- Division of Vascular and Endovascular Surgery, Long School of Medicine, University of Texas Health Sciences Center at San Antonio, San Antonio, TX
| | - Michael Shih
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeniann Yi
- Division of Vascular Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Ryan Gupta
- Division of Vascular Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Jacky Loa
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - David A Robinson
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Alexander Gombert
- Department of Vascular Surgery, European Vascular Center Aachen Maastricht, RWTH, University Hospital Aachen, Aachen, Germany
| | - Panagiotis Doukas
- Department of Vascular Surgery, European Vascular Center Aachen Maastricht, RWTH, University Hospital Aachen, Aachen, Germany
| | - Giovanni de Caridi
- Division of Vascular and Endovascular Surgery, Department of Biomorf, University of Messina, Messina, Italy
| | - Filippo Benedetto
- Division of Vascular and Endovascular Surgery, Department of Biomorf, University of Messina, Messina, Italy
| | - Catherine M Wittgen
- Division of Vascular Surgery, Department of Surgery, St. Louis University, St. Louis, MO
| | - Matthew R Smeds
- Division of Vascular Surgery, Department of Surgery, St. Louis University, St. Louis, MO
| | - Bauer E Sumpio
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Sean Harris
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Zoltan Szeberin
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Enikő Pomozi
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Francesco Stilo
- Division of Vascular Surgery, Department of Medicine and Surgery, Campus Bio-Medico University, Rome, Italy
| | - Nunzio Montelione
- Division of Vascular Surgery, Department of Medicine and Surgery, Campus Bio-Medico University, Rome, Italy
| | - Nicolas J Mouawad
- Division of Vascular and Endovascular Surgery, Department of Surgery, McLaren Health System, Bay City, MI
| | - Peter Lawrence
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
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Harris S, Roddey T, Shelton T, Bailey L, Brewer W, Ellison J, Wang W, Gleeson P. The functional lumbar index: Validation of a novel clinical assessment tool for individuals with low back pain. Musculoskelet Sci Pract 2022; 62:102666. [PMID: 36179496 DOI: 10.1016/j.msksp.2022.102666] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/06/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022]
Abstract
STUDY DESIGN Retrospective Diagnostic Cohort Study. LEVEL OF EVIDENCE Level 3b. OBJECTIVES To examine the concurrent and predictive validity of a novel clinical assessment tool, the Functional Lumbar Index (FLI). BACKGROUND Lumbar surgeries have increased exponentially in the past decade, adding to healthcare costs without improving outcomes. Limitations in clinicians' abilities to identify those individuals who are most likely to benefit from surgery may be enhanced with an effective physical assessment tool. METHODS The FLI was assessed on 291 individuals (179 conservative and 113 pre-surgical) seeking care for low-back pain (LBP) over a 2.5-year period. The FLI consists of several physical performance tests (PPT) with a novel criterion-based scoring system. Pearson correlations and Poisson regression analysis were used to establish concurrent and predictive validity at alpha = 0.05. RESULTS The subscale FLI components showed good to excellent inter-rater reliability with intraclass correlation coefficient values as follows: front plank = .993, right side plank = .824, left side plank .861, Sorensen = 0.836, overhead squat = 0.937. A statistically significant, moderate negative correlation was observed between FLI and modified Oswestry Disability Index (r = -0.540, p < .001). Regression analysis showed the FLI as the only significant predictor (p = .004) of failed conservative management for individuals with LBP. An ROC curve showed significant group prediction of the FLI with an AUC of 0.788 (p < .001) and cut-off score of 7.5. CONCLUSION The FLI is a reliable and valid measure for predicting failed conservative care management in patients with LBP. Clinicians are encouraged to use the FLI as part of their physical assessment when screening individuals with LBP who might need surgical intervention. Further research is needed to determine validity of the FLI in other patient populations. PUBLIC TRIAL REGISTRY N/A.
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Affiliation(s)
- Sean Harris
- Texas Woman's University, Houston, TX, USA; Memorial Hermann Health System, Houston, TX, USA.
| | | | | | - Lane Bailey
- Memorial Hermann Health System, Houston, TX, USA
| | | | | | - Wanyi Wang
- Texas Woman's University, Houston, TX, USA
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Harris S, Barkoukis H, McWhorter J, Ricelli O, Burns A, McManus C. Culinary Medicine Education: Curriculum inclusion and Program Director Attitudes, Beliefs and Confidence in ACEND Accredited Programs with a Supervised Practice Component. J Acad Nutr Diet 2022. [DOI: 10.1016/j.jand.2022.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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10
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Tie J, Cohen J, Lahouel K, Lo S, Wang Y, Wong R, Shapiro J, Harris S, Khattak A, Burge M, Horvath L, Karapetis C, Shannon J, Singh M, Yip D, Papadopoulos N, Tomasetti C, Kinzler K, Vogelstein B, Gibbs P. 318MO Circulating tumour DNA (ctDNA) dynamics, CEA and sites of recurrence for the randomised DYNAMIC study: Adjuvant chemotherapy (ACT) guided by ctDNA analysis in stage II colon cancer (CC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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11
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Robinson M, Vervier K, Harris S, Popple A, Klisko D, Hudson R, Bakdash G, Villemin C, Booth C, Adams D, Welsh S, Corrie P, Lawley T. 772P Discovery and exploration of a live bacterial consortium as co-therapy to enhance immune checkpoint inhibitor response in melanoma patients. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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12
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Ascierto P, Mohr P, Dronca R, Harris S, Wilson M, Gurm B, Howansky M, Ng WT, Ravimohan S, Vezina H, Pe Benito M, Gurman P. 882TiP Subcutaneous vs intravenous nivolumab in patients with melanoma following complete resection. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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13
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Nguyen M, Bain N, Grech L, Kwok A, Hamad N, Tognela A, Chan B, Nott L, Harris S, Chau N, Underhill C, Day D, McCartney A, Webber K, Segelov E. 1614P Influence of cancer on COVID-19 vaccine beliefs, attitudes and uptake. Ann Oncol 2022. [PMCID: PMC9472538 DOI: 10.1016/j.annonc.2022.07.1707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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14
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Abdulhasan M, Ruden X, Marben T, Harris S, Ruden DM, Awonuga AO, Puscheck EE, Rappolee DA. Using Live Imaging and Fluorescence Ubiquitinated Cell Cycle Indicator Embryonic Stem Cells to Distinguish G1 Cell Cycle Delays for General Stressors like Perfluoro-Octanoic Acid and Hyperosmotic Sorbitol or G2 Cell Cycle Delay for Mutagenic Stressors like Benzo(a)pyrene. Stem Cells Dev 2022; 31:296-310. [PMID: 35678645 DOI: 10.1089/scd.2021.0330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Lowest observable adverse effects level (LOAEL) is a standard point-of-departure dose in toxicology. However, first observable adverse effects level (FOAEL) was recently reported and is used, in this study, as one criterion to detect a mutagenic stimulus in a live imager. Fluorescence ubiquitinated cell cycle indicator (FUCCI) embryonic stem cells (ESC) are green in the S-G2-M phase of the cell cycle and not green in G1-phase. Standard media change here is a mild stress that delays G1-phase and media change increases green 2.5- to 5-fold. Since stress is mild, media change rapidly increases green cell number, but higher stresses of environmental toxicants and positive control hyperosmotic stress suppress increased green after media change. Perfluoro-octanoic acid (PFOA) and diethyl phthalate (DEP) previously suppressed progression of nongreen to green cell cycle progression. Here, bisphenol A (BPA), cortisol, and positive control hyperosmotic sorbitol also suppress green fluorescence, but benzo(a)pyrene (BaP) at high doses (10 μM) increases green fluorescence throughout the 74-h exposure. Since any stress can affect many cell cycle phases, messenger RNA (mRNA) markers are best interpreted in ratios as dose-dependent mutagens increase in G2/G1 and nonmutagens increase G1/G2. After 74-h exposure, RNAseq detects G1 and G2 markers and increasing BaP doses increase G2/G1 ratios but increasing hyperosmotic sorbitol and PFOA doses increase G1/G2 marker ratios. BaP causes rapid green increase in FOAEL at 2 h of stimulus, whereas retinoic acid caused significant green fluorescence increases only late in culture. Using a live imager to establish FOAEL and G2 delay with FUCCI ESC is a new method to allow commercial and basic developmental biologists to detect drugs and environmental stimuli that are mutagenic. Furthermore, it can be used to test compounds that prevent mutations. In longitudinal studies, uniquely provided by this viable reporter and live imager protocol, follow-up can be done to test whether the preventative compound itself causes harm.
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Affiliation(s)
- Mohammed Abdulhasan
- CS Mott Center for Human Growth and Development, Reproductive Endocrinology and Infertility, Department of Ob/Gyn, Wayne State University School of Medicine, Detroit, Michigan, USA.,Reproductive Stress 3M, Inc., Grosse Pointe Farms, Michigan, USA
| | - Ximena Ruden
- CS Mott Center for Human Growth and Development, Reproductive Endocrinology and Infertility, Department of Ob/Gyn, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Teya Marben
- CS Mott Center for Human Growth and Development, Reproductive Endocrinology and Infertility, Department of Ob/Gyn, Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Biology, College of Engineering and Science, University of Detroit Mercy, Detroit, Michigan, USA
| | - Sean Harris
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Douglas M Ruden
- CS Mott Center for Human Growth and Development, Reproductive Endocrinology and Infertility, Department of Ob/Gyn, Wayne State University School of Medicine, Detroit, Michigan, USA.,Institutes for Environmental Health Science, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Awoniyi O Awonuga
- CS Mott Center for Human Growth and Development, Reproductive Endocrinology and Infertility, Department of Ob/Gyn, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Elizabeth E Puscheck
- CS Mott Center for Human Growth and Development, Reproductive Endocrinology and Infertility, Department of Ob/Gyn, Wayne State University School of Medicine, Detroit, Michigan, USA.,Reproductive Stress 3M, Inc., Grosse Pointe Farms, Michigan, USA.,Invia Fertility Clinics, Hoffman Estates, Illinois, USA
| | - Daniel A Rappolee
- CS Mott Center for Human Growth and Development, Reproductive Endocrinology and Infertility, Department of Ob/Gyn, Wayne State University School of Medicine, Detroit, Michigan, USA.,Reproductive Stress 3M, Inc., Grosse Pointe Farms, Michigan, USA.,Program for Reproductive Sciences, Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Biology, University of Windsor, Windsor, Canada
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Chen JF, Brahmandam A, Harris S, Fischer U, Nassiri N. Elucidating the role of the AFX2 endograft in endovascular treatment of aortic pathology. Ann Vasc Surg 2022; 86:328-337. [PMID: 35589028 DOI: 10.1016/j.avsg.2022.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/17/2022] [Accepted: 04/23/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study is to elucidate the role of the AFX2 platform in the endovascular treatment of aortic pathology. METHODS All procedures by a single surgeon resulting in implantation of a bifurcated unibody stent graft were retrospectively reviewed. Indications for selection of the AFX2 endograft in each case were evaluated. Aortic anatomy was determined via review of pre-operative computed tomography (CT) scans. Cumulative event probabilities for endoleak, reintervention, and mortality were estimated. Patient and procedural details were described using mean, standard deviation, medians, and interquartile range (IQR). Kaplan-Meier survival analysis estimated freedom from mortality and reintervention. Cumulative incidence probabilities were calculated as one minus the Kaplan-Meier estimator. RESULTS Between March 2018 and December 2020, the author (NN) used 142 aortic endografts in 142 patients. Of these, 46 (32.4%) were AFX2 endografts and the remaining were modular bifurcated devices, predominantly Medtronic Endurant II and Terumo Treo. No AFX-Strata or AFX-Duraply devices were placed. Amongst the patients who received an AFX2, mean age was 71.3 +/- 9.8 years with 84.8% male. Median operative time was 116 (86-166) minutes, with contrast dose of 79 (41-120) milliliters and fluoroscopy time of 12 (8.6-18) minutes. Overall, 78.3% (n=36) of AFX2 devices were placed in aortas with maximum true lumen diameter <5.0cm. Median postoperative follow-up was 1.7 years (IQR 1.0-2.4 years), with a maximum follow-up of 3.6 years. There was 1 patient lost to follow-up at 5 months. The 2-year incidence of type II endoleak, reintervention, and all-cause mortality was 12.7% (95% CI, 0-29.6%), 2.2% (95% CI, 0-6.3%), and 11.3% (95% CI, 0.1-2.1.2%), respectively. There were no type I or III endoleaks. CONCLUSION The AFX2 endograft plays a safe and effective role in treatment of infrarenal aortic pathologies that may be otherwise more technically challenging for traditional modular, bifurcated devices.
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Affiliation(s)
- Julia Fayanne Chen
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Anand Brahmandam
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Sean Harris
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Uwe Fischer
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Naiem Nassiri
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
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16
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Harris S, Remilton M, Sarang K, Mar G. P.129 An analysis of perioperative pain management in women undergoing caesarean section. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Jordan SL, Brinkman B, Harris S, Cole T, Ortiz A. Core musculature co-contraction during suspension training exercises. J Bodyw Mov Ther 2022; 30:82-88. [DOI: 10.1016/j.jbmt.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/01/2021] [Accepted: 02/04/2022] [Indexed: 11/28/2022]
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18
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Thorsen ML, Harris S, McGarvey R, Palacios J, Thorsen A. Evaluating disparities in access to obstetric services for American Indian women across Montana. J Rural Health 2022; 38:151-160. [PMID: 33754411 PMCID: PMC8458487 DOI: 10.1111/jrh.12572] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Pregnant women across the rural United States have increasingly limited access to obstetric care, especially specialty care for high-risk women and infants. Limited research focuses on access for rural American Indian/Alaskan Native (AIAN) women, a population warranting attention given persistent inequalities in birth outcomes. METHODS Using Montana birth certificate data (2014-2018), we examined variation in travel time to give birth and access to different levels of obstetric care (i.e., the proportion of individuals living within 1- and 2-h drives to facilities), by rurality (Rural-Urban Continuum Code) and race (White and AIAN people). FINDINGS Results point to limited obstetric care access in remote rural areas in Montana, especially higher-level specialty care, compared to urban or urban-adjacent rural areas. AIAN women traveled significantly farther than White women to access care (24.2 min farther on average), even compared to White women from similarly rural areas (5-13 min farther, after controlling for sociodemographic characteristics, risk factors, and health care utilization). AIAN women were 20 times more likely to give birth at a hospital without obstetric services and had less access to complex obstetric care. Poor access was particularly pronounced among reservation-dwelling AIAN women. CONCLUSIONS It is imperative to consider racial disparities and health inequities underlying poor access to obstetric services across rural America. Current federal policies aim to reduce maternity care professional shortages. Our findings suggest that racial disparities in access to complex obstetric care will persist in Montana unless facility-level infrastructure is also expanded to reach areas serving AIAN women.
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Affiliation(s)
- Maggie L. Thorsen
- Department of Sociology and Anthropology, Montana State University, Bozeman, Montana
| | - Sean Harris
- Jake Jabs College of Business and Entrepreneurship, Montana State University, Bozeman, Montana
| | - Ronald McGarvey
- Department of Industrial and Manufacturing Systems Engineering and Truman School of Public Affairs, University of Missouri, Columbia, Missouri
| | - Janelle Palacios
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland, California
| | - Andreas Thorsen
- Jake Jabs College of Business and Entrepreneurship, Montana State University, Bozeman, Montana
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Sud S, Tatko S, Tan X, Gu D, Harris S, Lafata J, Shen C, Royce T. Associations With Virtual Visit Use Among Patients Receiving Radiation Therapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Mistry J, Hing CB, Harris S. Using a 3D handheld scanner to capture trochlear groove shape: proof of concept study. Ann R Coll Surg Engl 2021; 104:35-40. [PMID: 34414807 DOI: 10.1308/rcsann.2021.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Trochleoplasty is a surgical procedure used to treat patellar instability by modifying the trochlear groove. Analysis of the groove with a handheld scanner would enable accurate real-time planning and facilitate tailormade correction. We aimed to measure trochlear depth, sulcus angle, trochlear facet ratio, trochlear angle and lateral trochlear inclination angle and to establish inter- and intra-rater reliability for knee models to determine reliability and repeatability. METHODS The trochlear grooves of three knee models were scanned by two investigators. Three-dimensional reference models were created and surface-matched. Custom software was used to determine the desired parameters. The intraclass correlation coefficient (ICC) was used to determine test-retest reliability and the parameter results for each model that showed best reproducibility. RESULTS There was good interobserver reliability (trochlear depth, 1.0mm; sulcus angle, 2.7°; trochlear angle, 4.0°; lateral trochlear inclination angle, 4.0°), except in the trochlear facet ratio (32.0%) of one knee model. With outliers removed, the ICC was moderate to excellent in 73.34% of measurements, with trochlear depth showing the best reproducibility. DISCUSSION This feasibility study showed a handheld scanner in conjunction with supporting software can measure trochlear parameters with good to excellent inter- and intra-observer reliability.
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Affiliation(s)
- J Mistry
- St George's, University of London, UK
| | - C B Hing
- St George's University Hospitals NHS Foundation Trust, UK
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21
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Mistry J, Hing C, Harris S. 199 Use of A 3D Hand-Held Scanner to Capture Trochlear Groove Shape, A Proof-of-Concept Study. Br J Surg 2021. [DOI: 10.1093/bjs/znab135.018] [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]
Abstract
Abstract
Introduction
Trochleoplasty is a surgical procedure used to treat patellar instability through modifying the trochlear groove. Analysis of the groove with a hand-held scanner would enable accurate real time planning and facilitate tailor made correction. We aimed to measure trochlear depth, sulcus angle, trochlear facet ratio, trochlear angle and lateral trochlear inclination angle and establish inter- and intra-rater reliability for each knee model.
Method
The trochlear groove of the knee models was scanned by two investigators and 3D reference models created. These were surface matched and custom software along with Excel was utilised to determine the desired parameters. Intraclass correlation coefficient (ICC) was used for test-retest reliability and to determine which parameter results, for each model, showed the best reproducibility.
Results
There was good inter-observer reliability - trochlear depth (1.0 mm), sulcus angle (2.7°), trochlear angle (4.0°) and lateral trochlear inclination angle (4.0°), except in the trochlear facet ratio (32.0%) of one knee model. With outliers removed ICC was good-excellent in (46.7%) of measurements, with trochlear depth showing the best reproducibility.
Conclusions
This feasibility study showed that the hand-held scanner in conjunction with supporting software can measure trochlear parameters in a controlled environment and justifies extending research into its use in trochleoplasty.
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Affiliation(s)
- J Mistry
- St George's University of London, London, United Kingdom
| | - C Hing
- St George's University of London, London, United Kingdom
| | - S Harris
- Imperial College London, London, United Kingdom
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22
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Gale L, Harris S, Pattison S, Baker J, Fowler J. Development and evaluation of sub-element testing of SiC/SiC ceramic matrix composites at elevated temperatures. Ann Ital Chir 2021. [DOI: 10.1016/j.jeurceramsoc.2020.07.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Weir-McCall JR, Harris S, Miles KA, Qureshi NR, Rintoul RC, Dizdarevic S, Pike L, Cheow HK, Gilbert FJ. Impact of solitary pulmonary nodule size on qualitative and quantitative assessment using 18F-fluorodeoxyglucose PET/CT: the SPUTNIK trial. Eur J Nucl Med Mol Imaging 2021; 48:1560-1569. [PMID: 33130961 PMCID: PMC8113131 DOI: 10.1007/s00259-020-05089-y] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 10/20/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE To compare qualitative and semi-quantitative PET/CT criteria, and the impact of nodule size on the diagnosis of solitary pulmonary nodules in a prospective multicentre trial. METHODS Patients with an SPN on CT ≥ 8 and ≤ 30 mm were recruited to the SPUTNIK trial at 16 sites accredited by the UK PET Core Lab. Qualitative assessment used a five-point ordinal PET-grade compared to the mediastinal blood pool, and a combined PET/CT grade using the CT features. Semi-quantitative measures included SUVmax of the nodule, and as an uptake ratio to the mediastinal blood pool (SURBLOOD) or liver (SURLIVER). The endpoints were diagnosis of lung cancer via biopsy/histology or completion of 2-year follow-up. Impact of nodule size was analysed by comparison between nodule size tertiles. RESULTS Three hundred fifty-five participants completed PET/CT and 2-year follow-up, with 59% (209/355) malignant nodules. The AUCs of the three techniques were SUVmax 0.87 (95% CI 0.83;0.91); SURBLOOD 0.87 (95% CI 0.83; 0.91, p = 0.30 versus SUVmax); and SURLIVER 0.87 (95% CI 0.83; 0.91, p = 0.09 vs. SUVmax). The AUCs for all techniques remained stable across size tertiles (p > 0.1 for difference), although the optimal diagnostic threshold varied by size. For nodules < 12 mm, an SUVmax of 1.75 or visual uptake equal to the mediastinum yielded the highest accuracy. For nodules > 16 mm, an SUVmax ≥ 3.6 or visual PET uptake greater than the mediastinum was the most accurate. CONCLUSION In this multicentre trial, SUVmax was the most accurate technique for the diagnosis of solitary pulmonary nodules. Diagnostic thresholds should be altered according to nodule size. TRIAL REGISTRATION ISRCTN - ISRCTN30784948. ClinicalTrials.gov - NCT02013063.
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Affiliation(s)
- J R Weir-McCall
- Department of Radiology, Biomedical Research Centre, University of Cambridge School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - S Harris
- Public Health Sciences and Medical Statistics, University of Southampton, Southampton, UK
| | - K A Miles
- Institute of Nuclear Medicine, University College London, London, UK
| | - N R Qureshi
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - R C Rintoul
- Department of Thoracic Oncology, Royal Papworth Hospital / Department of Oncology, University of Cambridge, Cambridge, UK
| | - S Dizdarevic
- Departments of Imaging and Nuclear Medicine and Respiratory Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton and Sussex Medical School, Brighton, UK
| | - L Pike
- King's College London and Guy's & St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Heok K Cheow
- Addenbrookes Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Fiona J Gilbert
- Department of Radiology, Biomedical Research Centre, University of Cambridge School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK.
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Lebwohl M, Stein Gold L, Papp K, Han G, Pariser D, Lin T, Harris S, Jacobson A. Long‐term safety and efficacy of a fixed‐combination halobetasol propionate 0.01%/tazarotene 0.045% lotion in moderate‐to‐severe plaque psoriasis: phase 3 open‐label study. J Eur Acad Dermatol Venereol 2021; 35:1152-1160. [DOI: 10.1111/jdv.17113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/16/2020] [Indexed: 11/30/2022]
Affiliation(s)
- M.G. Lebwohl
- Icahn School of Medicine at Mount Sinai New York NY USA
| | | | - K. Papp
- Probity Medical Research and K. Papp Clinical Research Waterloo ON Canada
| | - G. Han
- Icahn School of Medicine at Mount Sinai New York NY USA
| | - D.M. Pariser
- Eastern Virginia Medical School and Virginia Clinical Research, Inc. Norfolk VA USA
| | - T. Lin
- Ortho Dermatologics† Bridgewater NJ USA
| | - S. Harris
- Bausch Health US, LLC† Bridgewater NJ USA
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Wallis C, Milella L, Colyer A, O'Flynn C, Harris S, Holcombe LJ. Subgingival microbiota of dogs with healthy gingiva or early periodontal disease from different geographical locations. BMC Vet Res 2021; 17:7. [PMID: 33407419 PMCID: PMC7789547 DOI: 10.1186/s12917-020-02660-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 10/30/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Periodontal disease is the most common oral disease of dogs worldwide and results from a complex interplay between plaque bacteria, the host and environmental factors. Recent studies have enhanced our understanding of the associations between the plaque microbiota and canine periodontal disease. These studies, however, were limited in their geographical reach. Thus associations between the canine oral microbiota and geographical location were investigated by determining the composition of subgingival plaque samples from 587 dogs residing in the United Kingdom (UK), United States of America (USA), China and Thailand using 454-pyrosequencing. RESULTS After quality filtering 6,944,757 sequence reads were obtained and clustering of these at ≥98% sequence resulted in 280 operational taxonomic units (OTUs) following exclusion of rare OTUs (present at < 0.05% in all four countries). The subgingival plaque from dog populations located in the UK, USA, China and Thailand had a similar composition although the abundance of certain taxa varied significantly among geographical locations. Exploration of the effect of clinical status and age revealed a marked similarity among the bacteria associated with increased age and those associated with gingivitis: Young dogs and those with no gingivitis were dominated by taxa from the phyla Bacteroidetes and Proteobacteria whereas older dogs and those with moderate gingivitis were dominated by members of the Firmicutes. The plaque microbiota of small breed dogs was found to significantly differ to medium and large breeds and was dominated by species belonging to the Firmicutes. CONCLUSIONS The bacterial associations with health, gingivitis and periodontitis were conserved across dogs from the UK, USA, China and Thailand. These bacterial signatures of periodontal health and disease have potential as biomarkers for disease detection.
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Affiliation(s)
- C Wallis
- WALTHAM Petcare Science Institute, Mars Petcare UK, Melton Mowbray, Leicestershire, UK.
| | - L Milella
- The Veterinary Dental Surgery, Byfleet, Surrey, UK
| | - A Colyer
- WALTHAM Petcare Science Institute, Mars Petcare UK, Melton Mowbray, Leicestershire, UK
| | - C O'Flynn
- WALTHAM Petcare Science Institute, Mars Petcare UK, Melton Mowbray, Leicestershire, UK
| | - S Harris
- WALTHAM Petcare Science Institute, Mars Petcare UK, Melton Mowbray, Leicestershire, UK
| | - L J Holcombe
- WALTHAM Petcare Science Institute, Mars Petcare UK, Melton Mowbray, Leicestershire, UK
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Nino V, Claudio D, Valladares L, Harris S. An Enhanced Kaizen Event in a Sterile Processing Department of a Rural Hospital: A Case Study. Int J Environ Res Public Health 2020; 17:ijerph17238748. [PMID: 33255618 PMCID: PMC7728093 DOI: 10.3390/ijerph17238748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/11/2020] [Accepted: 11/22/2020] [Indexed: 12/19/2022]
Abstract
Operating Rooms (ORs) generate the largest revenues and losses in a hospital. Without the prompt supply of sterile surgical trays from the Sterile Processing Department (SPD), the OR would not be able to perform surgeries to its busy schedule. Nevertheless, little emphasis has been brought in the medical literature to research on surgical instrument processing in the medical literature. The present study was done applies an Enhanced Kaizen Event (EKE) in the SPD of a rural hospital to identify sources of waste and minimize non-value-added steps in the SPD processes. The EKE consisted of three successive Plan-Do-Check-Act (PDCA) cycles, which focused on improvements at the departmental level first, then at an area level, and finally at the station level. The EKE yielded an improved streamlined workflow and a new design for the SPD layout, one of its areas, and a workstation. This paper aims at building a methodology, including identified steps. Results exhibited a 35% reduction in travel distance by the staff, eliminating non-value-added processes, reducing errors in the sterilization process, and eliminating cross-contamination for sterilized materials.
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Affiliation(s)
- Valentina Nino
- Mechanical & Industrial Engineering Department, Montana State University, Bozeman, MT 59717, USA;
- Correspondence: (V.N.); (D.C.); Tel.: +1-406-539-8772 (V.N.); +1-406-994-5943 (D.C.)
| | - David Claudio
- Mechanical & Industrial Engineering Department, Montana State University, Bozeman, MT 59717, USA;
- Correspondence: (V.N.); (D.C.); Tel.: +1-406-539-8772 (V.N.); +1-406-994-5943 (D.C.)
| | - Leonardo Valladares
- Mechanical & Industrial Engineering Department, Montana State University, Bozeman, MT 59717, USA;
| | - Sean Harris
- Jake Jabs College of Business & Entrepreneurship, Montana State University, Bozeman, MT 59717, USA;
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Greer C, Adamson P, Harris S, Horwood J, Troughton R, Darlow B. Very low birth weight is associated with reduced right ventricular function detected by strain imaging in early adulthood – findings from a prospective matched cohort study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0109] [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
Introduction
Being born at very low birth weight (VLBW, <1500g) is associated with increased rates of cardiopulmonary disorders in childhood. As survivors age, late cardiac effects, including right ventricular (RV) remodelling and occult pulmonary hypertension are emerging. Strain imaging provides prognostically important information regarding RV dysfunction in diverse cardiopulmonary conditions however, these indices have not previously been described within VLBW cohorts.
Purpose
To assess differences in right heart function using strain in young adults born at VLBW, compared to normal weight term born controls.
Methods
The New Zealand Very Low Birth Weight Study has followed all infants born in 1986 with birth weight <1500g. Of 323 survivors to adulthood, 228 (71%) had echocardiograms at 26–30 years which were compared to age and sex-matched term-born, normal-weight controls (n=100). RV global longitudinal strain (GLS) was measured by speckle tracking echocardiography by an investigator blinded to group allocation. Established measures of RV function (fractional area change (FAC), tricuspid annular systolic velocity (RV S') and tricuspid regurgitation velocities) were also obtained.
Results
VLBW subjects were smaller than their peers as young adults (Table 1). Strain measurement showed reduced myocardial deformation among VLBW subjects (RV myocardial GLS: −22.4% vs −23.5%, p=0.008; RV endocardial GLS: −23.6% vs −24.9%, p=0.005; free wall myocardial GLS −25.2% vs −26.1%, p=0.039; free wall endocardial GLS −26.7% vs −27.9%, p=0.009). TR velocity was higher in VLBW: 224 cm/s v 210 cm/s (p=0.002). RV S', and FAC were not different.
Conclusion
Young adults born at VLBW have impaired myocardial strain despite preserved RV function as assessed by standard techniques. Echocardiographic strain imaging may be an important tool to detect subclinical RV dysfunction.
Graph 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Greer
- Christchurch Hospital, Christchurch, New Zealand
| | - P Adamson
- University of Otago Christchurch, Christchurch, New Zealand
| | - S Harris
- University of Otago Christchurch, Christchurch, New Zealand
| | - J Horwood
- University of Otago Christchurch, Christchurch, New Zealand
| | - R Troughton
- University of Otago Christchurch, Christchurch, New Zealand
| | - B Darlow
- University of Otago Christchurch, Christchurch, New Zealand
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Hounkpatin HO, Harris S, Fraser SDS, Day J, Mindell JS, Taal MW, O'Donoghue D, Roderick PJ. Prevalence of chronic kidney disease in adults in England: comparison of nationally representative cross-sectional surveys from 2003 to 2016. BMJ Open 2020; 10:e038423. [PMID: 32792448 PMCID: PMC7430464 DOI: 10.1136/bmjopen-2020-038423] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/06/2020] [Accepted: 05/29/2020] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To identify recent trends in chronic kidney disease (CKD) prevalence in England and explore their association with changes in sociodemographic, behavioural and clinical factors. DESIGN Pooled cross-sectional analysis. SETTING Health Survey for England 2003, 2009/2010 combined and 2016. PARTICIPANTS 17 663 individuals (aged 16+) living in private households. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 and albuminuria (measured by albumin-creatinine ratio) during 2009/2010 and 2016 and trends in eGFR between 2003 and 2016. eGFR was estimated using serum creatinine Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease equations. RESULTS GFR <60 mL/min/1.73 m2 prevalence was 7.7% (95% CI 7.1% to 8.4%), 7.0% (6.4% to 7.7%) and 7.3%(6.5% to 8.2%) in 2003, 2009/2010 and 2016, respectively. Albuminuria prevalence was 8.7% (8.1% to 9.5%) in 2009/2010 and 9.8% (8.7% to 10.9%) in 2016. Prevalence of CKD G1-5 (eGFR <60 mL/min/1.73 m2 or albuminuria) was 12.6% (11.8% to 13.4%) in 2009/2010 and 13.9% (12.8% to 15.2%) in 2016. Prevalence of diabetes and obesity increased during 2003-2016 while prevalence of hypertension and smoking fell. The age-adjusted and gender-adjusted OR of eGFR <60 mL/min/1.73 m2 for 2016 versus 2009/2010 was 0.99 (0.82 to 1.18) and fully adjusted OR was 1.13 (0.93 to 1.37). There was no significant period effect on the prevalence of albuminuria or CKD G1-5 from 2009/2010 to 2016 in age and gender or fully adjusted models. CONCLUSION The fall in eGFR <60 mL/min/1.73 m2 seen from 2003 to 2009/2010 did not continue to 2016. However, absolute CKD burden is likely to rise with population growth and ageing, particularly if diabetes prevalence continues to increase. This highlights the need for greater CKD prevention efforts and continued surveillance.
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Affiliation(s)
- Hilda O Hounkpatin
- School of Primary Care, Population Sciences, and Medical Education, University of Southampton Faculty of Medicine, Southampton, UK
| | - S Harris
- School of Primary Care, Population Sciences, and Medical Education, University of Southampton Faculty of Medicine, Southampton, UK
| | - Simon D S Fraser
- School of Primary Care, Population Sciences, and Medical Education, University of Southampton Faculty of Medicine, Southampton, UK
| | - Julie Day
- Blood Sciences, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jennifer S Mindell
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Maarten W Taal
- Renal Medicine, Royal Derby University Hospital NHS Foundation Trust, Derby, UK
- Centre for Kidney Research and Innovation, University of Nottingham, Derby, UK
| | | | - Paul J Roderick
- School of Primary Care, Population Sciences, and Medical Education, University of Southampton Faculty of Medicine, Southampton, UK
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McKenzie H, Martland G, Ellis M, Eccles D, Harris S, Thirdborough S, Copson E, Thomas G. The Immune Microenvironment in Young Patients with Triple Negative Breast Cancer. Clin Oncol (R Coll Radiol) 2020. [DOI: 10.1016/j.clon.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Arulkumaran N, Wright T, Harris S, Singer M. Uncontrolled interventions during pandemics: a missed learning opportunity? Intensive Care Med 2020; 46:1930-1931. [PMID: 32705291 PMCID: PMC7376097 DOI: 10.1007/s00134-020-06180-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2020] [Indexed: 12/15/2022]
Affiliation(s)
- N Arulkumaran
- Bloomsbury Institute of Intensive Care Medicine, University College London, Cruciform Building, Gower St, London, WC1E 6BT, UK. .,Critical Care Unit, University College London Hospital, London, UK.
| | - T Wright
- Critical Care Unit, University College London Hospital, London, UK
| | - S Harris
- Bloomsbury Institute of Intensive Care Medicine, University College London, Cruciform Building, Gower St, London, WC1E 6BT, UK
| | - M Singer
- Bloomsbury Institute of Intensive Care Medicine, University College London, Cruciform Building, Gower St, London, WC1E 6BT, UK.,Critical Care Unit, University College London Hospital, London, UK
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McLean KA, Ahmed WUR, Akhbari M, Claireaux HA, English C, Frost J, Henshall DE, Khan M, Kwek I, Nicola M, Rehman S, Varghese S, Drake TM, Bell S, Nepogodiev D, McLean KA, Drake TM, Glasbey JC, Borakati A, Drake TM, Kamarajah S, McLean KA, Bath MF, Claireaux HA, Gundogan B, Mohan M, Deekonda P, Kong C, Joyce H, Mcnamee L, Woin E, Burke J, Khatri C, Fitzgerald JE, Harrison EM, Bhangu A, Nepogodiev D, Arulkumaran N, Bell S, Duthie F, Hughes J, Pinkney TD, Prowle J, Richards T, Thomas M, Dynes K, Patel M, Patel P, Wigley C, Suresh R, Shaw A, Klimach S, Jull P, Evans D, Preece R, Ibrahim I, Manikavasagar V, Smith R, Brown FS, Deekonda P, Teo R, Sim DPY, Borakati A, Logan AE, Barai I, Amin H, Suresh S, Sethi R, Bolton W, Corbridge O, Horne L, Attalla M, Morley R, Robinson C, Hoskins T, McAllister R, Lee S, Dennis Y, Nixon G, Heywood E, Wilson H, Ng L, Samaraweera S, Mills A, Doherty C, Woin E, Belchos J, Phan V, Chouari T, Gardner T, Goergen N, Hayes JDB, MacLeod CS, McCormack R, McKinley A, McKinstry S, Milligan W, Ooi L, Rafiq NM, Sammut T, Sinclair E, Smith M, Baker C, Boulton APR, Collins J, Copley HC, Fearnhead N, Fox H, Mah T, McKenna J, Naruka V, Nigam N, Nourallah B, Perera S, Qureshi A, Saggar S, Sun L, Wang X, Yang DD, Caroll P, Doyle C, Elangovan S, Falamarzi A, Perai KG, Greenan E, Jain D, Lang-Orsini M, Lim S, O'Byrne L, Ridgway P, Van der Laan S, Wong J, Arthur J, Barclay J, Bradley P, Edwin C, Finch E, Hayashi E, Hopkins M, Kelly D, Kelly M, McCartan N, Ormrod A, Pakenham A, Hayward J, Hitchen C, Kishore A, Martins T, Philomen J, Rao R, Rickards C, Burns N, Copeland M, Durand C, Dyal A, Ghaffar A, Gidwani A, Grant M, Gribbon C, Gruhn A, Leer M, Ahmad K, Beattie G, Beatty M, Campbell G, Donaldson G, Graham S, Holmes D, Kanabar S, Liu H, McCann C, Stewart R, Vara S, Ajibola-Taylor O, Andah EJE, Ani C, Cabdi NMO, Ito G, Jones M, Komoriyama A, Patel P, Titu L, Basra M, Gallogly P, Harinath G, Leong SH, Pradhan A, Siddiqui I, Zaat S, Ali A, Galea M, Looi WL, Ng JCK, Atkin G, Azizi A, Cargill Z, China Z, Elliot J, Jebakumar R, Lam J, Mudalige G, Onyerindu C, Renju M, Babu VS, Hussain M, Joji N, Lovett B, Mownah H, Ali B, Cresswell B, Dhillon AK, Dupaguntla YS, Hungwe C, Lowe-Zinola JD, Tsang JCH, Bevan K, Cardus C, Duggal A, Hossain S, McHugh M, Scott M, Chan F, Evans R, Gurung E, Haughey B, Jacob-Ramsdale B, Kerr M, Lee J, McCann E, O'Boyle K, Reid N, Hayat F, Hodgson S, Johnston R, Jones W, Khan M, Linn T, Long S, Seetharam P, Shaman S, Smart B, Anilkumar A, Davies J, Griffith J, Hughes B, Islam Y, Kidanu D, Mushaini N, Qamar I, Robinson H, Schramm M, Tan CY, Apperley H, Billyard C, Blazeby JM, Cannon SP, Carse S, Göpfert A, Loizidou A, Parkin J, Sanders E, Sharma S, Slade G, Telfer R, Huppatz IW, Worley E, Chandramoorthy L, Friend C, Harris L, Jain P, Karim MJ, Killington K, McGillicuddy J, Rafferty C, Rahunathan N, Rayne T, Varathan Y, Verma N, Zanichelli D, Arneill M, Brown F, Campbell B, Crozier L, Henry J, McCusker C, Prabakaran P, Wilson R, Asif U, Connor M, Dindyal S, Math N, Pagarkar A, Saleem H, Seth I, Sharma S, Standfield N, Swartbol T, Adamson R, Choi JE, El Tokhy O, Ho W, Javaid NR, Kelly M, Mehdi AS, Menon D, Plumptre I, Sturrock S, Turner J, Warren O, Crane E, Ferris B, Gadsby C, Smallwood J, Vipond M, Wilson V, Amarnath T, Doshi A, Gregory C, Kandiah K, Powell B, Spoor H, Toh C, Vizor R, Common M, Dunleavy K, Harris S, Luo C, Mesbah Z, Kumar AP, Redmond A, Skulsky S, Walsh T, Daly D, Deery L, Epanomeritakis E, Harty M, Kane D, Khan K, Mackey R, McConville J, McGinnity K, Nixon G, Ang A, Kee JY, Leung E, Norman S, Palaniappan SV, Sarathy PP, Yeoh T, Frost J, Hazeldine P, Jones L, Karbowiak M, Macdonald C, Mutarambirwa A, Omotade A, Runkel M, Ryan G, Sawers N, Searle C, Suresh S, Vig S, Ahmad A, McGartland R, Sim R, Song A, Wayman J, Brown R, Chang LH, Concannon K, Crilly C, Arnold TJ, Burgin A, Cadden F, Choy CH, Coleman M, Lim D, Luk J, Mahankali-Rao P, Prudence-Taylor AJ, Ramakrishnan D, Russell J, Fawole A, Gohil J, Green B, Hussain A, McMenamin L, McMenamin L, Tang M, Azmi F, Benchetrit S, Cope T, Haque A, Harlinska A, Holdsworth R, Ivo T, Martin J, Nisar T, Patel A, Sasapu K, Trevett J, Vernet G, Aamir A, Bird C, Durham-Hall A, Gibson W, Hartley J, May N, Maynard V, Johnson S, Wood CM, O'Brien M, Orbell J, Stringfellow TD, Tenters F, Tresidder S, Cheung W, Grant A, Tod N, Bews-Hair M, Lim ZH, Lim SW, Vella-Baldacchino M, Auckburally S, Chopada A, Easdon S, Goodson R, McCurdie F, Narouz M, Radford A, Rea E, Taylor O, Yu T, Alfa-Wali M, Amani L, Auluck I, Bruce P, Emberton J, Kumar R, Lagzouli N, Mehta A, Murtaza A, Raja M, Dennahy IS, Frew K, Given A, He YY, Karim MA, MacDonald E, McDonald E, McVinnie D, Ng SK, Pettit A, Sim DPY, Berthaume-Hawkins SD, Charnley R, Fenton K, Jones D, Murphy C, Ng JQ, Reehal R, Robinson H, Seraj SS, Shang E, Tonks A, White P, Yeo A, Chong P, Gabriel R, Patel N, Richardson E, Symons L, Aubrey-Jones D, Dawood S, Dobrzynska M, Faulkner S, Griffiths H, Mahmood F, Patel P, Perry M, Power A, Simpson R, Ali A, Brobbey P, Burrows A, Elder P, Ganyani R, Horseman C, Hurst P, Mann H, Marimuthu K, McBride S, Pilsworth E, Powers N, Stanier P, Innes R, Kersey T, Kopczynska M, Langasco N, Patel N, Rajagopal R, Atkins B, Beasley W, Lim ZC, Gill A, Ang HL, Williams H, Yogeswara T, Carter R, Fam M, Fong J, Latter J, Long M, Mackinnon S, McKenzie C, Osmanska J, Raghuvir V, Shafi A, Tsang K, Walker L, Bountra K, Coldicutt O, Fletcher D, Hudson S, Iqbal S, Bernal TL, Martin JWB, Moss-Lawton F, Smallwood J, Vipond M, Cardwell A, Edgerton K, Laws J, Rai A, Robinson K, Waite K, Ward J, Youssef H, Knight C, Koo PY, Lazarou A, Stanger S, Thorn C, Triniman MC, Botha A, Boyles L, Cumming S, Deepak S, Ezzat A, Fowler AJ, Gwozdz AM, Hussain SF, Khan S, Li H, Morrell BL, Neville J, Nitiahpapand R, Pickering O, Sagoo H, Sharma E, Welsh K, Denley S, Khan S, Agarwal M, Al-Saadi N, Bhambra R, Gupta A, Jawad ZAR, Jiao LR, Khan K, Mahir G, Singagireson S, Thoms BL, Tseu B, Wei R, Yang N, Britton N, Leinhardt D, Mahfooz M, Palkhi A, Price M, Sheikh S, Barker M, Bowley D, Cant M, Datta U, Farooqi M, Lee A, Morley G, Amin MN, Parry A, Patel S, Strang S, Yoganayagam N, Adlan A, Chandramoorthy S, Choudhary Y, Das K, Feldman M, France B, Grace R, Puddy H, Soor P, Ali M, Dhillon P, Faraj A, Gerard L, Glover M, Imran H, Kim S, Patrick Y, Peto J, Prabhudesai A, Smith R, Tang A, Vadgama N, Dhaliwal R, Ecclestone T, Harris A, Ong D, Patel D, Philp C, Stewart E, Wang L, Wong E, Xu Y, Ashaye T, Fozard T, Galloway F, Kaptanis S, Mistry P, Nguyen T, Olagbaiye F, Osman M, Philip Z, Rembacken R, Tayeh S, Theodoropoulou K, Herman A, Lau J, Saha A, Trotter M, Adeleye O, Cave D, Gunwa T, Magalhães J, Makwana S, Mason R, Parish M, Regan H, Renwick P, Roberts G, Salekin D, Sivakumar C, Tariq A, Liew I, McDade A, Stewart D, Hague M, Hudson-Peacock N, Jackson CES, James F, Pitt J, Walker EY, Aftab R, Ang JJ, Anwar S, Battle J, Budd E, Chui J, Crook H, Davies P, Easby S, Hackney E, Ho B, Imam SZ, Rammell J, Andrews H, Perry C, Schinle P, Ahmed P, Aquilina T, Balai E, Church M, Cumber E, Curtis A, Davies G, Dennis Y, Dumann E, Greenhalgh S, Kim P, King S, Metcalfe KHM, Passby L, Redgrave N, Soonawalla Z, Waters S, Zornoza A, Gulzar I, Hole J, Hull K, Ishaq H, Karaj J, Kelkar A, Love E, Patel S, Thakrar D, Vine M, Waterman A, Dib NP, Francis N, Hanson M, Ingleton R, Sadanand KS, Sukirthan N, Arnell S, Ball M, Bassam N, Beghal G, Chang A, Dawe V, George A, Huq T, Hussain A, Ikram B, Kanapeckaite L, Khan M, Ramjas D, Rushd A, Sait S, Serry M, Yardimci E, Capella S, Chenciner L, Episkopos C, Karam E, McCarthy C, Moore-Kelly W, Watson N, Ahluwalia V, Barnfield J, Ben-Gal O, Bloom I, Gharatya A, Khodatars K, Merchant N, Moonan A, Moore M, Patel K, Spiers H, Sundaram K, Turner J, Bath MF, Black J, Chadwick H, Huisman L, Ingram H, Khan S, Martin L, Metcalfe M, Sangal P, Seehra J, Thatcher A, Venturini S, Whitcroft I, Afzal Z, Brown S, Gani A, Gomaa A, Hussein N, Oh SY, Pazhaniappan N, Sharkey E, Sivagnanasithiyar T, Williams C, Yeung J, Cruddas L, Gurjar S, Pau A, Prakash R, Randhawa R, Chen L, Eiben I, Naylor M, Osei-Bordom D, Trenear R, Bannard-Smith J, Griffiths N, Patel BY, Saeed F, Abdikadir H, Bennett M, Church R, Clements SE, Court J, Delvi A, Hubert J, Macdonald B, Mansour F, Patel RR, Perris R, Small S, Betts A, Brown N, Chong A, Croitoru C, Grey A, Hickland P, Ho C, Hollington D, McKie L, Nelson AR, Stewart H, Eiben P, Nedham M, Ali I, Brown T, Cumming S, Hunt C, Joyner C, McAlinden C, Roberts J, Rogers D, Thachettu A, Tyson N, Vaughan R, Verma N, Yasin T, Andrew K, Bhamra N, Leong S, Mistry R, Noble H, Rashed F, Walker NR, Watson L, Worsfold M, Yarham E, Abdikadir H, Arshad A, Barmayehvar B, Cato L, Chan-lam N, Do V, Leong A, Sheikh Z, Zheleniakova T, Coppel J, Hussain ST, Mahmood R, Nourzaie R, Prowle J, Sheik-Ali S, Thomas A, Alagappan A, Ashour R, Bains H, Diamond J, Gordon J, Ibrahim B, Khalil M, Mittapalli D, Neo YN, Patil P, Peck FS, Reza N, Swan I, Whyte M, Chaudhry S, Hernon J, Khawar H, O'Brien J, Pullinger M, Rothnie K, Ujjal S, Bhatte S, Curtis J, Green S, Mayer A, Watkinson G, Chapple K, Hawthorne T, Khaliq M, Majkowski L, Malik TAM, Mclauchlan K, En BNW, Parton S, Robinson SD, Saat MI, Shurovi BN, Varatharasasingam K, Ward AE, Behranwala K, Bertelli M, Cohen J, Duff F, Fafemi O, Gupta R, Manimaran M, Mayhew J, Peprah D, Wong MHY, Farmer N, Houghton C, Kandhari N, Khan K, Ladha D, Mayes J, McLennan F, Panahi P, Seehra H, Agrawal R, Ahmed I, Ali S, Birkinshaw F, Choudhry M, Gokani S, Harrogate S, Jamal S, Nawrozzadeh F, Swaray A, Szczap A, Warusavitarne J, Abdalla M, Asemota N, Cullum R, Hartley M, Maxwell-Armstrong C, Mulvenna C, Phillips J, Yule A, Ahmed L, Clement KD, Craig N, Elseedawy E, Gorman D, Kane L, Livie J, Livie V, Moss E, Naasan A, Ravi F, Shields P, Zhu Y, Archer M, Cobley H, Dennis R, Downes C, Guevel B, Lamptey E, Murray H, Radhakrishnan A, Saravanabavan S, Sardar M, Shaw C, Tilliridou V, Wright R, Ye W, Alturki N, Helliwell R, Jones E, Kelly D, Lambotharan S, Scott K, Sivakumar R, Victor L, Boraluwe-Rallage H, Froggatt P, Haynes S, Hung YMA, Keyte A, Matthews L, Evans E, Haray P, John I, Mathivanan A, Morgan L, Oji O, Okorocha C, Rutherford A, Spiers H, Stageman N, Tsui A, Whitham R, Amoah-Arko A, Cecil E, Dietrich A, Fitzpatrick H, Guy C, Hair J, Hilton J, Jawad L, McAleer E, Taylor Z, Yap J, Akhbari M, Debnath D, Dhir T, Elbuzidi M, Elsaddig M, Glace S, Khawaja H, Koshy R, Lal K, Lobo L, McDermott A, Meredith J, Qamar MA, Vaidya A, Acquaah F, Barfi L, Carter N, Gnanappiragasam D, Ji C, Kaminski F, Lawday S, Mackay K, Sulaiman SK, Webb R, Ananthavarathan P, Dalal F, Farrar E, Hashemi R, Hossain M, Jiang J, Kiandee M, Lex J, Mason L, Matthews JH, McGeorge E, Modhwadia S, Pinkney T, Radotra A, Rickard L, Rodman L, Sales A, Tan KL, Bachi A, Bajwa DS, Battle J, Brown LR, Butler A, Calciu A, Davies E, Gardner I, Girdlestone T, Ikogho O, Keelan G, O'Loughlin P, Tam J, Elias J, Ngaage M, Thompson J, Bristow S, Brock E, Davis H, Pantelidou M, Sathiyakeerthy A, Singh K, Chaudhry A, Dickson G, Glen P, Gregoriou K, Hamid H, Mclean A, Mehtaji P, Neophytou G, Potts S, Belgaid DR, Burke J, Durno J, Ghailan N, Hanson M, Henshaw V, Nazir UR, Omar I, Riley BJ, Roberts J, Smart G, Van Winsen K, Bhatti A, Chan M, D'Auria M, Green S, Keshvala C, Li H, Maxwell-Armstrong C, Michaelidou M, Simmonds L, Smith C, Wimalathasan A, Abbas J, Cairns C, Chin YR, Connelly A, Moug S, Nair A, Svolkinas D, Coe P, Subar D, Wang H, Zaver V, Brayley J, Cookson P, Cunningham L, Gaukroger A, Ho M, Hough A, King J, O'Hagan D, Widdison A, Brown R, Brown B, Chavan A, Francis S, Hare L, Lund J, Malone N, Mavi B, McIlwaine A, Rangarajan S, Abuhussein N, Campbell HS, Daniels J, Fitzgerald I, Mansfield S, Pendrill A, Robertson D, Smart YW, Teng T, Yates J, Belgaumkar A, Katira A, Kossoff J, Kukran S, Laing C, Mathew B, Mohamed T, Myers S, Novell R, Phillips BL, Thomas M, Turlejski T, Turner S, Varcada M, Warren L, Wynell-Mayow W, Church R, Linley-Adams L, Osborn G, Saunders M, Spencer R, Srikanthan M, Tailor S, Tullett A, Ali M, Al-Masri S, Carr G, Ebhogiaye O, Heng S, Manivannan S, Manley J, McMillan LE, Peat C, Phillips B, Thomas S, Whewell H, Williams G, Bienias A, Cope EA, Courquin GR, Day L, Garner C, Gimson A, Harris C, Markham K, Moore T, Nadin T, Phillips C, Subratty SM, Brown K, Dada J, Durbacz M, Filipescu T, Harrison E, Kennedy ED, Khoo E, Kremel D, Lyell I, Pronin S, Tummon R, Ventre C, Walls L, Wootton E, Akhtar A, Davies E, El-Sawy D, Farooq M, Gaddah M, Griffiths H, Katsaiti I, Khadem N, Leong K, Williams I, Chean CS, Chudek D, Desai H, Ellerby N, Hammad A, Malla S, Murphy B, Oshin O, Popova P, Rana S, Ward T, Abbott TEF, Akpenyi O, Edozie F, El Matary R, English W, Jeyabaladevan S, Morgan C, Naidu V, Nicholls K, Peroos S, Prowle J, Sansome S, Torrance HD, Townsend D, Brecher J, Fung H, Kazmi Z, Outlaw P, Pursnani K, Ramanujam N, Razaq A, Sattar M, Sukumar S, Tan TSE, Chohan K, Dhuna S, Haq T, Kirby S, Lacy-Colson J, Logan P, Malik Q, McCann J, Mughal Z, Sadiq S, Sharif I, Shingles C, Simon A, Burnage S, Chan SSN, Craig ARJ, Duffield J, Dutta A, Eastwood M, Iqbal F, Mahmood F, Mahmood W, Patel C, Qadeer A, Robinson A, Rotundo A, Schade A, Slade RD, De Freitas M, Kinnersley H, McDowell E, Moens-Lecumberri S, Ramsden J, Rockall T, Wiffen L, Wright S, Bruce C, Francois V, Hamdan K, Limb C, Lunt AJ, Manley L, Marks M, Phillips CFE, Agnew CJF, Barr CJ, Benons N, Hart SJ, Kandage D, Krysztopik R, Mahalingam P, Mock J, Rajendran S, Stoddart MT, Clements B, Gillespie H, Lee S, McDougall R, Murray C, O'Loane R, Periketi S, Tan S, Amoah R, Bhudia R, Dudley B, Gilbert A, Griffiths B, Khan H, McKigney N, Roberts B, Samuel R, Seelarbokus A, Stubbing-Moore A, Thompson G, Williams P, Ahmed N, Akhtar R, Chandler E, Chappelow I, Gil H, Gower T, Kale A, Lingam G, Rutler L, Sellahewa C, Sheikh A, Stringer H, Taylor R, Aglan H, Ashraf MR, Choo S, Das E, Epstein J, Gentry R, Mills D, Poolovadoo Y, Ward N, Bull K, Cole A, Hack J, Khawari S, Lake C, Mandishona T, Perry R, Sleight S, Sultan S, Thornton T, Williams S, Arif T, Castle A, Chauhan P, Chesner R, Eilon T, Kamarajah S, Kambasha C, Lock L, Loka T, Mohammad F, Motahariasl S, Roper L, Sadhra SS, Sheikh A, Toma T, Wadood Q, Yip J, Ainger E, Busti S, Cunliffe L, Flamini T, Gaffing S, Moorcroft C, Peter M, Simpson L, Stokes E, Stott G, Wilson J, York J, Yousaf A, Borakati A, Brown M, Goaman A, Hodgson B, Ijeomah A, Iroegbu U, Kaur G, Lowe C, Mahmood S, Sattar Z, Sen P, Szuman A, Abbas N, Al-Ausi M, Anto N, Bhome R, Eccles L, Elliott J, Hughes EJ, Jones A, Karunatilleke AS, Knight JS, Manson CCF, Mekhail I, Michaels L, Noton TM, Okenyi E, Reeves T, Yasin IH, Banfield DA, Harris R, Lim D, Mason-Apps C, Roe T, Sandhu J, Shafiq N, Stickler E, Tam JP, Williams LM, Ainsworth P, Boualbanat Y, Doull C, Egan E, Evans L, Hassanin K, Ninkovic-Hall G, Odunlami W, Shergill M, Traish M, Cummings D, Kershaw S, Ong J, Reid F, Toellner H, Alwandi A, Amer M, George D, Haynes K, Hughes K, Peakall L, Premakumar Y, Punjabi N, Ramwell A, Sawkins H, Ashwood J, Baker A, Baron C, Bhide I, Blake E, De Cates C, Esmail R, Hosamuddin H, Kapp J, Nguru N, Raja M, Thomson F, Ahmed H, Aishwarya G, Al-Huneidi R, Ali S, Aziz R, Burke D, Clarke B, Kausar A, Maskill D, Mecia L, Myers L, Smith ACD, Walker G, Wroe N, Donohoe C, Gibbons D, Jordan P, Keogh C, Kiely A, Lalor P, McCrohan M, Powell C, Foley MP, Reynolds J, Silke E, Thorpe O, Kong JTH, White C, Ali Q, Dalrymple J, Ge Y, Khan H, Luo RS, Paine H, Paraskeva B, Parker L, Pillai K, Salciccioli J, Selvadurai S, Sonagara V, Springford LR, Tan L, Appleton S, Leadholm N, Zhang Y, Ahern D, Cotter M, Cremen S, Durrigan T, Flack V, Hrvacic N, Jones H, Jong B, Keane K, O'Connell PR, O'sullivan J, Pek G, Shirazi S, Barker C, Brown A, Carr W, Chen Y, Guillotte C, Harte J, Kokayi A, Lau K, McFarlane S, Morrison S, Broad J, Kenefick N, Makanji D, Printz V, Saito R, Thomas O, Breen H, Kirk S, Kong CH, O'Kane A, Eddama M, Engledow A, Freeman SK, Frost A, Goh C, Lee G, Poonawala R, Suri A, Taribagil P, Brown H, Christie S, Dean S, Gravell R, Haywood E, Holt F, Pilsworth E, Rabiu R, Roscoe HW, Shergill S, Sriram A, Sureshkumar A, Tan LC, Tanna A, Vakharia A, Bhullar S, Brannick S, Dunne E, Frere M, Kerin M, Kumar KM, Pratumsuwan T, Quek R, Salman M, Van Den Berg N, Wong C, Ahluwalia J, Bagga R, Borg CM, Calabria C, Draper A, Farwana M, Joyce H, Khan A, Mazza M, Pankin G, Sait MS, Sandhu N, Virani N, Wong J, Woodhams K, Croghan N, Ghag S, Hogg G, Ismail O, John N, Nadeem K, Naqi M, Noe SM, Sharma A, Tan S, Begum F, Best R, Collishaw A, Glasbey J, Golding D, Gwilym B, Harrison P, Jackman T, Lewis N, Luk YL, Porter T, Potluri S, Stechman M, Tate S, Thomas D, Walford B, Auld F, Bleakley A, Johnston S, Jones C, Khaw J, Milne S, O'Neill S, Singh KKR, Smith R, Swan A, Thorley N, Yalamarthi S, Yin ZD, Ali A, Balian V, Bana R, Clark K, Livesey C, McLachlan G, Mohammad M, Pranesh N, Richards C, Ross F, Sajid M, Brooke M, Francombe J, Gresly J, Hutchinson S, Kerrigan K, Matthews E, Nur S, Parsons L, Sandhu A, Vyas M, White F, Zulkifli A, Zuzarte L, Al-Mousawi A, Arya J, Azam S, Yahaya AA, Gill K, Hallan R, Hathaway C, Leptidis I, McDonagh L, Mitrasinovic S, Mushtaq N, Pang N, Peiris GB, Rinkoff S, Chan L, Christopher E, Farhan-Alanie MMH, Gonzalez-Ciscar A, Graham CJ, Lim H, McLean KA, Paterson HM, Rogers A, Roy C, Rutherford D, Smith F, Zubikarai G, Al-Khudairi R, Bamford M, Chang M, Cheng J, Hedley C, Joseph R, Mitchell B, Perera S, Rothwell L, Siddiqui A, Smith J, Taylor K, Wright OW, Baryan HK, Boyd G, Conchie H, Cox L, Davies J, Gardner S, Hill N, Krishna K, Lakin F, Scotcher S, Alberts J, Asad M, Barraclough J, Campbell A, Marshall D, Wakeford W, Cronbach P, D'Souza F, Gammeri E, Houlton J, Hall M, Kethees A, Patel R, Perera M, Prowle J, Shaid M, Webb E, Beattie S, Chadwick M, El-Taji O, Haddad S, Mann M, Patel M, Popat K, Rimmer L, Riyat H, Smith H, Anandarajah C, Cipparrone M, Desai K, Gao C, Goh ET, Howlader M, Jeffreys N, Karmarkar A, Mathew G, Mukhtar H, Ozcan E, Renukanthan A, Sarens N, Sinha C, Woolley A, Bogle R, Komolafe O, Loo F, Waugh D, Zeng R, Crewe A, Mathias J, Mills A, Owen A, Prior A, Saunders I, Baker A, Crilly L, McKeon J, Ubhi HK, Adeogun A, Carr R, Davison C, Devalia S, Hayat A, Karsan RB, Osborne C, Scott K, Weegenaar C, Wijeyaratne M, Babatunde F, Barnor-Ahiaku E, Beattie G, Chitsabesan P, Dixon O, Hall N, Ilenkovan N, Mackrell T, Nithianandasivam N, Orr J, Palazzo F, Saad M, Sandland-Taylor L, Sherlock J, Ashdown T, Chandler S, Garsaa T, Lloyd J, Loh SY, Ng S, Perkins C, Powell-Chandler A, Smith F, Underhill R. Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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Rahman SA, Walker RC, Lloyd MA, Grace BL, van Boxel GI, Kingma BF, Ruurda JP, van Hillegersberg R, Harris S, Parsons S, Mercer S, Griffiths EA, O'Neill JR, Turkington R, Fitzgerald RC, Underwood TJ. Machine learning to predict early recurrence after oesophageal cancer surgery. Br J Surg 2020; 107:1042-1052. [PMID: 31997313 PMCID: PMC7299663 DOI: 10.1002/bjs.11461] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/11/2019] [Accepted: 11/13/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Early cancer recurrence after oesophagectomy is a common problem, with an incidence of 20-30 per cent despite the widespread use of neoadjuvant treatment. Quantification of this risk is difficult and existing models perform poorly. This study aimed to develop a predictive model for early recurrence after surgery for oesophageal adenocarcinoma using a large multinational cohort and machine learning approaches. METHODS Consecutive patients who underwent oesophagectomy for adenocarcinoma and had neoadjuvant treatment in one Dutch and six UK oesophagogastric units were analysed. Using clinical characteristics and postoperative histopathology, models were generated using elastic net regression (ELR) and the machine learning methods random forest (RF) and extreme gradient boosting (XGB). Finally, a combined (ensemble) model of these was generated. The relative importance of factors to outcome was calculated as a percentage contribution to the model. RESULTS A total of 812 patients were included. The recurrence rate at less than 1 year was 29·1 per cent. All of the models demonstrated good discrimination. Internally validated areas under the receiver operating characteristic (ROC) curve (AUCs) were similar, with the ensemble model performing best (AUC 0·791 for ELR, 0·801 for RF, 0·804 for XGB, 0·805 for ensemble). Performance was similar when internal-external validation was used (validation across sites, AUC 0·804 for ensemble). In the final model, the most important variables were number of positive lymph nodes (25·7 per cent) and lymphovascular invasion (16·9 per cent). CONCLUSION The model derived using machine learning approaches and an international data set provided excellent performance in quantifying the risk of early recurrence after surgery, and will be useful in prognostication for clinicians and patients.
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Affiliation(s)
- S. A. Rahman
- Cancer Sciences UnitUniversity of SouthamptonSouthamptonUK
| | - R. C. Walker
- Cancer Sciences UnitUniversity of SouthamptonSouthamptonUK
| | - M. A. Lloyd
- Cancer Sciences UnitUniversity of SouthamptonSouthamptonUK
| | - B. L. Grace
- Cancer Sciences UnitUniversity of SouthamptonSouthamptonUK
| | - G. I. van Boxel
- Department of SurgeryUniversity Medical CentreUtrechtthe Netherlands
| | - B. F. Kingma
- Department of SurgeryUniversity Medical CentreUtrechtthe Netherlands
| | - J. P. Ruurda
- Department of SurgeryUniversity Medical CentreUtrechtthe Netherlands
| | | | - S. Harris
- Department of Public Health Sciences and Medical StatisticsUniversity of SouthamptonSouthamptonUK
| | - S. Parsons
- Department of SurgeryNottingham University Hospitals NHS TrustNottinghamUK
| | - S. Mercer
- Department of SurgeryPortsmouth Hospitals NHS TrustPortsmouthUK
| | - E. A. Griffiths
- Department of Upper Gastrointestinal SurgeryUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - J. R. O'Neill
- Cambridge Oesophagogastric CentreAddenbrookes Hospital, Cambridge University Hospitals Foundation TrustCambridgeUK
| | - R. Turkington
- Centre for Cancer Research and Cell BiologyQueen's University BelfastBelfastUK
| | - R. C. Fitzgerald
- Hutchison/Medical Research Council Cancer UnitUniversity of CambridgeCambridgeUK
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Parsons KJ, Rigg A, Conith AJ, Kitchener AC, Harris S, Zhu H. Skull morphology diverges between urban and rural populations of red foxes mirroring patterns of domestication and macroevolution. Proc Biol Sci 2020; 287:20200763. [PMID: 32486981 PMCID: PMC7341913 DOI: 10.1098/rspb.2020.0763] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/05/2020] [Indexed: 11/12/2022] Open
Abstract
Human activity is drastically altering the habitat use of natural populations. This has been documented as a driver of phenotypic divergence in a number of wild animal populations. Here, we show that urban and rural populations of red foxes (Vulpes vulpes) from London and surrounding boroughs are divergent in skull traits. These changes are primarily found to be involved with snout length, with urban individuals tending to have shorter and wider muzzles relative to rural individuals, smaller braincases and reduced sexual dimorphism. Changes were widespread and related to muscle attachment sites and thus are likely driven by differing biomechanical demands of feeding or cognition between habitats. Through extensive sampling of the genus Vulpes, we found no support for phylogenetic effects on skull morphology, but patterns of divergence found between urban and rural habitats in V. vulpes quantitatively aligned with macroevolutionary divergence between species. The patterns of skull divergence between urban and rural habitats matched the description of morphological changes that can occur during domestication. Specifically, urban populations of foxes show variation consistent with 'domestication syndrome'. Therefore, we suggest that occurrences of phenotypic divergence in relation to human activity, while interesting themselves, also have the potential to inform us of the conditions and mechanisms that could initiate domestication. Finally, this also suggests that patterns of domestication may be developmentally biased towards larger patterns of interspecific divergence.
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Affiliation(s)
- K. J. Parsons
- Institute of Biodiversity, Animal Health, and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK
| | - Anders Rigg
- Institute of Biodiversity, Animal Health, and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK
| | - A. J. Conith
- Department of Biology, University of Massachusetts, Amherst, MA 01003, USA
| | - A. C. Kitchener
- Department of Natural Sciences, National Museums Scotland, Chambers Street, Edinburgh EH1 1JF, UK
- Institute of Geography, School of Geosciences, University of Edinburgh, Drummond Street, Edinburgh EH8 9XP, UK
| | - S. Harris
- School of Biological Sciences, University of Bristol, Bristol BS8 1TQ, UK
| | - Haoyu Zhu
- Institute of Biodiversity, Animal Health, and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK
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Zhou M, Harris S, Cipriano A, Kapil R, He E, Shet M, Apseloff G. 0198 Psychomotor/Cognitive Effects, Pharmacokinetics and Safety of V117957, a Novel, Highly Potent and Selective Partial Agonist for Nociceptin/Orphanin-FQ Peptide (NOP) Receptors, Administered in Combination with Alcohol in Healthy Subjects. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.196] [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
Introduction
V117957 is an investigational nociceptin/orphanin-FQ peptide (NOP) receptor partial agonist designed to treat insomnia by promoting sleep onset and maintenance with minimal residual next-day somnolence or psychomotor impairment. The satisfactory safety/tolerability profile of V117957 has been previously established in ~200 healthy subjects with maximum doses at 30mg following a single oral administration and 10mg once daily for 2 weeks. The present study was conducted to assess the safety/tolerability and pharmacokinetics (PK) of V117957 with co-administered alcohol.
Methods
A randomized, double-blind, double-dummy, placebo-controlled, balanced six-period crossover design was employed. Single doses (2mg, 6mg) of V117957 and placebo were administered orally to healthy subjects in the morning with and without alcohol (0.7g/kg). Pharmacodynamic (PD) effects of V117957 were assessed, and safety/tolerability and PK interactions were also characterized. The primary PD endpoints (body sway, Digit Vigilance Test, and numeric working memory) were measured through 12 hours postdosing.
Results
Forty-eight subjects were enrolled and randomized; 46 completed. Compared with placebo, alcohol alone showed an impairment on psychomotor/cognitive performances through 2 hours postdose. V117957 alone showed a dose-dependent impairment. Compared with V117957 alone and alcohol alone, co-administration of alcohol and V117957 showed greater impairment until 8 hours postdose. No subject discontinued due to an adverse event (AE). No clinically meaningful treatment-emergent (TE) changes in clinical laboratory values, vital signs, SpO2 measurements, or 12-lead ECG results were observed. The most common TEAE was somnolence. All plasma and urine PK parameters for V117957 and alcohol were comparable when V117957 or alcohol was administered alone or in combination.
Conclusion
Single oral doses of V117957, 2mg or 6mg, administered alone or in combination with alcohol in healthy subjects resulted in no notable PK interaction between V117957 and alcohol. A dose-effect relationship in the magnitude and duration of impairment was observed for most psychomotor/cognitive performance parameters. Greater effects of V117957 with alcohol were observed for most psychomotor/cognitive performance parameters up to 8 hours post-dose.
Support
Funded by Imbrium Therapeutics, a subsidiary of Purdue Pharma L.P.
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Affiliation(s)
- M Zhou
- Imbrium Therapeutics, Stamford, CT
| | - S Harris
- Imbrium Therapeutics, Stamford, CT
| | | | - R Kapil
- Imbrium Therapeutics, Stamford, CT
| | - E He
- Imbrium Therapeutics, Stamford, CT
| | - M Shet
- Imbrium Therapeutics, Stamford, CT
| | - G Apseloff
- Ohio Clinical Trials, Inc., Columbus, OH
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Harris S, Zhou M, Cipriano A, Kapil R, Shet M, He E, Apseloff G. 0500 Evaluation of the Human Abuse Potential of Single Oral Doses of V117957, a Novel, Highly Potent and Selective Partial Agonist for Nociceptin/Orphanin-FQ Peptide (NOP) Receptors. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.497] [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
Introduction
The satisfactory safety/tolerability profile of V117957, an investigational NOP receptor partial agonist, has been previously established in ~200 healthy subjects with maximum doses at 30mg following a single oral administration and 10mg once daily for 2 weeks. V117957 exhibited linear plasma exposures at doses up to 10mg. In patients with insomnia disorder, V117957 demonstrated dose-dependent improvement in sleep efficiency and sleep maintenance between 0.5mg and 10mg as measured by polysomnography and patient diaries. The current study evaluated the abuse potential and safety of V117957 in healthy, nondependent recreational polydrug users with a history of central nervous system (CNS) depressant use.
Methods
The abuse potential of V117957 (1mg, 6mg, 10mg), placebo, and triazolam (0.5mg, 1mg) were assessed in a randomized, double-blind, double-dummy, placebo- and positive-controlled crossover study. Triazolam was utilized as a positive control based on its comparable pharmacokinetic and pharmacodynamic characteristics. V117957 doses (1mg, 6mg, 10mg) were selected to represent therapeutic, mid-range supratherapeutic, and maximum-tolerated supratherapeutic doses, respectively. Subjects were qualified based on pharmacodynamic responses following a single oral 0.75mg triazolam dose. Drug liking was measured through 24 hours, including the primary endpoint of maximum “at the moment” Drug-Liking Visual Analog Scale, as recommended by FDA. Secondary endpoints included Divided Attention Test (DAT) and Choice Reaction Time (CRT).
Results
The positive control (triazolam 0.5mg, 1mg) produced statistically significant greater abuse potential and cognitive/motor impairment versus placebo, which demonstrated study validity. In contrast, V117957 at 1mg was not statistically significantly different from placebo. At the supra-therapeutic doses of 6 and 10mg, V117957 was associated with abuse potential and cognitive/motor impairment greater than placebo, yet similar to those of triazolam 0.5 and 1mg.
Conclusion
Overall, in this valid study, V117957 1mg and placebo were associated with statistically significant lower potential for abuse and reduced cognitive/motor impairment compared with the two supratherapeutic doses of V117957 (6mg, 10mg), and triazolam (0.5mg, 1mg). V117957 1mg met FDA’s statistical criterion for similarity to placebo.
Support
Funded by Imbrium Therapeutics, a subsidiary of Purdue Pharma L.P.
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Affiliation(s)
- S Harris
- Imbrium Therapeutics, Stamford, CT
| | - M Zhou
- Imbrium Therapeutics, Stamford, CT
| | | | - R Kapil
- Imbrium Therapeutics, Stamford, CT
| | - M Shet
- Imbrium Therapeutics, Stamford, CT
| | - E He
- Imbrium Therapeutics, Stamford, CT
| | - G Apseloff
- Ohio Clinical Trials, Inc., Columbus, OH
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Moekotte AL, Malleo G, van Roessel S, Bonds M, Halimi A, Zarantonello L, Napoli N, Dreyer SB, Wellner UF, Bolm L, Mavroeidis VK, Robinson S, Khalil K, Ferraro D, Mortimer MC, Harris S, Al-Sarireh B, Fusai GK, Roberts KJ, Fontana M, White SA, Soonawalla Z, Jamieson NB, Boggi U, Alseidi A, Shablak A, Wilmink JW, Primrose JN, Salvia R, Bassi C, Besselink MG, Abu Hilal M. Gemcitabine-based adjuvant chemotherapy in subtypes of ampullary adenocarcinoma: international propensity score-matched cohort study. Br J Surg 2020; 107:1171-1182. [PMID: 32259295 DOI: 10.1002/bjs.11555] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/14/2019] [Accepted: 01/23/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Whether patients who undergo resection of ampullary adenocarcinoma have a survival benefit from adjuvant chemotherapy is currently unknown. The aim of this study was to compare survival between patients with and without adjuvant chemotherapy after resection of ampullary adenocarcinoma in a propensity score-matched analysis. METHODS An international multicentre cohort study was conducted, including patients who underwent pancreatoduodenectomy for ampullary adenocarcinoma between 2006 and 2017, in 13 centres in six countries. Propensity scores were used to match patients who received adjuvant chemotherapy with those who did not, in the entire cohort and in two subgroups (pancreatobiliary/mixed and intestinal subtypes). Survival was assessed using the Kaplan-Meier method and Cox regression analyses. RESULTS Overall, 1163 patients underwent pancreatoduodenectomy for ampullary adenocarcinoma. After excluding 187 patients, median survival in the remaining 976 patients was 67 (95 per cent c.i. 56 to 78) months. A total of 520 patients (53·3 per cent) received adjuvant chemotherapy. In a propensity score-matched cohort (194 patients in each group), survival was better among patients who received adjuvant chemotherapy than in those who did not (median survival not reached versus 60 months respectively; P = 0·051). A survival benefit was seen in patients with the pancreatobiliary/mixed subtype; median survival was not reached in patients receiving adjuvant chemotherapy and 32 months in the group without chemotherapy (P = 0·020). Patients with the intestinal subtype did not show any survival benefit from adjuvant chemotherapy. CONCLUSION Patients with resected ampullary adenocarcinoma may benefit from gemcitabine-based adjuvant chemotherapy, but this effect may be reserved for those with the pancreatobiliary and/or mixed subtype.
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Affiliation(s)
- A L Moekotte
- Departments of Surgery, Southampton, UK.,Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - G Malleo
- Department of Surgery, University Hospital of Verona, Verona, Italy
| | - S van Roessel
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - M Bonds
- Department of Surgery, Virginia Mason Medical Center, Seattle, Washington, USA
| | - A Halimi
- Pancreatic Surgery Unit, Division of Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - L Zarantonello
- Pancreatic Surgery Unit, Division of Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - N Napoli
- Department of Surgery, Pisa University Hospital, Pisa, Italy
| | - S B Dreyer
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - U F Wellner
- Department of Surgery, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - L Bolm
- Department of Surgery, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - V K Mavroeidis
- Department of Hepatobiliary and Pancreatic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Robinson
- Department of Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - K Khalil
- Faculty of Medicine, University of Birmingham, Birmingham, UK
| | - D Ferraro
- Department of Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - M C Mortimer
- Department of Surgery, Morriston Hospital, Swansea, UK
| | - S Harris
- Medical Statistics, Faculty of Medicine, University of Southampton, Southampton, UK
| | - B Al-Sarireh
- Department of Surgery, Morriston Hospital, Swansea, UK
| | - G K Fusai
- Department of Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - K J Roberts
- Faculty of Medicine, University of Birmingham, Birmingham, UK
| | - M Fontana
- Department of Surgery, University Hospital of Verona, Verona, Italy
| | - S A White
- Department of Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Z Soonawalla
- Department of Hepatobiliary and Pancreatic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - N B Jamieson
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - U Boggi
- Department of Surgery, Pisa University Hospital, Pisa, Italy
| | - A Alseidi
- Department of Surgery, Virginia Mason Medical Center, Seattle, Washington, USA
| | - A Shablak
- Departments of Medical Oncology, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - J W Wilmink
- Department of Medical Oncology, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - R Salvia
- Department of Surgery, University Hospital of Verona, Verona, Italy
| | - C Bassi
- Department of Surgery, University Hospital of Verona, Verona, Italy
| | - M G Besselink
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - M Abu Hilal
- Departments of Surgery, Southampton, UK.,Department of Surgery, Istituto Fondazione Poliambulanza, Brescia, Italy
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Grobman WA, Sandoval G, Reddy UM, Tita AT, Silver RM, Mallett G, Hill K, Rice MM, El-Sayed YY, Wapner RJ, Rouse DJ, Saade GR, Thorp JM, Chauhan SP, Iams JD, Chien EK, Casey BM, Gibbs RS, Srinivas SK, Swamy GK, Simhan HN, Macones GA, Peaceman A, Plunkett B, Paycheck K, Dinsmoor M, Harris S, Sheppard J, Biggio J, Harper L, Longo S, Servay C, Varner M, Sowles A, Coleman K, Atkinson D, Stratford J, Dellermann S, Meadows C, Esplin S, Martin C, Peterson K, Stradling S, Willson C, Lyell D, Girsen A, Knapp R, Gyamfi C, Bousleiman S, Perez-Delboy A, Talucci M, Carmona V, Plante L, Tocci C, Leopanto B, Hoffman M, Dill-Grant L, Palomares K, Otarola S, Skupski D, Chan R, Allard D, Gelsomino T, Rousseau J, Beati L, Milano J, Werner E, Salazar A, Costantine M, Chiossi G, Pacheco L, Saad A, Munn M, Jain S, Clark S, Clark K, Boggess K, Timlin S, Eichelberger K, Moore A, Beamon C, Byers H, Ortiz F, Garcia L, Sibai B, Bartholomew A, Buhimschi C, Landon M, Johnson F, Webb L, McKenna D, Fennig K, Snow K, Habli M, McClellan M, Lindeman C, Dalton W, Hackney D, Cozart H, Mayle A, Mercer B, Moseley L, Gerald J, Fay-Randall L, Garcia M, Sias A, Price J, Hale K, Phipers J, Heyborne K, Craig J, Parry S, Sehdev H, Bishop T, Ferrara J, Bickus M, Caritis S, Thom E, Doherty L, de Voest J. Health resource utilization of labor induction versus expectant management. Am J Obstet Gynecol 2020; 222:369.e1-369.e11. [PMID: 31930993 DOI: 10.1016/j.ajog.2020.01.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/26/2019] [Accepted: 01/06/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although induction of labor of low-risk nulliparous women at 39 weeks reduces the risk of cesarean delivery compared with expectant management, concern regarding more frequent use of labor induction remains, given that this intervention historically has been thought to incur greater resource utilization. OBJECTIVE The objective of the study was to determine whether planned elective labor induction at 39 weeks among low-risk nulliparous women, compared with expectant management, was associated with differences in health care resource utilization from the time of randomization through 8 weeks postpartum. STUDY DESIGN This is a planned secondary analysis of a multicenter randomized trial in which low-risk nulliparous women were assigned to induction of labor at 39 weeks or expectant management. We assessed resource utilization after randomization in 3 time periods: antepartum, delivery admission, and discharge through 8 weeks postpartum. RESULTS Of 6096 women with data available, those in the induction of labor group (n = 3059) were significantly less likely in the antepartum period after randomization to have at least 1 ambulatory visit for routine prenatal care (32.4% vs 68.4%), unanticipated care (0.5% vs 2.6%), or urgent care (16.2% vs 44.3%), or at least 1 antepartum hospitalization (0.8% vs 2.2%, P < .001 for all). They also had fewer tests (eg, sonograms, blood tests) and treatments (eg, antibiotics, intravenous hydration) prior to delivery. During the delivery admission, women in the induction of labor group spent a longer time in labor and delivery (median, 0.83 vs 0.57 days), but both women (P = .002) and their neonates (P < .001) had shorter postpartum stays. Women and neonates in both groups had similar frequencies of postpartum urgent care and hospital readmissions (P > .05 for all). CONCLUSION Women randomized to induction of labor had longer durations in labor and delivery but significantly fewer antepartum visits, tests, and treatments and shorter maternal and neonatal hospital durations after delivery. These results demonstrate that the health outcome advantages associated with induction of labor are gained without incurring uniformly greater health care resource use.
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Berg EL, Pride MC, Petkova SP, Lee RD, Copping NA, Shen Y, Adhikari A, Fenton TA, Pedersen LR, Noakes LS, Nieman BJ, Lerch JP, Harris S, Born HA, Peters MM, Deng P, Cameron DL, Fink KD, Beitnere U, O'Geen H, Anderson AE, Dindot SV, Nash KR, Weeber EJ, Wöhr M, Ellegood J, Segal DJ, Silverman JL. Translational outcomes in a full gene deletion of ubiquitin protein ligase E3A rat model of Angelman syndrome. Transl Psychiatry 2020; 10:39. [PMID: 32066685 PMCID: PMC7026078 DOI: 10.1038/s41398-020-0720-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/17/2019] [Accepted: 01/02/2020] [Indexed: 12/17/2022] Open
Abstract
Angelman syndrome (AS) is a rare neurodevelopmental disorder characterized by developmental delay, impaired communication, motor deficits and ataxia, intellectual disabilities, microcephaly, and seizures. The genetic cause of AS is the loss of expression of UBE3A (ubiquitin protein ligase E6-AP) in the brain, typically due to a deletion of the maternal 15q11-q13 region. Previous studies have been performed using a mouse model with a deletion of a single exon of Ube3a. Since three splice variants of Ube3a exist, this has led to a lack of consistent reports and the theory that perhaps not all mouse studies were assessing the effects of an absence of all functional UBE3A. Herein, we report the generation and functional characterization of a novel model of Angelman syndrome by deleting the entire Ube3a gene in the rat. We validated that this resulted in the first comprehensive gene deletion rodent model. Ultrasonic vocalizations from newborn Ube3am-/p+ were reduced in the maternal inherited deletion group with no observable change in the Ube3am+/p- paternal transmission cohort. We also discovered Ube3am-/p+ exhibited delayed reflex development, motor deficits in rearing and fine motor skills, aberrant social communication, and impaired touchscreen learning and memory in young adults. These behavioral deficits were large in effect size and easily apparent in the larger rodent species. Low social communication was detected using a playback task that is unique to rats. Structural imaging illustrated decreased brain volume in Ube3am-/p+ and a variety of intriguing neuroanatomical phenotypes while Ube3am+/p- did not exhibit altered neuroanatomy. Our report identifies, for the first time, unique AS relevant functional phenotypes and anatomical markers as preclinical outcomes to test various strategies for gene and molecular therapies in AS.
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Affiliation(s)
- E L Berg
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, USA
| | - M C Pride
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, USA
| | - S P Petkova
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, USA
| | - R D Lee
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, USA
| | - N A Copping
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Y Shen
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, USA
| | - A Adhikari
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, USA
| | - T A Fenton
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, USA
| | - L R Pedersen
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, USA
| | - L S Noakes
- Mouse Imaging Centre, Toronto Centre for Phenogenomics, The Hospital for Sick Children, Toronto, ON, Canada
| | - B J Nieman
- Mouse Imaging Centre, Toronto Centre for Phenogenomics, The Hospital for Sick Children, Toronto, ON, Canada
| | - J P Lerch
- Wellcome Centre for Integrative Neuroimaging, The University of Oxford, Oxford, UK
| | - S Harris
- Department of Pediatrics and Neurology, Baylor College of Medicine, Houston, TX, USA
| | - H A Born
- Department of Pediatrics and Neurology, Baylor College of Medicine, Houston, TX, USA
| | - M M Peters
- Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, FL, USA
| | - P Deng
- Stem Cell Program, Institute for Regenerative Cures, and Department of Neurology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - D L Cameron
- Stem Cell Program, Institute for Regenerative Cures, and Department of Neurology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - K D Fink
- Stem Cell Program, Institute for Regenerative Cures, and Department of Neurology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - U Beitnere
- MIND Institute, Genome Center, and Department of Biochemistry and Molecular Medicine, University of California Davis, Davis, CA, USA
| | - H O'Geen
- MIND Institute, Genome Center, and Department of Biochemistry and Molecular Medicine, University of California Davis, Davis, CA, USA
| | - A E Anderson
- Department of Pediatrics and Neurology, Baylor College of Medicine, Houston, TX, USA
| | - S V Dindot
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - K R Nash
- Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, FL, USA
| | - E J Weeber
- Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, FL, USA
| | - M Wöhr
- Behavioral Neuroscience, Experimental and Biological Psychology, Philipps-University of Marburg, Marburg, Germany
| | - J Ellegood
- Mouse Imaging Centre, Toronto Centre for Phenogenomics, The Hospital for Sick Children, Toronto, ON, Canada
| | - D J Segal
- MIND Institute, Genome Center, and Department of Biochemistry and Molecular Medicine, University of California Davis, Davis, CA, USA
| | - J L Silverman
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, USA.
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Greer C, Adamson P, Harris S, Horwood J, Troughton R, Darlow B. A002 Very Low Birth Weight is Associated With Reduced Right Ventricular Function Detected by Strain Imaging in Early Adulthood – Findings From a Prospective Cohort Study. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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40
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Savage HO, Rao A, Li B, Langley S, Hansom S, Dungu JN, Tan S, Farwell D, Phen P, Harris S. P5430Long term outcomes of patients receiving Implantable Cardioverter Defibrillators in a contemporary implant population in the Essex region of the UK. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0387] [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
Introduction
Implantable cardioverter-defibrillators (ICD) reduce the risk of sudden cardiac death in patients who are at risk and amongst among heart failure (HF) patients with a reduced left ventricular ejection fraction (LVEF).
Objective
The aim of this study was to determine the differences in outcomes amongst patients in a contemporary ICD implant population based on primary or secondary indications and an ischaemic or non-ischaemic aetiology. The primary outcome was death or appropriate device therapy for a ventricular arrhythmia. The secondary outcome was inappropriate shock therapy.
Purpose
The study cohort included consecutive patients who had an ICD or CRT-D implanted at a high-volume regional referral centre in Essex between 2014 and 2015. The censor point for follow up was 31/12/2018. Cumulative incidences were analysed by the method of Kaplan–Meier and compared using the log-rank test. In addition, the relationship between several clinical variables were tested in a multivariate Cox model to predict long-term mortality and this is described with hazard ratios (HR) and 95% CI.
Results
407 patients who received ICD treatment were followed up for a mean of 50±4 months. 63% had an Ischaemic cardiomyopathy and 60% had a primary prevention indication. Majority were men (81.5%), mean LVEF was (31±11) and mean age (71±11). The incidence of appropriate ICD therapy at 1-year post ICD insertion was 6.8% in all patients. This was significantly higher in patients with a secondary prevention indication compared to primary prevention (11.7% v 3.6% p=0.015) but similar in ischaemic compared to non-ischaemic patients (7.8% v 5.2% p=0.46). 1.9% patients had an inappropriate shock at 1 year and between group rate was similar. Overall 8.1% of patients did not survive beyond 1-year post implant with a mean time to death of 5.6±3.6 months. The cumulative incidence of the primary end-point at 1 year was similar in ischaemic and non-Ischaemic patients (7.8% v 8.6%; HR: 1.04, 95% CI 0.7–1.5, p=0.83) but was significantly higher at the end of study period in patients with an ischaemic aetiology (32.4% v 21%; HR: 1.59, 95% CI: 1.1–2.4, p=0.024) (Fig.1). In an adjusted Cox Hazard model, appropriate ICD therapy at 1 year (HR: 0.28, 95% CI: 0.17–0.47, p<0.001) and a secondary indication for ICD treatment (HR: 0.47, 95% CI: 0.31–0.73, p=0.001) were strongly associated with long-term mortality.
Figure 1
Conclusions
Our study highlights outcomes in a long-term follow up of ICD patients and in light of the debate around the DANISH trial, we have shown that at 1 year, the benefit of ICD therapy is comparable in non-ischaemic compared to ischaemic cardiomyopathies. Moreover, patients who had an ICD implanted for secondary prevention had a 3-fold mortality benefit at 1 year and had a higher rate of death. Appropriate ICD therapy and a secondary prevention indication predicted long term mortality.
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Affiliation(s)
- H O Savage
- Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - A Rao
- Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - B Li
- Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - S Langley
- Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - S Hansom
- Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - J N Dungu
- Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - S Tan
- Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - D Farwell
- Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - P Phen
- Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - S Harris
- Essex Cardiothoracic Centre, Basildon, United Kingdom
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Ashton PM, Thanh LT, Trieu PH, Van Anh D, Trinh NM, Beardsley J, Kibengo F, Chierakul W, Dance DAB, Rattanavong S, Davong V, Hung LQ, Chau NVV, Tung NLN, Chan AK, Thwaites GE, Lalloo DG, Anscombe C, Nhat LTH, Perfect J, Dougan G, Baker S, Harris S, Day JN. Three phylogenetic groups have driven the recent population expansion of Cryptococcus neoformans. Nat Commun 2019; 10:2035. [PMID: 31048698 PMCID: PMC6497710 DOI: 10.1038/s41467-019-10092-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 08/15/2018] [Accepted: 04/15/2019] [Indexed: 01/04/2023] Open
Abstract
Cryptococcus neoformans (C. neoformans var. grubii) is an environmentally acquired pathogen causing 181,000 HIV-associated deaths each year. We sequenced 699 isolates, primarily C. neoformans from HIV-infected patients, from 5 countries in Asia and Africa. The phylogeny of C. neoformans reveals a recent exponential population expansion, consistent with the increase in the number of susceptible hosts. In our study population, this expansion has been driven by three sub-clades of the C. neoformans VNIa lineage; VNIa-4, VNIa-5 and VNIa-93. These three sub-clades account for 91% of clinical isolates sequenced in our study. Combining the genome data with clinical information, we find that the VNIa-93 sub-clade, the most common sub-clade in Uganda and Malawi, was associated with better outcomes than VNIa-4 and VNIa-5, which predominate in Southeast Asia. This study lays the foundation for further work investigating the dominance of VNIa-4, VNIa-5 and VNIa-93 and the association between lineage and clinical phenotype.
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Affiliation(s)
- P M Ashton
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ho Chi Minh City, Vietnam
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK
| | - L T Thanh
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ho Chi Minh City, Vietnam
| | - P H Trieu
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ho Chi Minh City, Vietnam
| | - D Van Anh
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ho Chi Minh City, Vietnam
| | - N M Trinh
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ho Chi Minh City, Vietnam
| | - J Beardsley
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ho Chi Minh City, Vietnam
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK
- Marie Bashir Institute, University of Sydney, Sydney, 2050, NSW, Australia
| | - F Kibengo
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - W Chierakul
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - D A B Dance
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Laos
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - S Rattanavong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Laos
| | - V Davong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Laos
| | - L Q Hung
- Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - N V V Chau
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - N L N Tung
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - A K Chan
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, M4N 3M5, ON, Canada
- Dignitas International, Zomba, Malawi
| | - G E Thwaites
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ho Chi Minh City, Vietnam
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK
| | - D G Lalloo
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - C Anscombe
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ho Chi Minh City, Vietnam
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK
| | - L T H Nhat
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ho Chi Minh City, Vietnam
| | - J Perfect
- Department of Medicine and Department of Molecular Genetics and Microbiology, Division of Infectious Diseases, Duke University, Durham, NC, 27710, USA
| | - G Dougan
- Wellcome Trust-Cambridge Centre for Global Health Research, Cambridge, CB2 0XY, UK
- Pathogen Genomics, The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridge, CB10 1SA, Cambridgeshire, UK
- Department of Medicine, University of Cambridge, Cambridge, CB2 0SP, UK
| | - S Baker
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ho Chi Minh City, Vietnam
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK
- Wellcome Trust-Cambridge Centre for Global Health Research, Cambridge, CB2 0XY, UK
- Department of Medicine, University of Cambridge, Cambridge, CB2 0SP, UK
| | - S Harris
- Pathogen Genomics, The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridge, CB10 1SA, Cambridgeshire, UK
| | - J N Day
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ho Chi Minh City, Vietnam.
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK.
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Finch L, Harris S, Adams C, Sen J, Tickle J, Tzerakis N, Chari DM. WP1-22 DuraGen™ as an encapsulating material for neural stem cell delivery. J Neurol Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectivesAchieving neural regeneration after spinal cord injury (SCI) represents a significant challenge. Neural stem cell (NSC) therapy offers replacement of damaged cells and delivery of pro-regenerative factors, but >95% of cells die when transplanted to sites of neural injury. Biomaterial scaffolds provide cellular protective encapsulation to improve cell survival. However, current available scaffolds are overwhelmingly not approved for human use, presenting a major barrier to clinical translation. Surgical biomaterials offer the unique benefit of being FDA-approved for human implantation. Specifically, a neurosurgical grade material, DuraGen™, used predominantly for human duraplasty has many attractive features of an ideal biomaterial scaffold. Here, we have investigated the use of DuraGen™ as a 3D cell encapsulation device for potential use in combinatorial, regenerative therapies.MethodsPrimary NSCs were seeded into optimised sheets of DuraGen™. NSC growth and fate within DuraGen™ were assessed using 3D microscopic fluorescence imaging techniques.ResultsDuraGen™ supports the survival (ca 95% viability, 12 days) and 3D growth of NSCs. NSC phenotype, proliferative capacity and differentiation into astrocytes, neurons and oligodendrocytes were unaffected by DuraGen™.ConclusionsA ‘combinatorial therapy’, consisting of NSCs protected within a DuraGen™ matrix, offers a potential clinically translatable approach for neural cell therapy.
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Affiliation(s)
- J. Dorning
- School of Biological Sciences University of Bristol Bristol UK
| | - S. Harris
- School of Biological Sciences University of Bristol Bristol UK
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Harris S, Chivers P, McIntyre F, Piggott B, Farringdon F. Risk factors that predict head trauma exposure in semi-professional Australian Rules Football players. J Sci Med Sport 2018. [DOI: 10.1016/j.jsams.2018.09.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- G. Maude
- School of Biological Sciences University of Bristol Bristol UK
- Kalahari Research and Conservation Maun Botswana
| | | | - S. Harris
- School of Biological Sciences University of Bristol Bristol UK
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Wallis C, Patel KV, Marshall M, Staunton R, Milella L, Harris S, Holcombe LJ. A longitudinal assessment of periodontal health status in 53 Labrador retrievers. J Small Anim Pract 2018; 59:560-569. [PMID: 30006940 DOI: 10.1111/jsap.12870] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 03/22/2018] [Accepted: 04/18/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the incidence and rates of progression of gingivitis and periodontitis in Labrador retrievers. MATERIALS AND METHODS Fifty-three dogs, aged 1·1 to 5·9 years, had their periodontal health assessed every 6 months for up to 2 years. The extent of gingivitis and periodontitis was measured around the whole gingival margin of every tooth under general anaesthesia. RESULTS All dogs had gingivitis at the initial assessment. The majority (64·2%) of tooth aspects had very mild gingivitis. The palatal/lingual aspect of all tooth types was most likely to show bleeding when probed: 63·0% of these aspects had mild or moderate gingivitis. Over 2 years, 56·6% of dogs developed periodontitis and dogs as young as 1·9 years were affected. There was a significant positive correlation between the proportion of teeth with periodontitis and age. In total, 124 teeth (5·7%) developed periodontitis; 88 (71·0%) of these were incisors. The palatal/lingual aspect of the incisors developed the disease first (2·8% of incisor aspects). CLINICAL SIGNIFICANCE Periodontitis developed in regions that are difficult to see in conscious dogs implying that detection and treatment of disease requires periodic sedation or anaesthesia.
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Affiliation(s)
- C Wallis
- The WALTHAM Centre for Pet Nutrition, Melton Mowbray, Leicestershire LE14 4RT, UK
| | - K V Patel
- The WALTHAM Centre for Pet Nutrition, Melton Mowbray, Leicestershire LE14 4RT, UK
| | - M Marshall
- The WALTHAM Centre for Pet Nutrition, Melton Mowbray, Leicestershire LE14 4RT, UK
| | - R Staunton
- The WALTHAM Centre for Pet Nutrition, Melton Mowbray, Leicestershire LE14 4RT, UK
| | - L Milella
- The Veterinary Dental Surgery, 53 Parvis Road, Byfleet, Surrey KT14 7AA, UK
| | - S Harris
- The WALTHAM Centre for Pet Nutrition, Melton Mowbray, Leicestershire LE14 4RT, UK
| | - L J Holcombe
- The WALTHAM Centre for Pet Nutrition, Melton Mowbray, Leicestershire LE14 4RT, UK
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Pilkington SA, Bhome R, Welch RE, Ku F, Warden C, Harris S, Hicks J, Richardson C, Dudding TC, Knight JS, King AT, Mirnezami AH, Beck NE, Nichols PH, Nugent KP. Bilateral versus unilateral botulinum toxin injections for chronic anal fissure: a randomised trial. Tech Coloproctol 2018; 22:545-551. [PMID: 30022331 PMCID: PMC6097731 DOI: 10.1007/s10151-018-1821-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/29/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Botulinum toxin injected into the internal anal sphincter is used in the treatment of chronic anal fissure but there is no standardised technique for its administration. This randomised single centre trial compares bilateral (either side of fissure) to unilateral injection. METHODS Participants were randomised to receive bilateral (50 + 50 units) or unilateral (100 units) Dysport® injections into the internal anal sphincter in an outpatient setting. Injection-related pain assessed by visual analogue scale was the primary outcome measure. Secondary outcomes were healing rate, fissure pain, incontinence, and global health scores. RESULTS Between October 2008 and April 2012, 100 patients with chronic anal fissure were randomised to receive bilateral or unilateral injections. Injection-related pain was comparable in both groups. There was no difference in healing rate. Initially, there was greater improvement in fissure pain in the bilateral group but at 1 year the unilateral group showed greater improvement. Cleveland Clinic Incontinence score was lower in the unilateral group in the early post-treatment period and global health assessment (EuroQol EQ-VAS) was higher in the unilateral group at 1 year. CONCLUSIONS Injection-related pain was similar in bilateral and unilateral injection groups. Unilateral injection was as effective as bilateral injections in healing and improving fissure pain without any deterioration in continence.
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Affiliation(s)
- S A Pilkington
- Department of Colorectal Surgery, Southampton General Hospital, University Hospitals Southampton NHS Trust, Southampton, UK
| | - R Bhome
- Department of Colorectal Surgery, Southampton General Hospital, University Hospitals Southampton NHS Trust, Southampton, UK
- Academic Surgical Unit, University of Southampton, Level C South Academic Block, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - R E Welch
- School of Medicine, University of Southampton, Southampton, UK
| | - F Ku
- School of Medicine, University of Southampton, Southampton, UK
| | - C Warden
- Department of Colorectal Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - S Harris
- Primary Care and Population Studies Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - J Hicks
- Department of Colorectal Surgery, Southampton General Hospital, University Hospitals Southampton NHS Trust, Southampton, UK
| | - C Richardson
- Department of Colorectal Surgery, Southampton General Hospital, University Hospitals Southampton NHS Trust, Southampton, UK
| | - T C Dudding
- Department of Colorectal Surgery, Southampton General Hospital, University Hospitals Southampton NHS Trust, Southampton, UK
| | - J S Knight
- Department of Colorectal Surgery, Southampton General Hospital, University Hospitals Southampton NHS Trust, Southampton, UK
| | - A T King
- Department of Colorectal Surgery, Southampton General Hospital, University Hospitals Southampton NHS Trust, Southampton, UK
| | - A H Mirnezami
- Department of Colorectal Surgery, Southampton General Hospital, University Hospitals Southampton NHS Trust, Southampton, UK
- Academic Surgical Unit, University of Southampton, Level C South Academic Block, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - N E Beck
- Department of Colorectal Surgery, Southampton General Hospital, University Hospitals Southampton NHS Trust, Southampton, UK
| | - P H Nichols
- Department of Colorectal Surgery, Southampton General Hospital, University Hospitals Southampton NHS Trust, Southampton, UK
| | - K P Nugent
- Department of Colorectal Surgery, Southampton General Hospital, University Hospitals Southampton NHS Trust, Southampton, UK.
- Academic Surgical Unit, University of Southampton, Level C South Academic Block, Southampton General Hospital, Southampton, SO16 6YD, UK.
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Muller Z, Cuthill IC, Harris S. Group sizes of giraffes in Kenya: the influence of habitat, predation and the age and sex of individuals. J Zool (1987) 2018. [DOI: 10.1111/jzo.12571] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Z. Muller
- School of Biological Sciences; Life Sciences Building; University of Bristol; Bristol UK
| | - I. C. Cuthill
- School of Biological Sciences; Life Sciences Building; University of Bristol; Bristol UK
| | - S. Harris
- School of Biological Sciences; Life Sciences Building; University of Bristol; Bristol UK
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Halls MC, Berardi G, Cipriani F, Barkhatov L, Lainas P, Harris S, D'Hondt M, Rotellar F, Dagher I, Aldrighetti L, Troisi RI, Edwin B, Abu Hilal M. Development and validation of a difficulty score to predict intraoperative complications during laparoscopic liver resection. Br J Surg 2018; 105:1182-1191. [DOI: 10.1002/bjs.10821] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 12/04/2017] [Accepted: 12/13/2017] [Indexed: 12/11/2022]
Abstract
Abstract
Background
Previous studies have demonstrated that patient, surgical, tumour and operative variables affect the complexity of laparoscopic liver resections. However, current difficulty scoring systems address only tumour factors. The aim of this study was to develop and validate a predictive model for the risk of intraoperative complications during laparoscopic liver resections.
Methods
The prospectively maintained databases of seven European tertiary referral liver centres were compiled. Data from two-thirds of the patients were used for development and one-third for validation of the model. Intraoperative complications were based on a modified Satava classification. Using the methodology of the Framingham Heart Study, developed to identify risk factors that contribute to the development of cardiovascular disease, factors found to predict intraoperative complications independently were assigned points, and grouped into low-, moderate-, high- and extremely high-risk groups based on the likelihood of intraoperative complications.
Results
A total of 2856 patients were included. Neoadjuvant chemotherapy, lesion type and size, classification of resection and previous open liver resection were found to be independent predictors of intraoperative complications. Patients with intraoperative complications had a longer duration of hospital stay (5 versus 4 days; P < 0·001), higher complication rates (32·5 versus 15·5 per cent; P < 0·001), and higher 30-day (3·0 versus 0·3 per cent; P < 0·001) and 90-day (3·8 versus 0·8 per cent; P < 0·001) mortality rates than those who did not. The model was able to predict intraoperative complications (area under the receiver operating characteristic (ROC) curve (AUC) 0·677, 95 per cent c.i. 0·647 to 0·706) as well as postoperative 90-day mortality (AUC 0·769, 0·681 to 0·858).
Conclusion
This comprehensive scoring system, based on patient, surgical and tumour factors, and developed and validated using a large multicentre European database, helped estimate the risk of intraoperative complications.
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Affiliation(s)
- M C Halls
- Department of Hepato-Biliary and Pancreatic Surgery, University Hospital Southampton, Southampton, UK
| | - G Berardi
- Department of General and Hepatobiliary Surgery, Liver Transplantation, Ghent University Hospital Medical School, Ghent, Belgium
| | - F Cipriani
- Department of Hepato-Biliary and Pancreatic Surgery, University Hospital Southampton, Southampton, UK
- Department of Hepatobiliary Surgery, San Raffaele Hospital, Milan, Italy
| | - L Barkhatov
- Intervention Centre and Department of Hepatopancreatobiliary Surgery, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - P Lainas
- Department of Hepatobiliary Surgery, Antoine-Béclère Hospital, Paris, France
| | - S Harris
- Department of Public Health Sciences and Medical Statistics, Faulty of Medicine, University of Southampton, Southampton, UK
| | - M D'Hondt
- Department of Digestive and Hepatopancreatobiliary Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - F Rotellar
- Department of General Surgery, University of Navarra Hospital, Pamplona, Spain
| | - I Dagher
- Department of Hepatobiliary Surgery, Antoine-Béclère Hospital, Paris, France
| | - L Aldrighetti
- Department of Hepatobiliary Surgery, San Raffaele Hospital, Milan, Italy
| | - R I Troisi
- Department of General and Hepatobiliary Surgery, Liver Transplantation, Ghent University Hospital Medical School, Ghent, Belgium
| | - B Edwin
- Intervention Centre and Department of Hepatopancreatobiliary Surgery, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - M Abu Hilal
- Department of Hepato-Biliary and Pancreatic Surgery, University Hospital Southampton, Southampton, UK
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