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Orina F, Amukoye E, Bowyer C, Chakaya J, Das D, Devereux G, Dobson R, Dragosits U, Gray C, Kiplimo R, Lesosky M, Loh M, Meme H, Mortimer K, Ndombi A, Pearson C, Price H, Twigg M, West S, Semple S. Household carbon monoxide (CO) concentrations in a large African city: An unquantified public health burden? Environ Pollut 2024; 351:124054. [PMID: 38677455 DOI: 10.1016/j.envpol.2024.124054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/10/2024] [Accepted: 04/24/2024] [Indexed: 04/29/2024]
Abstract
Carbon monoxide (CO) is a poisonous gas produced by incomplete combustion of carbon-based fuels that is linked to mortality and morbidity. Household air pollution from burning fuels on poorly ventilated stoves can lead to high concentrations of CO in homes. There are few datasets available on household concentrations of CO in urban areas of sub-Saharan African countries. CO was measured every minute over 24 h in a sample of homes in Nairobi, Kenya. Data on household characteristics were gathered by questionnaire. Metrics of exposure were summarised and analysis of temporal changes in concentration was performed. Continuous 24-h data were available from 138 homes. The mean (SD), median (IQR) and maximum 24-h CO concentration was 4.9 (6.4), 2.8 (1.0-6.3) and 44 ppm, respectively. 50% of homes had detectable CO concentrations for 847 min (14h07m) or longer during the 24-h period, and 9% of homes would have activated a CO-alarm operating to European specifications. An association between a metric of total CO exposure and self-reported exposure to vapours >15 h per week was identified, however this were not statistically significant after adjustment for the multiple comparisons performed. Mean concentrations were broadly similar in homes from a more affluent area and an informal settlement. A model of typical exposure suggests that cooking is likely to be responsible for approximately 60% of the CO exposure of Nairobi schoolchildren. Household CO concentrations are substantial in Nairobi, Kenya, despite most homes using gas or liquid fuels. Concentrations tend to be highest during the evening, probably associated with periods of cooking. Household air pollution from cooking is the main source of CO exposure of Nairobi schoolchildren. The public health impacts of long-term CO exposure in cities in sub-Saharan Africa may be considerable and should be studied further.
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Affiliation(s)
- F Orina
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - E Amukoye
- Research and Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - C Bowyer
- Faculty of Creative and Cultural Industries, University of Portsmouth, Portsmouth, UK
| | - J Chakaya
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - D Das
- Institute of Occupational Medicine, Research Avenue North Riccarton, Edinburgh EH14 4AP, UK; Department of Environment and Geography, University of York, YO10 5NG, UK
| | - G Devereux
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - R Dobson
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, UK
| | - U Dragosits
- UK Centre for Ecology & Hydrology, Bush Estate, Penicuik, Midlothian EH26 0QB, UK
| | - C Gray
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - R Kiplimo
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - M Lesosky
- National Heart and Lung Institute, Imperial College London, London, SW3 6LR, UK
| | - M Loh
- Institute of Occupational Medicine, Research Avenue North Riccarton, Edinburgh EH14 4AP, UK
| | - H Meme
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - K Mortimer
- Cambridge Africa, Department of Pathology, University of Cambridge, Cambridge, UK; Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - A Ndombi
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - C Pearson
- UK Centre for Ecology & Hydrology, Bush Estate, Penicuik, Midlothian EH26 0QB, UK
| | - H Price
- Biological and Environmental Sciences, University of Stirling, Stirling, FK9 4LA, UK
| | - M Twigg
- UK Centre for Ecology & Hydrology, Bush Estate, Penicuik, Midlothian EH26 0QB, UK
| | - S West
- Stockholm Environment Institute, University of York, YO10 5NG, UK
| | - S Semple
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, UK.
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Gunsaulus M, Wang L, Haack L, Christopher A, Feingold B, Squires J, Horslen S, Hoskoppal A, Rose-Felker K, West S, Trucco S, Squires J, Olivieri L, Kreutzer J, Goldstein B, Alsaied T. Cardiac MRI-Derived Inferior Vena Cava Cross-Sectional Area Correlates with Measures of Fontan-Associated Liver Disease. Pediatr Cardiol 2024; 45:909-920. [PMID: 36454265 DOI: 10.1007/s00246-022-03054-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022]
Abstract
There is currently no clear consensus on screening techniques to evaluate the presence or severity of Fontan-associated liver disease (FALD). Cardiac MRI (CMR) is used routinely for post-Fontan surveillance, but CMR-derived measures that relate to the severity of FALD are not yet defined. This was a cross-sectional single-center study of post-Fontan patients who underwent a CMR. CMR exams were re-analyzed by a single pediatric cardiologist. Surrogates of FALD included Gamma-Glutamyl Transferase (GGT), Fibrosis-4 laboratory score (FIB-4), and imaging findings. Findings consistent with cirrhosis on liver ultrasound included increased liver echogenicity and/or nodularity. Statistical analyses were performed to investigate potential relationships between CMR parameters and markers of FALD. Sixty-one patients were included. A larger inferior vena cava cross-sectional area (IVC-CSA) indexed to height was significantly associated with a higher FIB-4 score (Spearman's ρ = 0.28, p = 0.04), a higher GGT level (Spearman's ρ = 0.40, p = 0.02), and findings consistent with cirrhosis on liver ultrasound (OR 1.17, 95% CI: (1.01, 1.35), p = 0.04). None of the other CMR parameters were associated with markers of FALD. A larger indexed IVC-CSA was associated with higher systemic ventricle end-diastolic pressure (EDP) on cardiac catheterization (Spearman's ρ = 0.39, p = 0.018) as well as older age (Spearman's ρ = 0.46, p = < 0.001). Indexed IVC-CSA was the only CMR parameter that was associated with markers of FALD. This measure has the potential to serve as an additional non-invasive tool to improve screening strategies for FALD.
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Affiliation(s)
- Megan Gunsaulus
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA.
| | - Li Wang
- Epidemiology Data Center, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Lindsey Haack
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA
| | - Adam Christopher
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA
| | - Brian Feingold
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA
| | - James Squires
- Pediatric Gastroenterology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Simon Horslen
- Pediatric Gastroenterology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Arvind Hoskoppal
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA
| | - Kirsten Rose-Felker
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA
| | - Shawn West
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA
| | - Sara Trucco
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA
| | - Judy Squires
- Pediatric Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Laura Olivieri
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA
| | - Jacqueline Kreutzer
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA
| | - Bryan Goldstein
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA
| | - Tarek Alsaied
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA
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West S, Heick Jensen T. Navigating the seas of co-submission: A chat with Steven West and Torben Heick Jensen. Mol Cell 2024; 84:2-4. [PMID: 38181761 DOI: 10.1016/j.molcel.2023.10.022] [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] [Received: 10/17/2023] [Revised: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 01/07/2024]
Abstract
Molecular Cell talks with corresponding authors Steven West and Torben Heick Jensen about the journey toward back-to-back publication of their recent Molecular Cell papers, and they share their advice for coordinating the steps along the way.
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Abdulkarim A, Shaji S, Elfituri M, Gunsaulus M, Zafar MA, Zaidi AN, Pass RH, Feingold B, Kurland G, Kreutzer J, Ghassemzadeh R, Goldstein B, West S, Alsaied T. Pulmonary Complications in Patients With Fontan Circulation: JACC Review Topic of the Week. J Am Coll Cardiol 2023; 81:2434-2444. [PMID: 37344046 DOI: 10.1016/j.jacc.2023.04.036] [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: 02/07/2023] [Revised: 04/03/2023] [Accepted: 04/10/2023] [Indexed: 06/23/2023]
Abstract
The Fontan operation has resulted in significant improvement in survival of patients with single ventricle physiology. As a result, there is a growing population of individuals with Fontan physiology reaching adolescence and adulthood. Despite the improved survival, there are long-term morbidities associated with the Fontan operation. Pulmonary complications are common and may contribute to both circulatory and pulmonary insufficiency, leading ultimately to Fontan failure. These complications include restrictive lung disease, sleep abnormalities, plastic bronchitis, and cyanosis. Cyanosis post-Fontan procedure can be attributed to multiple causes including systemic to pulmonary venous collateral channels and pulmonary arteriovenous malformations. This review presents the unique cardiopulmonary interactions in the Fontan circulation. Understanding the cardiopulmonary interactions along with improved recognition and treatment of pulmonary abnormalities may improve the long-term outcomes in this growing patient population. Interventions focused on improving pulmonary function including inspiratory muscle training and endurance training have shown a promising effect post-Fontan procedure.
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Affiliation(s)
- Ali Abdulkarim
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shawn Shaji
- Heart Institute, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA; Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mahmud Elfituri
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Megan Gunsaulus
- Heart Institute, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA; Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Muhammad A Zafar
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ali N Zaidi
- Mount Sinai Heart, Mount Sinai Kravis Children's Heart Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert H Pass
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Division of Pediatric Cardiology and Mount Sinai Kravis Children's Heart Center, New York, New York, USA
| | - Brian Feingold
- Heart Institute, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA; Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Geoffrey Kurland
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA; Division of Pediatric Pulmonology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jacqueline Kreutzer
- Heart Institute, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA; Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rod Ghassemzadeh
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Department of Critical Care, Pittsburgh, Pennsylvania, USA
| | - Bryan Goldstein
- Heart Institute, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA; Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Shawn West
- Heart Institute, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA; Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Tarek Alsaied
- Heart Institute, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA; Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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Magnetta D, Jackson L, Zeevi A, Turnquist H, Miller S, West S, Murtagh G, Feingold B. High Sensitivity Troponin-I is Associated with Acute Rejection in Pediatric Heart Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.068] [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: 04/05/2023] Open
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Wyatt JJ, Pearson RA, Frew J, Walker C, Richmond N, Wilkinson M, Wilkes K, Driver S, West S, Karen P, Brooks-Pearson RL, Ainslie D, Wilkins E, McCallum HM. The first patients treated with MR-CBCT soft-tissue matching in a MR-only prostate radiotherapy pathway. Radiography (Lond) 2023; 29:347-354. [PMID: 36736147 DOI: 10.1016/j.radi.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Magnetic Resonance (MR)-only radiotherapy for prostate cancer has previously been reported using fiducial markers for on-treatment verification. MR-Cone Beam Computed Tomography (CBCT) soft-tissue matching does not require invasive fiducial markers and enables MR-only treatments to other pelvic cancers. This study evaluated the first clinical implementation of MR-only prostate radiotherapy using MR-CBCT soft-tissue matching. METHODS Twenty prostate patients were treated with MR-only radiotherapy using a synthetic (s)CT-optimised plan with MR-CBCT soft-tissue matching. Two MR sequences were acquired: small Field Of View (FOV) for target delineation and large FOV for organs at risk delineation, sCT generation and on-treatment verification. Patients also received a CT for validation. The prostate was independently contoured on the small FOV MR, copied to the registered CT and modified if there were MR-CT soft-tissue alignment differences (MR-CT volume). This was compared to the MR-only volume with a paired t-test. The treatment plan was recalculated on CT and the doses compared. Independent offline CT-CBCT matches for 5/20 fractions were performed by three therapeutic radiographers using the MR-only contours and compared to the online MR-CBCT matches using two one-sided paired t-tests for equivalence within ±1 mm. RESULTS The MR-only volumes were significantly smaller than MR-CT (p = 0.003), with a volume ratio 0.92 ± 0.02 (mean ± standard error). The sCT isocentre dose difference to CT was 0.2 ± 0.1%. MR-CBCT soft-tissue matching was equivalent to CT-CBCT (p < 0.001), with differences of 0.1 ± 0.2 mm (vertical), -0.1 ± 0.2 mm (longitudinal) and 0.0 ± 0.1 mm (lateral). CONCLUSIONS MR-only radiotherapy with soft-tissue matching has been successfully clinically implemented. It produced significantly smaller target volumes with high dosimetric and on-treatment matching accuracy. IMPLICATIONS FOR PRACTICE MR-only prostate radiotherapy can be safely delivered without using invasive fiducial markers. This enables MR-only radiotherapy to be extended to other pelvic cancers where fiducial markers cannot be used.
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Affiliation(s)
- J J Wyatt
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle, UK.
| | - R A Pearson
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - J Frew
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - C Walker
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - N Richmond
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - M Wilkinson
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - K Wilkes
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - S Driver
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - S West
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - P Karen
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - R L Brooks-Pearson
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - D Ainslie
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - E Wilkins
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - H M McCallum
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
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Bottomley T, Gadsden J, West S. The failed peripheral nerve block. BJA Educ 2023; 23:92-100. [PMID: 36844443 PMCID: PMC9947978 DOI: 10.1016/j.bjae.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 01/21/2023] Open
Affiliation(s)
- T. Bottomley
- University College London NHS Foundation Trust, London, UK
| | - J. Gadsden
- Duke University Medical Centre, Durham, NC, USA
| | - S. West
- University College London NHS Foundation Trust, London, UK
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Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, Allsop L, Almeida P, Altmann D, Alvarez Corral M, Amoils S, Anderson D, Antoniades C, Arbane G, Arias A, Armour C, Armstrong L, Armstrong N, Arnold D, Arnold H, Ashish A, Ashworth A, Ashworth M, Aslani S, Assefa-Kebede H, Atkin C, Atkin P, Aung H, Austin L, Avram C, Ayoub A, Babores M, Baggott R, Bagshaw J, Baguley D, Bailey L, Baillie JK, Bain S, Bakali M, Bakau M, Baldry E, Baldwin D, Ballard C, Banerjee A, Bang B, Barker RE, Barman L, Barratt S, Barrett F, Basire D, Basu N, Bates M, Bates A, Batterham R, Baxendale H, Bayes H, Beadsworth M, Beckett P, Beggs M, Begum M, Bell D, Bell R, Bennett K, Beranova E, Bermperi A, Berridge A, Berry C, Betts S, Bevan E, Bhui K, Bingham M, Birchall K, Bishop L, Bisnauthsing K, Blaikely J, Bloss A, Bolger A, Bonnington J, Botkai A, Bourne C, Bourne M, Bramham K, Brear L, Breen G, Breeze J, Bright E, Brill S, Brindle K, Broad L, Broadley A, Brookes C, Broome M, Brown A, Brown A, Brown J, Brown J, Brown M, Brown M, Brown V, Brugha T, Brunskill N, Buch M, Buckley P, Bularga A, Bullmore E, Burden L, Burdett T, Burn D, Burns G, Burns A, Busby J, Butcher R, Butt A, Byrne S, Cairns P, Calder PC, Calvelo E, Carborn H, Card B, Carr C, Carr L, Carson G, Carter P, Casey A, Cassar M, Cavanagh J, Chablani M, Chambers RC, Chan F, Channon KM, Chapman K, Charalambou A, Chaudhuri N, Checkley A, Chen J, Cheng Y, Chetham L, Childs C, Chilvers ER, Chinoy H, Chiribiri A, Chong-James K, Choudhury N, Chowienczyk P, Christie C, Chrystal M, Clark D, Clark C, Clarke J, Clohisey S, Coakley G, Coburn Z, Coetzee S, Cole J, Coleman C, Conneh F, Connell D, Connolly B, Connor L, Cook A, Cooper B, Cooper J, Cooper S, Copeland D, Cosier T, Coulding M, Coupland C, Cox E, Craig T, Crisp P, Cristiano D, Crooks MG, Cross A, Cruz I, Cullinan P, Cuthbertson D, Daines L, Dalton M, Daly P, Daniels A, Dark P, Dasgin J, David A, David C, Davies E, Davies F, Davies G, Davies GA, Davies K, Dawson J, Daynes E, Deakin B, Deans A, Deas C, Deery J, Defres S, Dell A, Dempsey K, Denneny E, Dennis J, Dewar A, Dharmagunawardena R, Dickens C, Dipper A, Diver S, Diwanji SN, Dixon M, Djukanovic R, Dobson H, Dobson SL, Donaldson A, Dong T, Dormand N, Dougherty A, Dowling R, Drain S, Draxlbauer K, Drury K, Dulawan P, Dunleavy A, Dunn S, Earley J, Edwards S, Edwardson C, El-Taweel H, Elliott A, Elliott K, Ellis Y, Elmer A, Evans D, Evans H, Evans J, Evans R, Evans RI, Evans T, Evenden C, Evison L, Fabbri L, Fairbairn S, Fairman A, Fallon K, Faluyi D, Favager C, Fayzan T, Featherstone J, Felton T, Finch J, Finney S, Finnigan J, Finnigan L, Fisher H, Fletcher S, Flockton R, Flynn M, Foot H, Foote D, Ford A, Forton D, Fraile E, Francis C, Francis R, Francis S, Frankel A, Fraser E, Free R, French N, Fu X, Furniss J, Garner L, Gautam N, George J, George P, Gibbons M, Gill M, Gilmour L, Gleeson F, Glossop J, Glover S, Goodman N, Goodwin C, Gooptu B, Gordon H, Gorsuch T, Greatorex M, Greenhaff PL, Greenhalgh A, Greenwood J, Gregory H, Gregory R, Grieve D, Griffin D, Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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Sagray E, Johnson JN, Schumacher KR, West S, Lowery RE, Simpson K. Protein-losing enteropathy recurrence after pediatric heart transplantation: Multicenter case series. Pediatr Transplant 2022; 26:e14295. [PMID: 35451219 DOI: 10.1111/petr.14295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/03/2022] [Accepted: 04/09/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Protein-losing enteropathy (PLE) is a devastating complication of the Fontan circulation. Although orthotopic heart transplantation (HTx) typically results in resolution of PLE symptoms, isolated cases of PLE relapse have been described after HTx. METHODS Patients with Fontan-related PLE who had undergone HTx at participating centers and experienced relapse of PLE during follow-up were retrospectively identified. Available data related to pre- and post-HTx characteristics and PLE events were collected. RESULTS Eight patients from four different centers were identified. Median time from Fontan procedure to the development of PLE was 8 years, and median age at HTx was 17 years (range 7.7-21). In all patients, PLE resolved at a median time of 1 month after HTx (0.3-5). PLE recurrences occurred at a median time of 7.5 months after HTx (2-132). Each occurrence was associated with one or more significant clinical events; most commonly cellular- or antibody-mediated rejection; and less commonly graft dysfunction, infection, thrombosis, and posttransplant lymphoproliferative disease. PLE recurrences resolved after the successful treatment of the concomitant event, after a median time of 2 months in seven cases, while persisted and recurred in one patient in association with atypical mycobacterium infection and subsequent PTLD onset and relapses. Six patients were alive during follow-up at a median time of 4 years (1.3-22.5) after HTx. CONCLUSIONS This is the largest series of PLE recurrence after HTx. All cases were associated with one or more concomitant and significant clinical events. PLE typically resolved after resolution of the inciting clinical event.
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Affiliation(s)
- Ezequiel Sagray
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan N Johnson
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kurt R Schumacher
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Shawn West
- Pediatric Cardiology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ray E Lowery
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Kathleen Simpson
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Colorado, University of Colorado Denver, Aurora, Colorado, USA
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McGlothlin D, Granton J, Klepetko W, Beghetti M, Rosenzweig EB, Corris P, Horn E, Kanwar M, McRae K, Roman A, Tedford R, Badagliacca R, Bartolome S, Benza R, Caccamo M, Cogswell R, Dewachter C, Donahoe L, Fadel E, Farber HW, Feinstein J, Franco V, Frantz R, Gatzoulis M, Hwa (Anne) Goh C, Guazzi M, Hansmann G, Hastings S, Heerdt P, Hemnes A, Herpain A, Hsu CH, Kerr K, Kolaitis N, Kukreja J, Madani M, McCluskey S, McCulloch M, Moser B, Navaratnam M, Radegran G, Reimer C, Savale L, Shlobin O, Svetlichnaya J, Swetz K, Tashjian J, Thenappan T, Vizza CD, West S, Zuckerman W, Zuckermann A, De Marco T. ISHLT CONSENSUS STATEMENT: Peri-operative Management of Patients with Pulmonary Hypertension and Right Heart Failure Undergoing Surgery. J Heart Lung Transplant 2022; 41:1135-1194. [DOI: 10.1016/j.healun.2022.06.013] [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: 05/31/2022] [Accepted: 06/13/2022] [Indexed: 10/17/2022] Open
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11
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Godown J, Fountain D, Bansal N, Ameduri R, Anderson S, Beasley G, Burstein D, Knecht K, Molina K, Pye S, Richmond M, Spinner JA, Watanabe K, West S, Reinhardt Z, Scheel J, Urschel S, Villa C, Hollander SA. Heart Transplantation in Children With Down Syndrome. J Am Heart Assoc 2022; 11:e024883. [PMID: 35574952 PMCID: PMC9238550 DOI: 10.1161/jaha.121.024883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Children with Down syndrome (DS) have a high risk of cardiac disease that may prompt consideration for heart transplantation (HTx). However, transplantation in patients with DS is rarely reported. This project aimed to collect and describe waitlist and post– HTx outcomes in children with DS. Methods and Results This is a retrospective case series of children with DS listed for HTx. Pediatric HTx centers were identified by their participation in 2 international registries with centers reporting HTx in a patient with DS providing detailed demographic, medical, surgical, and posttransplant outcome data for analysis. A total of 26 patients with DS were listed for HTx from 1992 to 2020 (median age, 8.5 years; 46% male). High‐risk or failed repair of congenital heart disease was the most common indication for transplant (N=18, 69%). A total of 23 (88%) patients survived to transplant. All transplanted patients survived to hospital discharge with a median posttransplant length of stay of 22 days. At a median posttransplant follow‐up of 2.8 years, 20 (87%) patients were alive, 2 (9%) developed posttransplant lymphoproliferative disorder, and 8 (35%) were hospitalized for infection within the first year. Waitlist and posttransplant outcomes were similar in patients with and without DS (P=non‐significant for all). Conclusions Waitlist and post‐HTx outcomes in children with DS selected for transplant listing are comparable to pediatric HTx recipients overall. Given acceptable outcomes, the presence of DS alone should not be considered an absolute contraindication to HTx.
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Affiliation(s)
- Justin Godown
- Division of Pediatric Cardiology Monroe Carell Jr. Children’s Hospital at VanderbiltNashville TN
| | - Darlene Fountain
- Division of Pediatric Cardiology Monroe Carell Jr. Children’s Hospital at VanderbiltNashville TN
| | - Neha Bansal
- Division of Pediatric Cardiology Children’s Hospital at MontefioreBronx NY
| | - Rebecca Ameduri
- Division of Pediatric Cardiology University of Minnesota Minneapolis MN
| | - Susan Anderson
- Division of Pediatric Cardiology University of Minnesota Minneapolis MN
| | - Gary Beasley
- Division of Pediatric Cardiology LeBonheur Children's HospitalMemphis TN
| | - Danielle Burstein
- Division of Pediatric Cardiology Children's Hospital of PhiladelphiaPhiladelphia PA
| | - Kenneth Knecht
- Division of Pediatric Cardiology Arkansas Children's HospitalLittle Rock AR
| | - Kimberly Molina
- Division of Pediatric Cardiology Primary Children's HospitalSalt Lake City UT
| | - Sherry Pye
- Division of Pediatric Cardiology Arkansas Children's HospitalLittle Rock AR
| | - Marc Richmond
- Division of Pediatric Cardiology Columbia University Medical Center New York NY
| | - Joseph A. Spinner
- Division of Pediatric Cardiology Texas Children's HospitalHouston TX
| | - Kae Watanabe
- Division of Pediatric Cardiology Lurie Children's HospitalChicago IL
| | - Shawn West
- Division of Pediatric Cardiology Children's Hospital of PittsburghPittsburgh PA
| | - Zdenka Reinhardt
- Division of Pediatric Cardiology Freeman Hospital The Newcastle upon TyneUnited Kingdom
| | - Janet Scheel
- Division of Pediatric Cardiology Washington University St. Louis MO
| | - Simon Urschel
- Division of Pediatric Cardiology University of Alberta Edmonton AB Canada
| | - Chet Villa
- Division of Pediatric Cardiology Cincinnati Children's Hospital Medical Center Cincinnati OH
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Affiliation(s)
- T. Ashken
- Chelsea and Westminster Hospital, London, UK
| | - S. West
- University College London Hospitals NHS Foundation Trust, London, UK
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McCallum H, Wyatt J, Frew J, Walker C, Richmond N, Wilkinson M, Driver S, Pilling K, Rachel L B, West S, Pearson R. PO-1794: Real-life experiences of an MR-Only prostate radiotherapy pathway with MR-CBCT soft-tissue matching. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01812-0] [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: 10/22/2022]
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14
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Wyatt J, Pearson R, Frew J, Walker C, Richmond N, Wilkinson M, Wilkes K, Driver S, West S, Pilling K, Brooks R, Ainslie D, Wilkins E, McCallum H. OC-0473: Evaluation of first 20 patients treated with MR-Only prostate radiotherapy with MR-CBCT matching. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00495-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kemna M, Shaw D, Ameduri R, Azeka E, Bradford T, Jorgensen N, Lin K, Menteer J, Moller T, Reardon L, Schumacher K, Shih R, Stendahl G, West S, Wisotzkey B, Zangwill S. Posterior Reversible Encephalopathy Syndrome (PRES) after Pediatric Heart Transplantation: A Multicenter Study. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1270] [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: 10/24/2022] Open
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Griffiths E, Schumacher K, DiPaola F, Chen S, Gerrish H, West S, Nandi D, McCulloch M, O'Connor M, Zangwill S, Lee T, Friedland-Little J, Carlo W, Alejos J, Lambert L, Rezvani M, Shaaban A, Ou Z, Molina K. The Fontan Liver after Cardiac Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1271] [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: 10/24/2022] Open
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Pearson RA, Brooks R, Driver S, Frew JA, Pedley ID, Pilling K, Richmond N, Walker C, West S, Wilkinson M, Wyatt J, McCallum H. Magnetic Resonance-only Workflow: Implementation in a UK Centre. Clin Oncol (R Coll Radiol) 2019; 32:278. [PMID: 31786082 DOI: 10.1016/j.clon.2019.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/24/2019] [Indexed: 01/06/2023]
Affiliation(s)
- R A Pearson
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - R Brooks
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - S Driver
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J A Frew
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - I D Pedley
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - K Pilling
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - N Richmond
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - C Walker
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - S West
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - M Wilkinson
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J Wyatt
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - H McCallum
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
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Magnetta DA, Godown J, West S, Zinn M, Rose-Felker K, Miller S, Feingold B. Impact of the 2016 revision of US Pediatric Heart Allocation Policy on waitlist characteristics and outcomes. Am J Transplant 2019; 19:3276-3283. [PMID: 31544351 DOI: 10.1111/ajt.15567] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/19/2019] [Accepted: 08/04/2019] [Indexed: 01/25/2023]
Abstract
US Pediatric Heart Allocation Policy was recently revised, deprioritizing candidates with cardiomyopathy while maintaining status 1A eligibility for congenital heart disease (CHD) candidates on "high-dose" inotropes. We compared waitlist characteristics and mortality around this change. Status 1A listings decreased (70% to 56%, P < .001) and CHD representation increased among status 1A listings (48% vs 64%, P < .001). Waitlist mortality overall (subdistribution hazard ratio [SHR] 0.96, P = .63) and among status 1A candidates (SHR 1.16, P = .14) were unchanged. CHD waitlist mortality trended better (SHR 0.82, P = .06) but was unchanged for CHD candidates listed status 1A (SHR 0.92, P = .47). Status 1A listing exceptions increased 2- to 3-fold among hypertrophic and restrictive cardiomyopathy candidates and 13.5-fold among dilated cardiomyopathy (DCM) candidates. Hypertrophic (SHR 6.25, P = .004) and restrictive (SHR 3.87, P = .03) cardiomyopathy candidates without status 1A exception had increased waitlist mortality, but those with DCM did not (SHR 1.26, P = .32). Ventricular assist device (VAD) use increased only among DCM candidates ≥1 years old (26% vs 38%, P < .001). Current allocation policy has increased CHD status 1A representation but has not improved their waitlist mortality. Excessive DCM status 1A listing exceptions and continued status 1A prioritization of children on stable VADs potentially diminish the intended benefits of policy revision.
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Affiliation(s)
- Defne A Magnetta
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Justin Godown
- Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shawn West
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matthew Zinn
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kirsten Rose-Felker
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Susan Miller
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Brian Feingold
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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West S, Smail O, Bond B. The acute influence of sucrose consumption with and without vitamin C co-ingestion on microvascular reactivity in healthy young adults. Microvasc Res 2019; 126:103906. [DOI: 10.1016/j.mvr.2019.103906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 02/07/2023]
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Shackleton C, Evans R, Shamley D, West S, Albertus Y. Effectiveness of over-ground robotic locomotor training in improving walking performance, cardiovascular demands, secondary complications and user-satisfaction in individuals with spinal cord injuries: A systematic review. J Rehabil Med 2019; 51:723-733. [DOI: 10.2340/16501977-2601] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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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21
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Schumacher KR, Yu S, Butts R, Castleberry C, Chen S, Edens E, Godown J, Johnson J, Kemna M, Lin K, Lowery R, Simpson K, West S, Wilmot I, Gossett JG. Fontan-associated protein-losing enteropathy and post‒heart transplant outcomes: A multicenter study. J Heart Lung Transplant 2018; 38:17-25. [PMID: 30391195 DOI: 10.1016/j.healun.2018.09.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/08/2018] [Accepted: 09/25/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The influence of Fontan-associated protein-losing enteropathy's (PLE) severity, duration, and treatment on heart transplant (HTx) outcomes is unknown. We hypothesized that long-standing PLE and PLE requiring more intensive therapy are associated with increased post-HTx mortality. METHODS This 12-center, retrospective cohort study of post-Fontan patients with PLE referred for HTx from 2003 to 2015 involved collection of demographic, medical, surgical, and catheterization data, as well as PLE-specific data, including duration of disease, intensity/details of treatment, hospitalizations, and complications. Factors associated with waitlist and post-HTx outcomes and PLE resolution were sought. RESULTS Eighty patients (median of 5 per center) were referred for HTx evaluation. Of 68 patients listed for HTx, 8 were removed due to deterioration, 4 died waiting, and 4 remain listed. In 52 patients undergoing HTx, post-HTx 1-month survival was 92% and 1-year survival was 83%. PLE-specific factors, including duration of PLE pre-HTx, pre-HTx hospitalizations, need for/frequency of albumin replacement, PLE therapies, and growth parameters had no association with post-HTx mortality. Immunosuppressant regimen was associated with mortality; standard mycophenolate mofetil immunotherapy was used in 95% of survivors compared with only 44% of non-survivors (p = 0.03). Rejection (53%) and infection (42%) post-HTx were common, but not associated with PLE-specific factors. PLE resolved completely in all but 1 HTx survivor at a median of 1 month (interquartile range 1 to 3 months); resolution was not affected by PLE-specific factors. CONCLUSIONS PLE severity, duration, and treatment do not influence post-HTx outcome, but immunosuppressive regimen may have an impact on survival. PLE resolves in nearly all survivors.
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Affiliation(s)
- Kurt R Schumacher
- University of Michigan Congenital Heart Center, Ann Arbor, Michigan, USA.
| | - Sunkyung Yu
- University of Michigan Congenital Heart Center, Ann Arbor, Michigan, USA
| | - Ryan Butts
- University of Texas-Southwestern Children's Medical Center Dallas, Dallas, Texas, USA
| | - Chesney Castleberry
- Washington University, St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - Sharon Chen
- Stanford University, Lucile Packard Children's Hospital, Palo Alto, California, USA
| | - Erik Edens
- University of Iowa, Iowa City, Iowa, USA
| | - Justin Godown
- Vanderbilt University, Monroe Carell Chidren's Hospital, Nashville, Tennessee, USA
| | | | - Mariska Kemna
- Seattle Children's Hospital, Seattle, Washington, USA
| | - Kimberly Lin
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ray Lowery
- University of Michigan Congenital Heart Center, Ann Arbor, Michigan, USA
| | - Kathleen Simpson
- Washington University, St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - Shawn West
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ivan Wilmot
- Cincinnati Children's Medical Center, Cincinnati, Ohio, USA
| | - Jeffrey G Gossett
- University of California‒San Francisco Benioff Children's Hospital, San Francisco, California, USA
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Gambetta K, Wittlieb-Weber C, Bock M, Villa C, Johnson J, Lal A, Schumacher K, Law S, Deshpande S, West S, Friedland-Little J, Lytrivi I, Butts R, Cunningham C, Knecht K, McCullough M. Impact of Genotype on Boys with Duchenne Muscular Dystrophy. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.290] [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: 10/17/2022] Open
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23
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Godown J, Pruitt E, Vo J, Dodd D, Lytrivi I, Boyle G, Sutcliffe D, Kleinmahon J, Shih R, Urschel S, Das B, Carlo W, Zuckerman W, West S, McCulloch M, Zinn M, Simpson K, Kindel S, Szmuszkovicz J, Chrisant M, Auerbach S, Carboni M, Hsu D. Practice Variation in the Diagnosis of Acute Rejection Among Pediatric Heart Transplant Centers: An Analysis of the Pediatric Heart Transplant Study (PHTS) Database. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.465] [Citation(s) in RCA: 3] [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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Mistry MS, Trucco SM, Maul T, Sharma MS, Wang L, West S. Predictors of Poor Outcomes in Pediatric Venoarterial Extracorporeal Membrane Oxygenation. World J Pediatr Congenit Heart Surg 2018; 9:297-304. [PMID: 29552945 DOI: 10.1177/2150135118762391] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides respiratory and hemodynamic support to pediatric patients in severe cardiac failure. We aim to identify risk factors associated with poorer outcomes in this population. METHODS A retrospective chart review was conducted of pediatric patients requiring VA-ECMO support for cardiac indications at our institution from 2004 to 2015. Data were collected on demographics, indication, markers of cardiac output, ventricular assist device (VAD) insertion, heart transplantation, or left atrial (LA) decompression. Univariate Cox proportional hazards models were used to calculate hazard ratios (HRs) for variables associated with the composite primary outcome of transplant-free survival (TFS). RESULTS Of the 68 reviewed patients, 65% were male, 84% were white, 38% had a prior surgery, 13% had a prior transplant, 10% had a prior ECMO support, and 87.5% required vasoactive support within six hours of cannulation. The ECMO indications included congenital heart disease repaired >30 days prior (12%), cardiomyopathy (41%), posttransplant rejection (7%), and cardiorespiratory failure (40%). The TFS was 54.5% at discharge and 47.7% at one year. Predictors of transplant and/or death include epinephrine use (hazard ratio [HR] = 2.269, P = .041), elevated lactate (HR = 1.081, P = 0005), and elevated creatinine (HR = 1.081, P = .005) within six hours prior to cannulation. Sixteen (23.6%) patients underwent LA decompression. Placement of VAD occurred in 16 (23.5%) patients, for which nonwhite race (HR = 2.94, P = .034) and prior ECMO (HR = 3.42, P = .053) were the only identified risk factors. CONCLUSIONS Need for VA-ECMO for cardiac support carries high inpatient morbidity and mortality. Epinephrine use and elevated lactate and creatinine were associated with especially poor outcomes. Patients who survived to discharge had good short-term follow-up results.
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Affiliation(s)
- Maanasi S Mistry
- 1 Pediatric Cardiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Sara M Trucco
- 1 Pediatric Cardiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Timothy Maul
- 2 Biomedical Engineering, University of Pittsburgh, Pittsburgh, PA, USA.,3 Nemours Children's Hospital, Orlando, FL, USA
| | - Mahesh S Sharma
- 4 Pediatric Cardiothoracic Surgery, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Li Wang
- 5 Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shawn West
- 1 Pediatric Cardiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
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Johnson JN, Yu S, Lowery R, Butts R, Castleberry C, Chen S, Edens E, Godown J, Gossett J, Kemna M, Lin K, Simpson K, West S, Wilmot I, Schumacher K. TREATMENT VARIATION AND ITS IMPLICATION FOR SEVERE FONTAN-ASSOCIATED PROTEIN LOSING ENTEROPATHY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31165-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Ramulu P, Mihailovic A, Gitlin L, West S, Friedman D. TIME AND ACTIVITY-NORMALIZED FALL RATES IN GLAUCOMA. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P. Ramulu
- Ophthalmolgoy, Johns Hopkins Medical Center, Baltimore, Maryland
| | - A. Mihailovic
- Ophthalmolgoy, Johns Hopkins Medical Center, Baltimore, Maryland
| | - L.N. Gitlin
- Ophthalmolgoy, Johns Hopkins Medical Center, Baltimore, Maryland
| | - S. West
- Ophthalmolgoy, Johns Hopkins Medical Center, Baltimore, Maryland
| | - D. Friedman
- Ophthalmolgoy, Johns Hopkins Medical Center, Baltimore, Maryland
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Swenor B, Munoz B, West S. IS VISUAL IMPAIRMENT JUST ANOTHER COMORBID CONDITION? Innov Aging 2017. [DOI: 10.1093/geroni/igx004.693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B. Swenor
- Ophthalmology, Johns Hopkins University, Baltimore, Maryland
| | - B. Munoz
- Ophthalmology, Johns Hopkins University, Baltimore, Maryland
| | - S. West
- Ophthalmology, Johns Hopkins University, Baltimore, Maryland
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28
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Ollila MM, West S, Keinänen-Kiukaaniemi S, Jokelainen J, Auvinen J, Puukka K, Ruokonen A, Järvelin MR, Tapanainen JS, Franks S, Piltonen TT, Morin-Papunen LC. Overweight and obese but not normal weight women with PCOS are at increased risk of Type 2 diabetes mellitus-a prospective population-based cohort study. Hum Reprod 2017; 32:968. [PMID: 28333219 DOI: 10.1093/humrep/dex030] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M M Ollila
- Department of Obstetrics and Gynaecology, Oulu University Hospital, University of Oulu, Medical Research Center Oulu and PEDEGO Research Unit, FI, OYS, Oulu, Finland
| | - S West
- Department of Obstetrics and Gynaecology, Oulu University Hospital, University of Oulu, Medical Research Center Oulu and PEDEGO Research Unit, FI, OYS, Oulu, Finland
| | - S Keinänen-Kiukaaniemi
- Center for Life Course Health Research, University of Oulu, FI, Oulu, Finland.,Unit of Primary Health Care, Oulu University Hospital, FI, Oulu, Finland
| | - J Jokelainen
- Center for Life Course Health Research, University of Oulu, FI, Oulu, Finland.,Unit of Primary Health Care, Oulu University Hospital, FI, Oulu, Finland
| | - J Auvinen
- Center for Life Course Health Research, University of Oulu, FI, Oulu, Finland.,Unit of Primary Health Care, Oulu University Hospital, FI, Oulu, Finland
| | - K Puukka
- NordLab Oulu, Department of Clinical Chemistry, Oulu University Hospital, University of Oulu and Medical Research Center, FI, Oulu, Finland
| | - A Ruokonen
- NordLab Oulu, Department of Clinical Chemistry, Oulu University Hospital, University of Oulu and Medical Research Center, FI, Oulu, Finland
| | - M-R Järvelin
- Center for Life Course Health Research, University of Oulu, FI, Oulu, Finland.,Department of Children, Young People and Families, National Institute for Health and Welfare, FI, Oulu, Finland.,Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment & Health, School of Public Health, Imperial College London,London, UK
| | - J S Tapanainen
- Department of Obstetrics and Gynaecology, Oulu University Hospital, University of Oulu, Medical Research Center Oulu and PEDEGO Research Unit, FI, OYS, Oulu, Finland.,Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, FI, Helsinki, Finland
| | - S Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, London, UK
| | - T T Piltonen
- Department of Obstetrics and Gynaecology, Oulu University Hospital, University of Oulu, Medical Research Center Oulu and PEDEGO Research Unit, FI, OYS, Oulu, Finland
| | - L C Morin-Papunen
- Department of Obstetrics and Gynaecology, Oulu University Hospital, University of Oulu, Medical Research Center Oulu and PEDEGO Research Unit, FI, OYS, Oulu, Finland
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Ollila MM, West S, Keinänen-Kiukaanniemi S, Jokelainen J, Auvinen J, Puukka K, Ruokonen A, Järvelin MR, Tapanainen JS, Franks S, Piltonen TT, Morin-Papunen LC. Overweight and obese but not normal weight women with PCOS are at increased risk of Type 2 diabetes mellitus-a prospective, population-based cohort study. Hum Reprod 2016; 32:423-431. [PMID: 28031324 DOI: 10.1093/humrep/dew329] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/29/2016] [Accepted: 12/16/2016] [Indexed: 12/15/2022] Open
Abstract
STUDY QUESTION What are the respective roles of polycystic ovary syndrome (PCOS), long-term weight gain and obesity for the development of prediabetes or Type 2 diabetes mellitus (T2DM) by age 46 years? SUMMARY ANSWER The risk of T2DM in women with PCOS is mainly due to overweight and obesity, although these two factors have a synergistic effect on the development of T2DM. WHAT IS KNOWN ALREADY PCOS is associated with an increased risk of prediabetes and T2DM. However, the respective roles of PCOS per se and BMI for the development of T2DM have remained unclear. STUDY DESIGN, SIZE, DURATION In a prospective, general population-based follow-up birth cohort 1966 (n = 5889), postal questionnaires were sent at ages 14 (95% answered), 31 (80% answered) and 46 years (72% answered). Questions about oligoamenorrhoea and hirsutism were asked at age 31 years, and a question about PCOS diagnosis at 46 years. Clinical examination and blood sampling were performed at 31 years in 3127 women, and at 46 years in 3280 women. A 2-h oral glucose tolerance test (OGTT) was performed at 46 years of age in 2780 women. PARTICIPANTS/MATERIALS, SETTING, METHODS Women reporting both oligoamenorrhoea and hirsutism at age 31 years and/or diagnosis of PCOS by 46 years were considered as women with PCOS (n = 279). Women without any symptoms at 31 years and without PCOS diagnosis by 46 years were considered as controls (n = 1577). The level of glucose metabolism was classified according to the results of the OGTT and previous information of glucose metabolism status from the national drug and hospital discharge registers. MAIN RESULTS AND THE ROLE OF CHANCE PCOS per se significantly increased the risk of T2DM in overweight/obese (BMI ≥ 25.0 kg/m2) women with PCOS when compared to overweight/obese controls (odds ratio: 2.45, 95% CI: 1.28-4.67). Normal weight women with PCOS did not present with an increased risk of prediabetes or T2DM. The increase in weight between ages 14, 31 and 46 years was significantly greater in women with PCOS developing T2DM than in women with PCOS and normal glucose tolerance, with the most significant increase occurring in early adulthood (between 14 and 31 years: median with [25%; 75% quartiles]: 27.25 kg [20.43; 34.78] versus 13.80 kg [8.55; 20.20], P < 0.001). LIMITATIONS, REASONS FOR CAUTION The diagnosis of PCOS was based on self-reporting, and the questionnaire at 46 years did not distinguish between polycystic ovaries only in ultrasonography and the syndrome. Ovarian ultrasonography was not available to aid the diagnosis of PCOS. WIDER IMPLICATIONS OF THE FINDINGS These results emphasize weight management already during adolescence and early adulthood to prevent the development of T2DM in women with PCOS, as the period between 14 and 31 years seems to be a crucial time-window during which the women with PCOS who are destined to develop T2DM by 46 years of age experience a dramatic weight gain. Furthermore, our results support the view that, particularly in times of limited sources of healthcare systems, OGTT screening should be targeted to overweight/obese women with PCOS rather than to all women with PCOS. STUDY FUNDING/COMPETING INTERESTS Finnish Medical Foundation; North Ostrobothnia Regional Fund; Academy of Finland (project grants 104781, 120315, 129269, 1114194, 24300796, Center of Excellence in Complex Disease Genetics and SALVE); Sigrid Juselius Foundation; Biocenter Oulu; University Hospital Oulu and University of Oulu (75617); Medical Research Center Oulu; National Institute for Health Research (UK); National Heart, Lung, and Blood Institute (grant 5R01HL087679-02) through the STAMPEED program (1RL1MH083268-01); National Institute of Health/National Institute of Mental Health (5R01MH63706:02); ENGAGE project and grant agreement HEALTH-F4-2007-201413; EU FP7 EurHEALTHAgeing-277849 European Commission and Medical Research Council, UK (G0500539, G0600705, G1002319, PrevMetSyn/SALVE) and Medical Research Center, Centenary Early Career Award. The authors have no conflicts of interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M M Ollila
- Department of Obstetrics and Gynaecology, Oulu University Hospital, University of Oulu, Medical Research Center Oulu and PEDEGO Research Unit, FI-90029, OYS, Oulu, Finland
| | - S West
- Department of Obstetrics and Gynaecology, Oulu University Hospital, University of Oulu, Medical Research Center Oulu and PEDEGO Research Unit, FI-90029, OYS, Oulu, Finland
| | - S Keinänen-Kiukaanniemi
- Center for Life Course Health Research, University of Oulu, FI-90014, Oulu, Finland.,Unit of Primary Health Care, Oulu University Hospital, FI-90220, Oulu, Finland
| | - J Jokelainen
- Center for Life Course Health Research, University of Oulu, FI-90014, Oulu, Finland.,Unit of Primary Health Care, Oulu University Hospital, FI-90220, Oulu, Finland
| | - J Auvinen
- Center for Life Course Health Research, University of Oulu, FI-90014, Oulu, Finland.,Unit of Primary Health Care, Oulu University Hospital, FI-90220, Oulu, Finland
| | - K Puukka
- NordLab Oulu, Department of Clinical Chemistry, Oulu University Hospital, University of Oulu and Medical Research Center Oulu, FI-90220, Oulu, Finland
| | - A Ruokonen
- NordLab Oulu, Department of Clinical Chemistry, Oulu University Hospital, University of Oulu and Medical Research Center Oulu, FI-90220, Oulu, Finland
| | - M-R Järvelin
- Center for Life Course Health Research, University of Oulu, FI-90014, Oulu, Finland.,Department of Children, Young People and Families, National Institute for Health and Welfare, FI-90101, Oulu, Finland.,Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment & Health, School of Public Health, Imperial College London, W2 1PG, London, UK
| | - J S Tapanainen
- Department of Obstetrics and Gynaecology, Oulu University Hospital, University of Oulu, Medical Research Center Oulu and PEDEGO Research Unit, FI-90029, OYS, Oulu, Finland.,Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, FI-00014, Helsinki, Finland
| | - S Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, W12 0NN, London, UK
| | - T T Piltonen
- Department of Obstetrics and Gynaecology, Oulu University Hospital, University of Oulu, Medical Research Center Oulu and PEDEGO Research Unit, FI-90029, OYS, Oulu, Finland
| | - L C Morin-Papunen
- Department of Obstetrics and Gynaecology, Oulu University Hospital, University of Oulu, Medical Research Center Oulu and PEDEGO Research Unit, FI-90029, OYS, Oulu, Finland
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Khetarpal A, Anderson K, West S. P66 Falling asleep while driving: is driving safety advice given to patients with excessive daytime sleepiness? Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.209] [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: 11/04/2022]
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31
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Palmer EL, West S. S25 Survey of the new driver and vehicle licensing authority (DVLA) guidance for obstructive sleep apnoea (OSA): uk sleep centres opinion. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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32
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Mangiola M, Feingold B, John L, Hunter B, Curry C, Jelinek L, Nichol L, Miller S, Zinn M, West S, McCulloch MA, Zeevi A. P149 Successful pediatric heart transplant across low titer-C1q-negative DSA and a discordant flow/CDC crossmatch results after bortezomib therapy. Hum Immunol 2016. [DOI: 10.1016/j.humimm.2016.07.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Butts R, Boyle G, Deshpande S, Gambetta K, Knecht K, Prada Ruiz C, Richmond M, West S, Lal A. Pediatric Myocarditis in a Contemporary Multi-Center Cohort. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.1186] [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: 10/22/2022] Open
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Allen MB, Billig E, Reese PP, Shults J, Hasz R, West S, Abt PL. Donor Hemodynamics as a Predictor of Outcomes After Kidney Transplantation From Donors After Cardiac Death. Am J Transplant 2016; 16:181-93. [PMID: 26361242 DOI: 10.1111/ajt.13432] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/22/2015] [Accepted: 06/22/2015] [Indexed: 01/25/2023]
Abstract
Donation after cardiac death is an important source of transplantable organs, but evidence suggests donor warm ischemia contributes to inferior outcomes. Attempts to predict recipient outcome using donor hemodynamic measurements have not yielded statistically significant results. We evaluated novel measures of donor hemodynamics as predictors of delayed graft function and graft failure in a cohort of 1050 kidneys from 566 donors. Hemodynamics were described using regression line slopes, areas under the curve, and time beyond thresholds for systolic blood pressure, oxygen saturation, and shock index (heart rate divided by systolic blood pressure). A logistic generalized estimation equation model showed that area under the curve for systolic blood pressure was predictive of delayed graft function (above median: odds ratio 1.42, 95% confidence interval [CI] 1.06-1.90). Multivariable Cox regression demonstrated that slope of oxygen saturation during the first 10 minutes after extubation was associated with graft failure (below median: hazard ratio 1.30, 95% CI 1.03-1.64), with 5-year graft survival of 70.0% (95%CI 64.5%-74.8%) for donors above the median versus 61.4% (95%CI 55.5%-66.7%) for those below the median. Among older donors, increased shock index slope was associated with increased hazard of graft failure. Validation of these findings is necessary to determine the utility of characterizing donor warm ischemia to predict recipient outcome.
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Affiliation(s)
- M B Allen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - E Billig
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - P P Reese
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.,Renal Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - J Shults
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - R Hasz
- Gift of Life Donor Program, Philadelphia, PA
| | - S West
- Gift of Life Donor Program, Philadelphia, PA
| | - P L Abt
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.,Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
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McPherson K, West S. Percutaneous emergency airway access: prevention, preparation, technique and training. Br J Anaesth 2015; 116:143-4. [PMID: 26675962 DOI: 10.1093/bja/aev417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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36
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Murphy CJ, Gosh D, West S. P113 Clinical use of Adaptive Servo-Ventilation across the UK: results of a postal survey: Abstract P113 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.250] [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: 11/03/2022]
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Jeffery J, Stirling E, Al-Hadad I, Mussa M, Auld J, West S. Understanding and application of the glasgow coma scale amongst health care professionals caring for patients with traumatic head injury. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.526] [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: 10/22/2022]
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Gao R, Kratzing C, Pither C, Sharkey L, West S, Butler A, Woodward J, Duncan S, Green J, Chukualim B, Gabe S, Jamieson N, Middleton S. Nutritional outcomes following small bowel transplantation – The first year post-operative nutritional nadir. Clin Nutr ESPEN 2015; 10:e190-e191. [DOI: 10.1016/j.clnesp.2015.03.033] [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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Giles SL, deSouza NM, Collins DJ, Morgan VA, West S, Davies FE, Morgan GJ, Messiou C. Assessing myeloma bone disease with whole-body diffusion-weighted imaging: comparison with x-ray skeletal survey by region and relationship with laboratory estimates of disease burden. Clin Radiol 2015; 70:614-21. [PMID: 25799364 PMCID: PMC4443503 DOI: 10.1016/j.crad.2015.02.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 02/13/2015] [Accepted: 02/19/2015] [Indexed: 11/23/2022]
Abstract
AIM To estimate and compare the extent of myeloma bone disease by skeletal region using whole-body diffusion-weighted imaging (WB-DWI) and skeletal survey (SS) and record interobserver agreement, and to investigate differences in imaging assessments of disease extent and apparent diffusion coefficient (ADC) between patients with pathological high versus low disease burden. MATERIALS AND METHODS Twenty patients with relapsed myeloma underwent WB-DWI and SS. Lesions were scored by number and size for each skeletal region by two independent observers using WB-DWI and SS. Observer scores, ADC, and ADC-defined volume of tumour-infiltrated marrow were compared between patients with high and low disease burden (assessed by serum paraproteins and marrow biopsy). RESULTS Observer scores were higher on WB-DWI than SS in every region (p<0.05) except the skull, with greater interobserver reliability in rating the whole skeleton (WB-DWI: ICC = 0.74, 95% CI: 0.443-0.886; SS: ICC = 0.44, 95% CI: 0.002-0.730) and individual body regions. WB-DWI scores were not significantly higher in patients with high versus low disease burden (observer 1: mean ± SD: 48.8 ± 7, 38.6 ± 14.5, observer 2: mean ± SD: 37.3 ± 13.5, 30.4 ± 15.5; p = 0.06, p = 0.35). CONCLUSION WB-DWI demonstrated more lesions than SS in all regions except the skull with greater interobserver agreement. Sensitivity is not a limiting factor when considering WB-DWI in the management pathway of patients with myeloma.
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Affiliation(s)
- S L Giles
- MRI Department, Royal Marsden Hospital, Sutton, Surrey, UK.
| | - N M deSouza
- Clinical Magnetic Resonance Unit, Institute of Cancer Research, Sutton, Surrey, UK
| | - D J Collins
- Clinical Magnetic Resonance Unit, Institute of Cancer Research, Sutton, Surrey, UK
| | - V A Morgan
- MRI Department, Royal Marsden Hospital, Sutton, Surrey, UK
| | - S West
- Haemato-oncology Department, Royal Marsden Hospital, Sutton, Surrey, UK
| | - F E Davies
- Haemato-oncology Department, Royal Marsden Hospital, Sutton, Surrey, UK; Molecular Pathology, Institute of Cancer Research, Sutton, Surrey, UK
| | - G J Morgan
- Haemato-oncology Department, Royal Marsden Hospital, Sutton, Surrey, UK; Molecular Pathology, Institute of Cancer Research, Sutton, Surrey, UK
| | - C Messiou
- MRI Department, Royal Marsden Hospital, Sutton, Surrey, UK
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Vassileva P, Gieser S, West S, Cholakova T, Vitale S, Sheffield V. Prevalence of blindness and visual impairment due to cataract--Sofia Eye Survey. Dev Ophthalmol 2015; 27:19-24. [PMID: 8969958 DOI: 10.1159/000425645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Baril-Gravel L, Labonté ME, Couture P, Vohl MC, Charest A, Guay V, Jenkins DA, Connelly PW, West S, Kris-Etherton PM, Jones PJ, Fleming JA, Lamarche B. Docosahexaenoic acid-enriched canola oil increases adiponectin concentrations: a randomized crossover controlled intervention trial. Nutr Metab Cardiovasc Dis 2015; 25:52-59. [PMID: 25240692 DOI: 10.1016/j.numecd.2014.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/18/2014] [Accepted: 08/09/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS Little is known about the effect of various dietary fatty acids on pro- and anti-inflammatory processes. We investigated the effect of 5 oils containing various amounts of alpha-linolenic acid (ALA), linoleic acid (LA), oleic acid (OA) and docosahexaenoic acid (DHA) on plasma inflammatory biomarkers and expression levels of key inflammatory genes and transcription factors in whole blood cells. METHODS AND RESULTS In a randomized, crossover controlled nutrition intervention, 114 adult men and women with abdominal obesity and at least one other criterion for the metabolic syndrome consumed 5 experimental isoenergetic diets for 4 weeks each, separated by 4-week washout periods. Each diet provided 60 g/3000 kcal of different oils: 1) control corn/safflower oil blend (CornSaff; LA-rich), 2) flax/safflower oil blend (FlaxSaff; ALA-rich), 3) conventional canola oil (Canola; OA-rich), 4) high oleic canola oil (CanolaOleic; highest OA content), 5) DHA-enriched high oleic canola oil (CanolaDHA; OA- and DHA-rich). Gene expression in whole blood cells was assessed in a subset of 62 subjects. CanolaDHA increased plasma adiponectin concentrations compared with the control CornSaff oil treatment (+4.5%, P = 0.04) and FlaxSaff (+6.9%, P = 0.0008). CanolaDHA also reduced relative expression levels of interleukin (IL)1B compared with CornSaff and Canola (-11% and -13%, respectively, both P = 0.03). High-sensitivity C-reactive protein concentrations were lower after Canola than after FlaxSaff (-17.8%, P = 0.047). CONCLUSION DHA-enriched canola oil exerts anti-inflammatory effects compared with polyunsaturated fatty acids from plant sources.
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MESH Headings
- Adiponectin/agonists
- Adiponectin/blood
- Adult
- Aged
- Anti-Inflammatory Agents, Non-Steroidal/analysis
- Anti-Inflammatory Agents, Non-Steroidal/chemistry
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Biomarkers/blood
- Biomarkers/metabolism
- Blood Cells/immunology
- Blood Cells/metabolism
- Body Mass Index
- Canada/epidemiology
- Cross-Over Studies
- Docosahexaenoic Acids/analysis
- Docosahexaenoic Acids/therapeutic use
- Double-Blind Method
- Fatty Acids, Monounsaturated/chemistry
- Fatty Acids, Monounsaturated/therapeutic use
- Female
- Food, Fortified
- Gene Expression Regulation
- Humans
- Inflammation Mediators/antagonists & inhibitors
- Inflammation Mediators/blood
- Inflammation Mediators/metabolism
- Male
- Metabolic Syndrome/epidemiology
- Metabolic Syndrome/etiology
- Metabolic Syndrome/prevention & control
- Middle Aged
- Obesity, Abdominal/diet therapy
- Obesity, Abdominal/immunology
- Obesity, Abdominal/metabolism
- Obesity, Abdominal/physiopathology
- Pennsylvania/epidemiology
- Rapeseed Oil
- Risk
- Young Adult
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Affiliation(s)
- L Baril-Gravel
- Institute of Nutrition and Functional Foods, Laval University, Québec, QC G1V 0A6, Canada
| | - M-E Labonté
- Institute of Nutrition and Functional Foods, Laval University, Québec, QC G1V 0A6, Canada
| | - P Couture
- Institute of Nutrition and Functional Foods, Laval University, Québec, QC G1V 0A6, Canada
| | - M-C Vohl
- Institute of Nutrition and Functional Foods, Laval University, Québec, QC G1V 0A6, Canada
| | - A Charest
- Institute of Nutrition and Functional Foods, Laval University, Québec, QC G1V 0A6, Canada
| | - V Guay
- Institute of Nutrition and Functional Foods, Laval University, Québec, QC G1V 0A6, Canada
| | - D A Jenkins
- Keenan Research Centre for Biomedical Science of St-Michael's Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada
| | - P W Connelly
- Keenan Research Centre for Biomedical Science of St-Michael's Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada
| | - S West
- Pennsylvania State University, University Park, PA 16802, USA
| | | | - P J Jones
- Richardson Centre for Functional Foods and Nutraceuticals, University of Manitoba, Winnipeg, MB R3T 6C5, Canada
| | - J A Fleming
- Pennsylvania State University, University Park, PA 16802, USA
| | - B Lamarche
- Institute of Nutrition and Functional Foods, Laval University, Québec, QC G1V 0A6, Canada.
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Sharrock R, Baudouin S, West S. S23 Results Of A National Survey Of Pre-operative Screening For Obstructive Sleep Apnoea. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.29] [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: 11/04/2022]
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West S, Dunford C, Mayston MJ, Forsyth R. The School Function Assessment: identifying levels of participation and demonstrating progress for pupils with acquired brain injuries in a residential rehabilitation setting. Child Care Health Dev 2014; 40:689-97. [PMID: 23902410 DOI: 10.1111/cch.12089] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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] [Accepted: 06/08/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Delivering and monitoring residential rehabilitation services for pupils with acquired brain injuries (ABI) is challenging because of variability in aetiology, age and pre-morbid characteristics. Therapists and educators in this residential rehabilitation setting identified the need for a comprehensive tool which would capture the pupils' ability to participate in typical, everyday, school-based functional activities. This study aimed to explore the ability of the School Function Assessment (SFA) to identify levels of participation in school-based functional tasks and demonstrate progress for pupils with an ABI in a residential rehabilitation setting. METHODS The SFA was conducted on admission and discharge for pupils with ABI receiving residential rehabilitation between January 2007 and October 2011. Data analysis used Kruskal-Wallis to determine between-group differences in age, time post injury and weeks in rehabilitation. Linear mixed effects modelling was used to establish differences between admission and discharge scores. Case vignettes demonstrated how the SFA was used with individual pupils. RESULTS Seventy pupils were identified (31 traumatic brain injury; 29 non-traumatic and 10 anoxic) 42 boys and 28 girls whose age at injury was 4.5-17.2 years (median 12.8). The SFA demonstrated that 54/70 pupils had made progress with their ability to participate in school activities. Significant differences were found between admission and discharge SFA scores for participation, physical and cognitive assistance and adaptation and activity performance (P < 0.05). There was wide variability between individual profiles reflecting the heterogeneity of ABI. CONCLUSIONS The SFA determined levels of participation in school-based functional tasks for these residential pupils with an ABI and demonstrated progress both at the group and individual level in this residential rehabilitation setting. It identified the amount of support a pupil would need when they return to their local school and their strengths and needs in relation to participation in physical and cognitive school-based functional activities.
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Affiliation(s)
- S West
- Harrison Research Centre, The Children's Trust, Tadworth, UK
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West S, Lashen H, Bloigu A, Franks S, Puukka K, Ruokonen A, Järvelin MR, Tapanainen JS, Morin-Papunen L. Irregular menstruation and hyperandrogenaemia in adolescence are associated with polycystic ovary syndrome and infertility in later life: Northern Finland Birth Cohort 1986 study. Hum Reprod 2014; 29:2339-51. [PMID: 25085801 DOI: 10.1093/humrep/deu200] [Citation(s) in RCA: 40] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Do teenage girls with a history of menstrual irregularity and/or elevated androgen levels in adolescence exhibit an increased risk of polycystic ovary syndrome (PCOS) and/or infertility later on in adulthood? SUMMARY ANSWER Our results suggest that menstrual irregularity and/or elevated androgen levels at 16 years are still associated with symptoms of PCOS at 26 years as well as infertility problems at 26 years but not with decreased pregnancy or delivery rates at 26 years. WHAT IS KNOWN ALREADY Hyperandrogenaemia is associated with menstrual irregularity, hirsutism, acne and potentially higher risk for PCOS, but there are few follow-up studies investigating whether adolescent hyperandrogenaemia and/or menstrual irregularity are an early sign of PCOS. STUDY DESIGN, SIZE, DURATION A prospective population-based cohort study was conducted using two postal questionnaires targeting girls in the Northern Finland Birth Cohort 1986 (NFBC1986, n = 4567). The NFBC1986 comprises all expected births from the year 1986 in the two northernmost provinces of Finland. Collection of the database was performed at the age of 16 and 26. The 16-year and 26-year questionnaires included one question about the regularity and length of the menstrual cycle. The 26-year questionnaire also included questions about symptoms of PCOS, reproduction and infertility problems. PARTICIPANTS, SETTING, METHODS The response rates for the questionnaires were 80% (n = 3669) at 16 years and 50% (n = 2270) at 26 years. At 15-16 years, of 2448 girls, 709 (29%) girls reported menstrual irregularity (symptomatic girls) and 1739 (71%) had regular periods (non-symptomatic girls). After combining data from the two questionnaires a total of 2033 girls were included in the analyses. The χ(2) and Student's t-test was used to compare reproductive outcome and prevalence of clinical hyperandrogenaemia, PCOS and infertility at 26 years between the study groups. Univariate and multivariate logistic regression models were employed to estimate the association of menstrual irregularity at 16 years with clinical hyperandrogenaemia, PCOS and infertility at 26 years. MAIN RESULTS AND THE ROLE OF CHANCE At follow-up, the proportion of symptomatic girls who had conceived at least once (68.0 versus 67.9%) and had delivered at least one child (25.7 versus 28.1%) was similar to the non-symptomatic women and the groups had similar miscarriage rates (11.6 versus 12.1%). Logistic regression analyses indicated that menstrual irregularity at 16 years was associated with an increased risk of menstrual irregularity [adjusted odds ratio (OR) 1.37, 95% confidence interval (CI) 1.00-1.88, P = 0.050], PCOS (adjusted OR 2.91, 95% CI 1.74-4.84, P < 0.001) and infertility problems (adjusted OR 2.07, 95% CI 1.16-3.76, P = 0.013) at 26 years. At 26 years, women with PCOS (P = 0.013), hirsutism (P = 0.001) and acne (P < 0.001) exhibited significantly higher values of free androgen index (FAI) at 16 years than control women. There was a significant linear trend in the higher FAI quartiles at 16 years towards higher prevalence of PCOS (P = 0.005), hirsutism (P < 0.001) and acne (P < 0.001) at 26 years. Only 10.5% of the girls with menstrual irregularity at 16 years had PCOS at 26 years. LIMITATIONS, REASONS FOR CAUTION The diagnosis of menstrual irregularity was based on a self-reported questionnaire, thus introducing a risk of information bias in reporting the symptoms. Moreover, ovarian ultrasonography was not available to aid the diagnosis of PCOS and there was no clinical evaluation of hyperandrogenism. The relatively low rate of participation to the questionnaire at 26 years may also have biased the results. WIDER IMPLICATIONS OF THE FINDINGS Our findings confirm that menstrual irregularity and/or elevated androgen levels are already present in adolescence in women with PCOS and infertility in later life, which strengthens the importance of early identification of menstrual irregularity. STUDY FUNDING/COMPETING INTERESTS This work was supported by grants from the Finnish Medical Society Duodecim, the North Ostrobothnia Regional Fund, the Academy of Finland, the Sigrid Juselius Foundation, University Hospital Oulu and University of Oulu, the European Commission and the Medical Research Council, UK, Welcome Trust (089549/Z/09/Z). None of the authors have any conflict of interest.
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Affiliation(s)
- S West
- Department of Obstetrics and Gynaecology, University Hospital of Oulu, University of Oulu, Oulu, Finland
| | - H Lashen
- Department of Human Metabolism, University of Sheffield, Jessop Wing, Sheffield S10 2SF, UK
| | - A Bloigu
- Department of Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland
| | - S Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - K Puukka
- NordLab Oulu, Oulu University Hospital and Department of Clinical Chemistry, University of Oulu, Oulu, Finland
| | - A Ruokonen
- NordLab Oulu, Oulu University Hospital and Department of Clinical Chemistry, University of Oulu, Oulu, Finland
| | - M-R Järvelin
- Department of Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland Department of Epidemiology and Biostatistics, MRC Health Protection Agency (HPA) Centre for Environment and Health, School of Public Health, Imperial College London, London, UK Institute of Health Sciences, University of Oulu, Oulu, Finland Biocenter Oulu, University of Oulu, Oulu, Finland Unit of Primary Care, University Hospital of Oulu, University of Oulu, Oulu, Finland
| | - J S Tapanainen
- Department of Obstetrics and Gynaecology, University Hospital of Oulu, University of Oulu, Oulu, Finland Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - L Morin-Papunen
- Department of Obstetrics and Gynaecology, University Hospital of Oulu, University of Oulu, Oulu, Finland
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Pither C, Green J, Butler A, Chukaulim B, West S, Gao R, Gabe S, Middleton S. Psychiatric Disorders in Patients Undergoing Intestinal Transplantation. Transplant Proc 2014; 46:2136-9. [DOI: 10.1016/j.transproceed.2014.06.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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West S, Horn H, Hijnen W, Castillo C, Wagner M. Confocal laser scanning microscopy as a tool to validate the efficiency of membrane cleaning procedures to remove biofilms. Sep Purif Technol 2014. [DOI: 10.1016/j.seppur.2013.11.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Szoka N, Miskimins R, Tobey D, Greenbaum A, Faizi S, Lu S, West S, Howdieshell T, Demarest G, Nir I. Management of Hepatic Trauma from 2005 to 2012 in New Mexico’s Single Level One Trauma Center. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.1039] [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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West S, Vähäsarja M, Bloigu A, Pouta A, Franks S, Hartikainen AL, Järvelin MR, Corbett S, Vääräsmäki M, Morin-Papunen L. The impact of self-reported oligo-amenorrhea and hirsutism on fertility and lifetime reproductive success: results from the Northern Finland Birth Cohort 1966. Hum Reprod 2013; 29:628-33. [PMID: 24324025 DOI: 10.1093/humrep/det437] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
STUDY QUESTION To what extent do self-reported oligo-amenorrhea and hirsutism affect reproductive performance (childlessness, age at first delivery, family size and miscarriage rates)? SUMMARY ANSWER At the age of 44, among women with both self-reported oligo-amenorrhea and hirsutism the prevalence of childlessness was not significantly different from non-symptomatic women but they had a smaller family size than non-symptomatic women. WHAT IS KNOWN ALREADY Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by oligo-amenorrhea or amenorrhea, hyperandrogenism and hirsutism and it is the most frequent cause of anovulatory infertility, but there are few studies on the reproductive capacity of women with PCOS. In our previous population-based cohort study the women with self-reported oligo-amenorrhea and hirsutism were found to have more infertility problems and smaller family size than non-symptomatic women at the age of 31. STUDY DESIGN, SIZE, DURATION A prospective population-based cohort study. The population of the study is derived from the prospective Northern Finland Birth Cohort 1966 (NFBC1966), comprising all expected births from the year 1966 in the two northernmost provinces of Finland (n = 12 058). Of them, 5889 were females. Enrollment in this database begun at the 24th gestational week and so far data have been collected from the subjects at the ages of 1, 14 and 31 years. PARTICIPANTS/MATERIALS, SETTING, METHODS A postal questionnaire including questions about oligo-amenorrhea and hirsutism was sent to all women at the age of 31 (n = 5608, response rate 81%, n = 4535) and a clinical examination was performed (attendance rate 76.5%). Those who reported both hirsutism and oligo-amenorrhea were defined as women with both symptoms (n = 153). Data on pregnancies/deliveries were obtained from the Finnish Medical Birth Register (FMBR) in 2010 when the women were 44 years old. MAIN RESULTS AND THE ROLE OF CHANCE Women with both symptoms had delivered at least one child as often as non-symptomatic women [75.2 versus 79.0%, adjusted odds ratio (OR) 0.86, 95% confidence intervals (CI) 0.57-1.30], were of similar age [mean (SD)] at first delivery [27.7 (4.81) versus 27.3 (4.71)] and had similar incidence of miscarriages. However, non-symptomatic women had more often ≥2 deliveries (61.6 versus 52.9%, adjusted OR 0.70, 95% CI 0.49-1.00, P = 0.048) and had larger family size [mean (SD)] [2.4 (1.4) versus 1.9 (0.8), P < 0.001]. Women with both symptoms had been treated more often for infertility than non-symptomatic women (6.1 versus 2.4%, adjusted OR 2.74, 95% CI 1.14-6.60, P = 0.024). LIMITATIONS, REASONS FOR CAUTION The diagnosis of oligo-amenorrhea and hirsutism was based on a questionnaire, suggesting a risk of information bias in reporting the symptoms. However, we have previously shown that self-reported oligo-amenorrhea and hirsutism can distinguish most women with the typical profile of PCOS. Only the women who had delivered at least once were recorded in the FMBR, thus excluding from the study those who had experienced miscarriages and/or infertility treatments but did not have a live birth. This feature could potentially decrease the differences in incidence of miscarriages and/or infertility treatment between symptomatic and non-symptomatic subjects. WIDER IMPLICATIONS OF THE FINDINGS This is one of the few studies, in which the impact of self-reported oligo-amenorrhea and hirsutism on lifetime reproductive success can be measured. Our results suggest that even at more advanced age, women with both symptoms do not quite match the parity of healthy non-symptomatic women, and that infertility treatment does not always restore normal reproductive capacity in these women. Obese women with both symptoms had the worst prognostic as regards reproduction, which emphasizes the importance of life intervention and preventive politics against obesity in this group of women. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by grants from the Finnish Medical Society Duodecim, the North Ostrobothnia Regional Fund, the Academy of Finland, University Hospital Oulu, Biocenter, University of Oulu, Finland, the European Commission and the Medical Research Council, UK, the National Institute for Health Research (NIHR). None of the authors has any conflict of interest to declare.
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Affiliation(s)
- S West
- Department of Obstetrics and Gynecology, University Hospital of Oulu, University of Oulu, Oulu, Finland
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