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Goh R, Bacchi S, Kovoor JG, Gupta AK, Tan S, Stretton B, Ovenden CD, To MS, Moey A, Schultz D, Li JY, Juneja R, Kleinig T, Jannes J. Renal disease is not associated with delays in hyperacute stroke management in South Australia. Emerg Med Australas 2024; 36:479-481. [PMID: 38374542 DOI: 10.1111/1742-6723.14378] [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] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/18/2024] [Accepted: 02/01/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE The aims of the present study were to determine how renal disease is associated with the time to receive hyperacute stroke care. METHODS The present study involved a 5-year cohort of all patients admitted to stroke units in South Australia. RESULTS In those with pre-existing renal disease there were no significant differences in the time taken to receive a scan, thrombolysis or endovascular thrombectomy. CONCLUSIONS The present study shows that in protocolised settings there were no significant delays in hyperacute stroke management for patients with renal disease.
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Affiliation(s)
- Rudy Goh
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Flinders University College of Medicine and Public Health, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide, South Australia, Australia
| | - Brandon Stretton
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Minh-Son To
- Flinders University College of Medicine and Public Health, Adelaide, South Australia, Australia
| | - Andrew Moey
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - David Schultz
- Flinders University College of Medicine and Public Health, Adelaide, South Australia, Australia
| | - Jordan Y Li
- Flinders University College of Medicine and Public Health, Adelaide, South Australia, Australia
- Department of Renal Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Rajiv Juneja
- Flinders University College of Medicine and Public Health, Adelaide, South Australia, Australia
- Department of Renal Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Timothy Kleinig
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jim Jannes
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Bacchi S, Tan S, Slee M. Glucocorticoid-induced adrenal suppression: physiological basis and strategies for glucocorticoid weaning. Med J Aust 2024. [PMID: 38714488 DOI: 10.5694/mja2.52298] [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] [Received: 01/16/2024] [Accepted: 03/04/2024] [Indexed: 05/10/2024]
Affiliation(s)
- Stephen Bacchi
- Lyell McEwin Hospital, Adelaide, SA
- College of Medicine and Public Health, Flinders University, Adelaide, SA
| | | | - Mark Slee
- College of Medicine and Public Health, Flinders University, Adelaide, SA
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Feng TM, Wei JM, Tan S, Chen LX, Liu GN. Involvement of PD-1 +CD4 + T cells in the development of traumatic tracheal stenosis by regulating the IL-17/STAT3 pathway. Biochim Biophys Acta Mol Basis Dis 2024; 1870:167216. [PMID: 38718843 DOI: 10.1016/j.bbadis.2024.167216] [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: 10/14/2023] [Revised: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024]
Abstract
Studies have highlighted an upregulation of PD-1 expression in CD4+ T cells, which accelerates lung fibrosis by activating the IL-17/STAT3 pathway, leading to IL-17A and TGF-β1 secretion. However, the relation with traumatic tracheal stenosis (TS) remains unexplored. Our analysis found significant increases in PD-1+CD4+ T cells, IL-17A, and TGF-β1 in the TS patients (n = 10). The cellular model used CD4+ T cells co-cultured with bronchial fibroblasts while the animal model used a nylon brush to scrape the damaged tracheal mucosa. Interventions with PD-1 and STAT3 inhibitors both in vivo (n = 5) and in vitro (n = 6) showed decreased expression of TGF-β1 and IL-17A in CD4+ T cells, decreased collagen I synthesis in vivo, and reduced tractal fibrosis in vitro. Furthermore, PD-1's modulation of the STAT3 was evident. This research unveils PD-1+CD4+ T cells' role in TS, thus suggesting a novel immunotherapeutic strategy to counteract tracheal fibrosis.
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Affiliation(s)
- T M Feng
- Department of Respiratory Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - J M Wei
- Department of Respiratory Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - S Tan
- Department of Respiratory Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - L X Chen
- Department of Respiratory Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - G N Liu
- Department of Respiratory Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China.
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Lee YM, Stretton B, Tan S, Gupta A, Kovoor J, Bacchi S, Lim W, Chan WO. Captive markets and medical artificial intelligence. J Med Imaging Radiat Oncol 2024; 68:278-281. [PMID: 38563301 DOI: 10.1111/1754-9485.13648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Yong Min Lee
- Ophthalmology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Brandon Stretton
- Ophthalmology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sheryn Tan
- Ophthalmology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Aashray Gupta
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Joshua Kovoor
- Ophthalmology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Ophthalmology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Flinders University, Adelaide, South Australia, Australia
| | - Wanyin Lim
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Radiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Weng Onn Chan
- Ophthalmology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Tan S, Ng JS, Tang C, Stretton B, Kovoor J, Gupta A, Delloso T, Zhang T, Goh R, El-Masri S, Kiley M, Maddocks I, Harroud A, Stacpoole S, Crawford G, Bacchi S. Subcutaneous sodium valproate in palliative care: A systematic review. Palliat Med 2024; 38:492-497. [PMID: 38444061 PMCID: PMC11025302 DOI: 10.1177/02692163241234597] [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] [Indexed: 03/07/2024]
Abstract
BACKGROUND Seizures are an important palliative symptom, the management of which can be complicated by patients' capacity to swallow oral medications. In this setting, and the wish to avoid intravenous access, subcutaneous infusions may be employed. Options for antiseizure medications that can be provided subcutaneously may be limited. Subcutaneous sodium valproate may be an additional management strategy. AIM To evaluate the published experience of subcutaneous valproate use in palliative care, namely with respect to effectiveness and tolerability. DESIGN A systematic review was registered (PROSPERO CRD42023453427), conducted and reported according to PRISMA reporting guidelines. DATA SOURCES The databases PubMed, EMBASE and Scopus were searched for publications until August 11, 2023. RESULTS The searches returned 429 results, of which six fulfilled inclusion criteria. Case series were the most common study design, and most studies included <10 individuals who received subcutaneous sodium valproate. There were three studies that presented results on the utility of subcutaneous sodium valproate for seizure control, which described it to be an effective strategy. One study also described it as an effective treatment for neuropathic pain. The doses were often based on presumed 1:1 oral to subcutaneous conversion ratios. Only one study described a local site adverse reaction, which resolved with a change of administration site. CONCLUSIONS There are limited data on the use of subcutaneous sodium valproate in palliative care. However, palliative symptoms for which subcutaneous sodium valproate have been used successfully are seizures and neuropathic pain. The available data have described few adverse effects, supporting its use with an appropriate degree of caution.
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Affiliation(s)
- Sheryn Tan
- University of Adelaide, Adelaide, SA, Australia
| | | | - Charis Tang
- University of Adelaide, Adelaide, SA, Australia
| | - Brandon Stretton
- University of Adelaide, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Joshua Kovoor
- University of Adelaide, Adelaide, SA, Australia
- Ballarat Base Hospital, Ballarat Central, VIC, Australia
| | | | | | | | - Rudy Goh
- University of Adelaide, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | | | - Ian Maddocks
- Flinders University, Bedford Park, SA, Australia
| | | | - Sybil Stacpoole
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Gregory Crawford
- University of Adelaide, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Stephen Bacchi
- Flinders University, Bedford Park, SA, Australia
- Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
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Bacchi S, Kovoor JG, Goh R, Gupta AK, Tan S, Ovenden CD, To MS, Moey A, Sanders P, Chew DP, Schultz D, Kovoor P, Kleinig T, Jannes J. Pre-stroke anticoagulation for atrial fibrillation in primary English speakers and non-primary English speakers: a multicentre retrospective cohort study. Intern Med J 2024; 54:620-625. [PMID: 37860995 DOI: 10.1111/imj.16253] [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] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/16/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Anticoagulation can prevent most strokes in individuals with atrial fibrillation (AF); however, many people presenting with stroke and known AF are not anticoagulated. Language barriers and poor health literacy have previously been associated with decreased patient medication adherence. The association between language barriers and initiation of anticoagulation therapy for AF is uncertain. AIMS The aims of this study were to determine whether demographic factors, including non-English primary language, were (1) associated with not being initiated on anticoagulation for known AF prior to admission with stroke, and (2) associated with non-adherence to anticoagulation in the setting of known AF prior to admission with stroke. METHODS A multicentre retrospective cohort study was conducted for consecutive individuals admitted to the three South Australian tertiary hospitals with stroke units over a 5-year period. RESULTS There were 6829 individuals admitted with stroke. These cases included 5835 ischaemic stroke patients, 1333 of whom had pre-existing AF. Only 40.0% presenting with ischaemic stroke in the setting of known pre-existing AF were anticoagulated. When controlling for demographics, socioeconomic status and past medical history (including the components of the CHADS2VASC score and anticoagulation contraindications), having a primary language other than English was associated with a lower likelihood of having been commenced on anticoagulant for known pre-stroke AF (odds ratio: 0.52, 95% confidence interval: 0.36-0.77, P = 0.001), but was not associated with a differing likelihood of anticoagulation adherence. CONCLUSIONS A significant proportion of patients with stroke have pre-existing unanticoagulated AF; these rates are substantially higher if the primary language is other than English. Targeted research and interventions to minimise evidence-treatment gaps in this cohort may significantly reduce stroke burden.
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Affiliation(s)
- Stephen Bacchi
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rudy Goh
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Minh-Son To
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Andrew Moey
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Prashanthan Sanders
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Derek P Chew
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - David Schultz
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Pramesh Kovoor
- Westmead Private Hospital, Sydney, New South Wales, Australia
| | - Timothy Kleinig
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jim Jannes
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Tan S, Goh R, Ng JS, Tang C, Ng C, Kovoor J, Stretton B, Gupta A, Ovenden C, Courtney MR, Neal A, Whitham E, Frasca J, Kiley M, Abou‐Hamden A, Bacchi S. Identifying epilepsy surgery referral candidates with natural language processing in an Australian context. Epilepsia Open 2024; 9:635-642. [PMID: 38261415 PMCID: PMC10984289 DOI: 10.1002/epi4.12901] [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] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/02/2023] [Accepted: 12/24/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE Epilepsy surgery is known to be underutilized. Machine learning-natural language processing (ML-NLP) may be able to assist with identifying patients suitable for referral for epilepsy surgery evaluation. METHODS Data were collected from two tertiary hospitals for patients seen in neurology outpatients for whom the diagnosis of "epilepsy" was mentioned. Individual case note review was undertaken to characterize the nature of the diagnoses discussed in these notes, and whether those with epilepsy fulfilled prespecified criteria for epilepsy surgery workup (namely focal drug refractory epilepsy without contraindications). ML-NLP algorithms were then developed using fivefold cross-validation on the first free-text clinic note for each patient to identify these criteria. RESULTS There were 457 notes included in the study, of which 250 patients had epilepsy. There were 37 (14.8%) individuals who fulfilled the prespecified criteria for epilepsy surgery referral without described contraindications, 32 (12.8%) of whom were not referred for epilepsy surgical evaluation in the given clinic visit. In the prediction of suitability for epilepsy surgery workup using the prespecified criteria, the tested models performed similarly. For example, the random forest model returned an area under the receiver operator characteristic curve of 0.97 (95% confidence interval 0.93-1.0) for this task, sensitivity of 1.0, and specificity of 0.93. SIGNIFICANCE This study has shown that there are patients in tertiary hospitals in South Australia who fulfill prespecified criteria for epilepsy surgery evaluation who may not have been referred for such evaluation. ML-NLP may assist with the identification of patients suitable for such referral. PLAIN LANGUAGE SUMMARY Epilepsy surgery is a beneficial treatment for selected individuals with drug-resistant epilepsy. However, it is vastly underutilized. One reason for this underutilization is a lack of prompt referral of possible epilepsy surgery candidates to comprehensive epilepsy centers. Natural language processing, coupled with machine learning, may be able to identify possible epilepsy surgery candidates through the analysis of unstructured clinic notes. This study, conducted in two tertiary hospitals in South Australia, demonstrated that there are individuals who fulfill criteria for epilepsy surgery evaluation referral but have not yet been referred. Machine learning-natural language processing demonstrates promising results in assisting with the identification of such suitable candidates in Australia.
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Affiliation(s)
- Sheryn Tan
- University of AdelaideAdelaideSouth AustraliaAustralia
| | - Rudy Goh
- University of AdelaideAdelaideSouth AustraliaAustralia
- Royal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Jeng Swen Ng
- University of AdelaideAdelaideSouth AustraliaAustralia
| | - Charis Tang
- University of AdelaideAdelaideSouth AustraliaAustralia
| | - Cleo Ng
- University of AdelaideAdelaideSouth AustraliaAustralia
| | - Joshua Kovoor
- University of AdelaideAdelaideSouth AustraliaAustralia
- Royal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Brandon Stretton
- University of AdelaideAdelaideSouth AustraliaAustralia
- Royal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Aashray Gupta
- University of AdelaideAdelaideSouth AustraliaAustralia
- Gold Coast University HospitalSouthportQueenslandAustralia
| | - Christopher Ovenden
- University of AdelaideAdelaideSouth AustraliaAustralia
- Royal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | | | | | - Emma Whitham
- Flinders University and Medical CentreBedford ParkSouth AustraliaAustralia
| | - Joseph Frasca
- Flinders University and Medical CentreBedford ParkSouth AustraliaAustralia
| | - Michelle Kiley
- University of AdelaideAdelaideSouth AustraliaAustralia
- Royal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Amal Abou‐Hamden
- University of AdelaideAdelaideSouth AustraliaAustralia
- Royal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Stephen Bacchi
- University of AdelaideAdelaideSouth AustraliaAustralia
- Royal Adelaide HospitalAdelaideSouth AustraliaAustralia
- Flinders University and Medical CentreBedford ParkSouth AustraliaAustralia
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Mayooran N, Sherif A, Koulouroudias M, Gnanalingham S, Ahmed Saleh WU, Tan S, Boulemden A, Szafranek A. Surgical resection of primary intracardiac sarcomas and outcomes: A review of case reports over 20 years. Indian J Thorac Cardiovasc Surg 2024; 40:213-218. [PMID: 38389783 PMCID: PMC10879044 DOI: 10.1007/s12055-023-01618-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 02/24/2024] Open
Abstract
Objective A quarter of all cardiac tumors are malignant, and most (~ 95%) are sarcomas. It is the most aggressive malignant cardiac tumor carrying the worst prognosis. Tumor involvement with the vital intracardiac structures makes it difficult for complete surgical resection. We aimed to study the role of complete surgical resection and its importance in long-term outcomes. Methods We analyzed published literature from 2002 to 2022 using PubMed. Cases reported adult, intracardiac sarcomas, and received surgical resections were included. We reviewed 132 published case reports, including and analyzed the following variables: demographics, clinical presentations, diagnostic imaging modality, the extent of surgical resection, pathological diagnosis, tumor location, postoperative chemo-radiation therapy, and follow-up (including re-operation, local and distant recurrence). Results A total of 135 patients are included from 132 articles. The mean age was 46.69 (18-86) and 76 patients were females. The main complaints were dyspnea (70%) and chest pain (32%). Performed investigations were transthoracic echocardiography (TTE) in 114/135 (84%), computer tomography (CT) scan 89/135 (66%), trans-esophageal echocardiography (TOE) 22%, and cardiac magnetic resonance imaging (MRI) 29%. The most common location was the atrium (left 46%, right 30%). Complete surgical resection was performed in 91 cases (67%), and frozen section was performed in 62 patients (43 positives). Incomplete resections were in 42 cases. Patients who underwent complete surgical resection had mean survival of 14.58 months and median of 10.5 months, compared to incomplete resection patients with 9.12 months and 6.5 months respectively. Conclusion Our review shows complete surgical resection results in better short- and long-term outcomes in intracardiac sarcoma patients. Furthermore, combining chemo-radiotherapy has additional benefits towards long-term survival.
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Affiliation(s)
- Nithiananthan Mayooran
- Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham University Hospital, Nottingham, UK
- Nottingham University Hospital, Nottingham, UK
| | - A. Sherif
- Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham University Hospital, Nottingham, UK
| | - M. Koulouroudias
- Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham University Hospital, Nottingham, UK
| | | | - W. U. Ahmed Saleh
- Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham University Hospital, Nottingham, UK
| | - S. Tan
- Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham University Hospital, Nottingham, UK
| | - A. Boulemden
- Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham University Hospital, Nottingham, UK
| | - A. Szafranek
- Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham University Hospital, Nottingham, UK
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Bacchi S, Tan S, Stretton B, Kovoor J, Gupta A, McNeil K, Crawford G. Illusion of control recognition may promote early palliative care engagement. Intern Med J 2024; 54:523-524. [PMID: 38475963 DOI: 10.1111/imj.16352] [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] [Received: 01/05/2024] [Accepted: 01/30/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Stephen Bacchi
- Flinders University, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide, South Australia, Australia
| | - Brandon Stretton
- Flinders University, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Joshua Kovoor
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Aashray Gupta
- University of Adelaide, Adelaide, South Australia, Australia
| | - Keith McNeil
- Commission on Excellence and Innovation in Health, Adelaide, South Australia, Australia
| | - Gregory Crawford
- University of Adelaide, Adelaide, South Australia, Australia
- Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
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Tan S, Vuong A, Kovoor J, Gupta A, Chan W, Umapathysivam M, Wong B, Gluck S, Gilbert T, Bacchi S. Beware of little expenses: Low-value endocrinological blood tests in geriatric medical inpatients. Australas J Ageing 2024; 43:211-214. [PMID: 37431697 DOI: 10.1111/ajag.13226] [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: 02/05/2023] [Revised: 06/02/2023] [Accepted: 06/21/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVES Blood tests for endocrinological derangements are frequently requested in general medical inpatients, in particular those in the older age group. Interrogation of these tests may present opportunities for healthcare savings. METHODS This multicentre retrospective study over a 2.5-year period examined the frequency with which three common endocrinological investigations [thyroid stimulating hormone (TSH), HbA1c, 25-hydroxy Vitamin D3] were performed in this population, including the frequency of duplicate tests within a given admission, and the frequency of abnormal test results. The Medicare Benefits Schedule was used to calculate the cost associated with these tests. RESULTS There were 28,564 individual admissions included in the study. Individuals ≥65 years old were the majority of inpatients in whom the selected tests were performed (80% of tests). TSH was performed in 6730 admissions, HbA1c was performed in 2259 admissions, and vitamin D levels were performed in 5632 admissions. There were 6114 vitamin D tests performed during the study period, of which 2911 (48%) returned outside the normal range. The cost associated with vitamin D level testing was $183,726. Over the study period, 8% of tests for TSH, HbA1c, and Vitamin D were duplicates (where a second test was performed within a single admission), which was associated with a cost of $32,134. CONCLUSIONS Tests for common endocrinological abnormalities are associated with significant healthcare costs. Avenues by which future savings may be pursued include the investigation of strategies to reduce duplicate ordering and examining the rationale and guidelines associated with ordering tests such as vitamin D levels.
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Affiliation(s)
- Sheryn Tan
- University of Adelaide, Adelaide, South Australia, Australia
| | - Alysha Vuong
- Flinders University, Bedford Park, South Australia, Australia
| | - Joshua Kovoor
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Aashray Gupta
- University of Adelaide, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - WengOnn Chan
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Mahesh Umapathysivam
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Bianca Wong
- Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Samuel Gluck
- University of Adelaide, Adelaide, South Australia, Australia
- Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Toby Gilbert
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- University of Adelaide, Adelaide, South Australia, Australia
- Flinders University, Bedford Park, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Yulia DE, Tan S. Intraocular pressure measurements in paediatric glaucoma: A narrative review on accuracy, tolerability, and ease of use. Med J Malaysia 2024; 79:206-211. [PMID: 38553928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Numerous tonometers are available to measure intraocular pressure (IOP) in children with glaucoma. This review aims to discuss IOP measurement techniques and principles and compare the accuracy, tolerability and ease of use of available tonometers in measuring IOP in paediatric glaucoma patients. MATERIALS AND METHODS A review of observational studies was conducted to discuss the accuracy, tolerability and ease of use of tonometers in measuring IOP in children with glaucoma. RESULTS Goldmann applanation tonometry (GAT) and its portable handheld versions remain the gold standard in measuring IOP. Tono-Pen (Reichert Ophthalmic Instruments, Depew, New York, USA) and rebound tonometer (RBT) both correlate well with GAT. Although both tonometers tend to overestimate IOP, Tono-Pen overestimates more than RBT. Overestimation is more remarkable in higher IOP and corneal pathologies (such as but not limited to scarred cornea and denser corneal opacity). RBT was better tolerated than other tonometers in children and was easier to use in children of all ages. CONCLUSIONS RBT is the preferred tonometer for measuring IOP in children with glaucoma, as it is less traumatic, time efficient and does not require fluorescein dye or anaesthesia. However, examiners should use a second tonometer to confirm elevated IOP readings from the RBT.
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Affiliation(s)
- D E Yulia
- Universitas Indonesia, Cipto Mangunkusumo National Central General Hospital, Faculty of Medicine, Department of Ophthalmology, Jakarta, Indonesia.
| | - S Tan
- Universitas Indonesia, Faculty of Medicine, Jakarta, Indonesia
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Stretton B, Koovor JG, Hains L, Kleinig O, Tan S, Gupta AK, Ittimani M, Dwyer A, McNeil K, Chan W, Cusack M, O'Callaghan PG, Maddison J, Bacchi S. How will the artificial intelligence algorithm work within the constraints of this healthcare system? Intern Med J 2024; 54:190-191. [PMID: 38267379 DOI: 10.1111/imj.16308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 11/30/2023] [Indexed: 01/26/2024]
Affiliation(s)
- Brandon Stretton
- SA Health, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Joshua G Koovor
- SA Health, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Lewis Hains
- University of Adelaide, Adelaide, South Australia, Australia
| | - Oliver Kleinig
- University of Adelaide, Adelaide, South Australia, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
| | - Mana Ittimani
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Andrew Dwyer
- SA Health, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Keith McNeil
- Commission on Excellence and Innovation in Health, Adelaide, South Australia, Australia
| | - WengOnn Chan
- SA Health, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | | | - Patrick G O'Callaghan
- SA Health, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - John Maddison
- SA Health, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- SA Health, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Flinders University, Adelaide, South Australia, Australia
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Gounou C, Rouyer L, Siegfried G, Harté E, Bouvet F, d'Agata L, Darbo E, Lefeuvre M, Derieppe MA, Bouton L, Mélane M, Chapeau D, Martineau J, Prouzet-Mauleon V, Tan S, Souleyreau W, Saltel F, Argoul F, Khatib AM, Brisson AR, Iggo R, Bouter A. Inhibition of the membrane repair protein annexin-A2 prevents tumor invasion and metastasis. Cell Mol Life Sci 2023; 81:7. [PMID: 38092984 PMCID: PMC10719157 DOI: 10.1007/s00018-023-05049-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 12/17/2023]
Abstract
Cancer cells are exposed to major compressive and shearing forces during invasion and metastasis, leading to extensive plasma membrane damage. To survive this mechanical stress, they need to repair membrane injury efficiently. Targeting the membrane repair machinery is thus potentially a new way to prevent invasion and metastasis. We show here that annexin-A2 (ANXA2) is required for membrane repair in invasive breast and pancreatic cancer cells. Mechanistically, we show by fluorescence and electron microscopy that cells fail to reseal shear-stress damaged membrane when ANXA2 is silenced or the protein is inhibited with neutralizing antibody. Silencing of ANXA2 has no effect on proliferation in vitro, and may even accelerate migration in wound healing assays, but reduces tumor cell dissemination in both mice and zebrafish. We expect that inhibiting membrane repair will be particularly effective in aggressive, poor prognosis tumors because they rely on the membrane repair machinery to survive membrane damage during tumor invasion and metastasis. This could be achieved either with anti-ANXA2 antibodies, which have been shown to inhibit metastasis of breast and pancreatic cancer cells, or with small molecule drugs.
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Affiliation(s)
- C Gounou
- CNRS, Bordeaux INP, CBMN, UMR 5248, University of Bordeaux, Bât. B14, Allée Geoffroy Saint Hilaire, 33600, Pessac, France
| | - L Rouyer
- INSERM, BRIC, U 1312, University of Bordeaux, 33000, Bordeaux, France
| | - G Siegfried
- INSERM, BRIC, U 1312, University of Bordeaux, 33000, Bordeaux, France
- XenoFish, B2 Ouest, Allée Geoffroy St Hilaire CS50023, 33615, Pessac, France
| | - E Harté
- CNRS, LOMA, UMR 5798, University of Bordeaux, 33400, Talence, France
| | - F Bouvet
- CNRS, Bordeaux INP, CBMN, UMR 5248, University of Bordeaux, Bât. B14, Allée Geoffroy Saint Hilaire, 33600, Pessac, France
| | - L d'Agata
- CNRS, Bordeaux INP, CBMN, UMR 5248, University of Bordeaux, Bât. B14, Allée Geoffroy Saint Hilaire, 33600, Pessac, France
| | - E Darbo
- INSERM, BRIC, U 1312, University of Bordeaux, 33000, Bordeaux, France
| | - M Lefeuvre
- CNRS, Bordeaux INP, CBMN, UMR 5248, University of Bordeaux, Bât. B14, Allée Geoffroy Saint Hilaire, 33600, Pessac, France
| | - M A Derieppe
- Animalerie Mutualisée, Service Commun des Animaleries, University of Bordeaux, 33000, Bordeaux, France
| | - L Bouton
- INSERM, BRIC, U 1312, University of Bordeaux, 33000, Bordeaux, France
| | - M Mélane
- CNRS, LOMA, UMR 5798, University of Bordeaux, 33400, Talence, France
| | - D Chapeau
- CNRS, Bordeaux INP, CBMN, UMR 5248, University of Bordeaux, Bât. B14, Allée Geoffroy Saint Hilaire, 33600, Pessac, France
| | - J Martineau
- Animalerie Mutualisée, Service Commun des Animaleries, University of Bordeaux, 33000, Bordeaux, France
| | - V Prouzet-Mauleon
- INSERM, BRIC, U 1312, University of Bordeaux, 33000, Bordeaux, France
- CRISPRedit, TBMcore, UAR CNRS 3427, Inserm US 005, University of Bordeaux, Bordeaux, France
| | - S Tan
- CNRS, Bordeaux INP, CBMN, UMR 5248, University of Bordeaux, Bât. B14, Allée Geoffroy Saint Hilaire, 33600, Pessac, France
| | - W Souleyreau
- INSERM, BRIC, U 1312, University of Bordeaux, 33000, Bordeaux, France
| | - F Saltel
- INSERM, BRIC, U 1312, University of Bordeaux, 33000, Bordeaux, France
| | - F Argoul
- CNRS, LOMA, UMR 5798, University of Bordeaux, 33400, Talence, France
| | - A M Khatib
- INSERM, BRIC, U 1312, University of Bordeaux, 33000, Bordeaux, France
- XenoFish, B2 Ouest, Allée Geoffroy St Hilaire CS50023, 33615, Pessac, France
- Bergonié Institute, Bordeaux, France
| | - A R Brisson
- CNRS, Bordeaux INP, CBMN, UMR 5248, University of Bordeaux, Bât. B14, Allée Geoffroy Saint Hilaire, 33600, Pessac, France
| | - R Iggo
- INSERM, BRIC, U 1312, University of Bordeaux, 33000, Bordeaux, France
| | - A Bouter
- CNRS, Bordeaux INP, CBMN, UMR 5248, University of Bordeaux, Bât. B14, Allée Geoffroy Saint Hilaire, 33600, Pessac, France.
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14
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Tan S, Machrumnizar M. Fish and Food-Fatale: Food-borne Trematode Opisthorchis viverrini and Cholangiocarcinoma. Helminthologia 2023; 60:287-299. [PMID: 38222491 PMCID: PMC10787637 DOI: 10.2478/helm-2023-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/20/2023] [Indexed: 01/16/2024] Open
Abstract
Neglected Tropical Diseases (NTDs) are a group of communicable diseases with a long history with human beings. NTDs are the proxy of poverty since they affect those in low-income and extreme-poverty populations, as those populations lack access to proper health care, clean water, sanitary conditions, and hygiene. NTDs create losses for a nation that come from the health and the economic sectors as well since the costs of diagnosis, prevention, and treatment strain the national purse strings. One of the 20 different forms of NTDs on the list is food-borne trematodes, comprises of Fasciola, Paragonimus, Clonorchis, and Opisthorchis. Currently, it is estimated that food-borne trematodes can cause a devastating effect on mortality and morbidity. All of them are zoonotic, as humans become infected by ingestion of a second intermediate host, such as freshwater snails, fish, or water vegetables. Opisthorchis viverrini, one of the food-borne trematodes that can be found mostly in South East Asia regions, especially in the Mekong basin, is regarded as a group 1 carcinogen leading to cholangiocarcinoma (CCA). This study aims to present the updated review of Opisthorchis viverrini and CCA.
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Affiliation(s)
- S. Tan
- Department of Parasitology, Faculty of Medicine, Universitas Trisakti, Jakarta11440, Indonesia
- Tropical Diseases and Public Health Research Centre, Faculty of Medicine, Universitas Trisakti, Jakarta11440, Indonesia
| | - M. Machrumnizar
- Department of Parasitology, Faculty of Medicine, Universitas Trisakti, Jakarta11440, Indonesia
- Tropical Diseases and Public Health Research Centre, Faculty of Medicine, Universitas Trisakti, Jakarta11440, Indonesia
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15
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Stretton B, Jiang M, Kovoor J, Inglis JM, Lam L, Tan S, Yuson C, Smith W, Shakib S, Bacchi S. Artificial intelligence-enabled penicillin allergy delabelling: an implementation study. Intern Med J 2023; 53:2119-2122. [PMID: 37997266 DOI: 10.1111/imj.16266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/18/2023] [Indexed: 11/25/2023]
Abstract
Inaccurate penicillin allergy labels may be delabelled following evaluation. The intervention in this study was an email-based notification system regarding the appropriateness for penicillin allergy evaluation, with a view to delabelling, as identified by a deep learning artificial intelligence algorithm. Of the intervention group (n = 59), three (5.1%) individuals had their penicillin allergies delabelled, which was significantly more than the control group (0%, P = 0.002). Further research to optimise such approaches is required.
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Affiliation(s)
- Brandon Stretton
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Melinda Jiang
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Joshua Kovoor
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Joshua M Inglis
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Lydia Lam
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Sheryn Tan
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Chino Yuson
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - William Smith
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Sepehr Shakib
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
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Tan S, Goh R, Burton E, Bacchi S, Slee M. Cerebrospinal fluid protein: what is a normal reference range? Intern Med J 2023; 53:2147. [PMID: 37997268 DOI: 10.1111/imj.16268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 09/13/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Sheryn Tan
- University of Adelaide, Adelaide, South Australia, Australia
| | - Rudy Goh
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Emily Burton
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Department of Neurology, Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Department of Neurology, Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Mark Slee
- Department of Neurology, Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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17
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Tan S, Stretton B, Lee YM, Gupta A, Kovoor J, Bacchi S. More time per patient or more patients per unit time? Emerg Med Australas 2023; 35:885-886. [PMID: 37580089 DOI: 10.1111/1742-6723.14295] [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] [Received: 07/30/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Sheryn Tan
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Brandon Stretton
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Yong Min Lee
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Aashray Gupta
- The University of Adelaide, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Joshua Kovoor
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Flinders University, Adelaide, South Australia, Australia
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18
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Tan S, Tran V, Stretton B, Gupta A, Kovoor J, Bacchi S. The Final Frontier: Palliative Care in Space is an Inevitability. J Palliat Care 2023; 38:405-406. [PMID: 36846866 PMCID: PMC10566210 DOI: 10.1177/08258597231159839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
As space exploration becomes increasingly common, palliative care for astronauts will require greater consideration. All aspects of palliative care need to be specifically adapted for astronauts. For example, addressing additional circumstances such as inability to see loved ones from Earth will be an important part of meeting their psychological and spiritual needs. A different approach to pharmacological management of end-of-life symptoms is also warranted due to changes in human physiology and pharmacokinetics in space.
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Affiliation(s)
- Sheryn Tan
- The University of Adelaide, Adelaide Medical School, Adelaide, SA, Australia
| | - Vienna Tran
- The University of Adelaide, Adelaide Medical School, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Brandon Stretton
- The University of Adelaide, Adelaide Medical School, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Aashray Gupta
- The University of Adelaide, Adelaide Medical School, Adelaide, SA, Australia
| | - Joshua Kovoor
- The University of Adelaide, Adelaide Medical School, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Stephen Bacchi
- The University of Adelaide, Adelaide Medical School, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Flinders University, Bedford Park, SA, Australia
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19
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Wiseman TJ, Tan S, Stretton B, Kovoor J, Gupta A, Fabian J, Chan WO, Malycha J, Gluck S, Gilbert T, Zannettino AC, Bacchi S. Double or nothing: Costs of duplicate haematinic ordering in medical inpatients. Transfus Med 2023; 33:423-425. [PMID: 37385797 DOI: 10.1111/tme.12984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/02/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Affiliation(s)
| | - Sheryn Tan
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Brandon Stretton
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Joshua Kovoor
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Aashray Gupta
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Jack Fabian
- General Medicine, Ophthalmology, Neurology, Critical Care, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Weng Onn Chan
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- General Medicine, Ophthalmology, Neurology, Critical Care, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - James Malycha
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- General Medicine, Ophthalmology, Neurology, Critical Care, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Samuel Gluck
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Medical Education, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Toby Gilbert
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Andrew C Zannettino
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
- College of Medicine, Flinders University, Bedford Park, South Australia, Australia
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Lam L, Koopowitz S, Thompson A, Smith G, Tan S, Gupta A, Kovoor J, Harroud A, Bacchi S, Slee M. A systematic review of the symptomatic management of Lhermitte's phenomenon. J Clin Neurosci 2023; 116:32-36. [PMID: 37603922 DOI: 10.1016/j.jocn.2023.08.017] [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] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/20/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Lhermitte's phenomenon (LP) is a transient shock-like sensation that radiates down the spine into the extremities, usually with neck flexion. The potential efficacy and tolerability of various symptomatic therapies in the management of LP have not been systematically reviewed previously. METHOD A systematic review was conducted using PubMed, EMBASE, and the Cochrane Library from inception to August 2022 for peer-reviewed articles describing the treatment of patients with Lhermitte's phenomenon. The review adheres to the PRISMA guidelines and was registered on PROSPERO. RESULTS This systematic review included sixty-six articles, which included 450 patients with LP. Treatment of the underlying cause varied by aetiology. Whilst LP is most commonly considered in the context of structural pathology of the cervical cord, medication-induced LP was a common theme in the literature. The most common cause of medication-induced LP was platinum-based chemotherapy agents such as cisplatin and oxaliplatin. In medication-induced LP, symptoms typically resolved with cessation of the causative agent. Non-pharmacological treatment options were associated with mild-moderate symptomatic improvement. The most commonly used agents to treat patients with LP were carbamazepine and gabapentin, which resulted in variable degrees of symptomatic benefit. CONCLUSIONS No randomised studies currently exist to support the use of symptomatic therapies to treat LP. Observational data suggest that some therapies may yield a symptomatic benefit in the management of LP. However, this systematic review identified a significant paucity of evidence in the literature, which suggests that further controlled studies are needed to investigate the optimal management of this common neurologic phenomenon.
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Affiliation(s)
- Lydia Lam
- Royal Adelaide Hospital, Adelaide, SA 5000, Australia; University of Adelaide, Adelaide, SA 5005, Australia.
| | | | | | - Georgia Smith
- Flinders University, Bedford Park, SA 5042, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide, SA 5005, Australia
| | - Aashray Gupta
- University of Adelaide, Adelaide, SA 5005, Australia
| | - Joshua Kovoor
- Royal Adelaide Hospital, Adelaide, SA 5000, Australia; University of Adelaide, Adelaide, SA 5005, Australia
| | - Adil Harroud
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec H3A 0G4, Canada
| | - Stephen Bacchi
- Royal Adelaide Hospital, Adelaide, SA 5000, Australia; University of Adelaide, Adelaide, SA 5005, Australia; Flinders University, Bedford Park, SA 5042, Australia
| | - Mark Slee
- Flinders University, Bedford Park, SA 5042, Australia
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Tan S, Tang C, Ng JS, Ng C, Kovoor J, Gupta A, Goh R, Bacchi S, Jannes J, Kleinig T. Delays in the diagnosis of ischaemic stroke presenting with persistent reduced level of consciousness: A systematic review. J Clin Neurosci 2023; 115:14-19. [PMID: 37454440 DOI: 10.1016/j.jocn.2023.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 06/12/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Stroke presenting with a reduced level of consciousness (RLOC) may result in diagnostic error and/or delay. Missed or delayed diagnosis of acute ischaemic stroke may preclude otherwise applicable hyperacute stroke interventions. The frequency, reasons for, and consequences of diagnostic error and delay due to RLOC are uncertain. METHOD The databases PubMed, EMBASE, and Cochrane library were searched in adherence with the PRISMA guidelines. The systematic review was prospectively registered on PROSPERO. RESULTS Initial searches returned 1162 results, of which 6 fulfilled inclusion criteria. The majority of identified studies show that ischaemic stroke presenting with RLOC is at increased risk of missed or delayed diagnosis. Hyperacute stroke interventions may also be delayed. There is limited evidence regarding the reason for these delays; however, the delays may result from neuroimaging delay associated with diagnostic uncertainty. There is also limited evidence regarding the outcomes of patients with stroke and RLOC who experience diagnostic delay; however, the available literature suggests that outcomes may be poor, including motor and cognitive impairment, as well as long-term impaired consciousness. The included studies did not evaluate, but have suggested urgent MRI access, educational interventions, and protocolisation of the evaluation of RLOC as means to reduce poor outcomes. CONCLUSIONS Ischaemic stroke patients with RLOC are at risk of diagnostic delay and error. These patients may have poor outcomes. Additional research is required to identify the contributing factors more clearly and to provide amelioration strategies.
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Affiliation(s)
- Sheryn Tan
- University of Adelaide, Adelaide, SA 5005, Australia.
| | - Charis Tang
- University of Adelaide, Adelaide, SA 5005, Australia
| | - Jeng Swen Ng
- University of Adelaide, Adelaide, SA 5005, Australia
| | - Cleo Ng
- University of Adelaide, Adelaide, SA 5005, Australia
| | - Joshua Kovoor
- University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Aashray Gupta
- University of Adelaide, Adelaide, SA 5005, Australia; Gold Coast University Hospital, Southport, QLD 4215, Australia
| | - Rudy Goh
- University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia; Lyell McEwin Hospital, Elizabeth Vale, SA 5112, Australia
| | - Stephen Bacchi
- University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia; Flinders University, Bedford Park, SA 5042, Australia
| | - Jim Jannes
- University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Timothy Kleinig
- University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia
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22
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Lam A, Squires E, Tan S, Swen NJ, Barilla A, Kovoor J, Gupta A, Bacchi S, Khurana S. Artificial intelligence for predicting acute appendicitis: a systematic review. ANZ J Surg 2023; 93:2070-2078. [PMID: 37458222 DOI: 10.1111/ans.18610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/06/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Paediatric appendicitis may be challenging to diagnose, and outcomes difficult to predict. While diagnostic and prognostic scores exist, artificial intelligence (AI) may be able to assist with these tasks. METHOD A systematic review was conducted aiming to evaluate the currently available evidence regarding the use of AI in the diagnosis and prognostication of paediatric appendicitis. In accordance with the PRISMA guidelines, the databases PubMed, EMBASE, and Cochrane Library were searched. This review was prospectively registered on PROSPERO. RESULTS Ten studies met inclusion criteria. All studies described the derivation and validation of AI models, and none described evaluation of the implementation of these models. Commonly used input parameters included varying combinations of demographic, clinical, laboratory, and imaging characteristics. While multiple studies used histopathological examination as the ground truth for a diagnosis of appendicitis, less robust techniques, such as the use of ICD10 codes, were also employed. Commonly used algorithms have included random forest models and artificial neural networks. High levels of model performance have been described for diagnosis of appendicitis and, to a lesser extent, subtypes of appendicitis (such as complicated versus uncomplicated appendicitis). Most studies did not provide all measures of model performance required to assess clinical usability. CONCLUSIONS The available evidence suggests the creation of prediction models for diagnosis and classification of appendicitis using AI techniques, is being increasingly explored. However, further implementation studies are required to demonstrate benefit in system or patient-centred outcomes with model deployment and to progress these models to the stage of clinical usability.
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Affiliation(s)
- Antoinette Lam
- University of Adelaide, Adelaide, South Australia, Australia
| | - Emily Squires
- Flinders University, Adelaide, South Australia, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide, South Australia, Australia
| | - Ng Jeng Swen
- University of Adelaide, Adelaide, South Australia, Australia
| | | | - Joshua Kovoor
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Aashray Gupta
- University of Adelaide, Adelaide, South Australia, Australia
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- University of Adelaide, Adelaide, South Australia, Australia
- Flinders University, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sanjeev Khurana
- University of Adelaide, Adelaide, South Australia, Australia
- Women's and Children's Hospital, Adelaide, South Australia, Australia
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Bacchi S, Tan S, Slee M. Toward a common clinical lexicon of consciousness. Intern Emerg Med 2023; 18:1851-1853. [PMID: 37422543 PMCID: PMC10504159 DOI: 10.1007/s11739-023-03359-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Stephen Bacchi
- Department of Neurology, Flinders Medical Centre, SA Health, Flinders Drive, Bedford Park, SA, 5042, Australia.
- College of Medicine and Public Health, Flinders University of South, Adelaide, Australia.
- University of Adelaide, Adelaide, SA, 5000, Australia.
| | - Sheryn Tan
- University of Adelaide, Adelaide, SA, 5000, Australia
| | - Mark Slee
- Department of Neurology, Flinders Medical Centre, SA Health, Flinders Drive, Bedford Park, SA, 5042, Australia
- College of Medicine and Public Health, Flinders University of South, Adelaide, Australia
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Oymaci E, Kahramansoy N, Tan S, Aydogan S, Yildirim M. The diagnostic role of preoperative blood tests in complicated appendicitis: A feasible approach to surgical decision. Niger J Clin Pract 2023; 26:1005-1010. [PMID: 37635587 DOI: 10.4103/njcp.njcp_906_22] [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] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Background An accurate diagnosis and timely surgical intervention have significant importance in noncomplicated appendicitis (NCA) and complicated appendicitis (CA). Therefore, any factor that helps in the prediction of CA also contributes to suitable treatment options. Aim This retrospective study aimed to identify any relationship between acute appendicitis (AA) and preoperative blood test levels and whether these parameters can differentiate between NCA and CA patients. Patients and Methods A database of 201 appendectomies and 100 control healthy patients was analyzed between 2019 and 2022. Patients were divided into three groups: NCA without peritonitis or phlegmonous appendicitis as group 1; CA with perforated, necrotizing appendicitis with peritonitis as group 2; and the healthy control group (CG) as group 3. White blood cell (WBC), platelet distribution width (PDW), mean platelet volume (MPV), red cell distribution width (RDW), creatine kinase (CK), and bilirubin levels were collected from the patients and compared statistically between the groups. Results Age, WBC, and PDW levels were set as predictive in the differential diagnosis of CA as a result of receiver operating characteristic (ROC) analysis. The multivariate analysis demonstrated that age (OR: 1.023; 95% CI: 1.000-1.045; P = 0.04), male sex (OR: 3.718; 95% CI: 1.501-9.213; P = 0.005), WBC levels (OR: 1.000; 95% CI: 1.000-1.000; P = 0.002), and PDW levels (OR: 2.129; 95% CI: 1.301-3.484; P = 0.003) were independently associated with CA. Conclusion Age, higher WBC count, and PDW levels are valuable in differentiating the diagnosis of CA from NCA, and this could be a feasible approach for surgical decisions.
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Affiliation(s)
- E Oymaci
- Department of General Surgery, Health Sciences University, Izmir Bozyaka Education and Research Hospital, Turkey
| | - N Kahramansoy
- Department of General Surgery, Health Sciences University, Izmir Bozyaka Education and Research Hospital, Turkey
| | - S Tan
- Department of General Surgery, Health Sciences University, Izmir Bozyaka Education and Research Hospital, Turkey
| | - S Aydogan
- Department of General Surgery, Health Sciences University, Izmir Bozyaka Education and Research Hospital, Turkey
| | - M Yildirim
- Department of General Surgery, Health Sciences University, Izmir Bozyaka Education and Research Hospital, Turkey
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25
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Bacchi S, Kovoor J, Gupta A, Tan S, Sherbon T, Bersten A, O'Callaghan PG, Chan WO. Improving health care efficiency one click at a time. Intern Med J 2023; 53:1261-1264. [PMID: 37401652 DOI: 10.1111/imj.16160] [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] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/24/2023] [Indexed: 07/05/2023]
Abstract
Computers are an integral component of modern hospitals. Mouse clicks are currently inherent to this use of computers. However, mouse clicks are not instantaneous. These clicks may be associated with significant costs. Estimated costs associated with 10 additional clicks per day for 20 000 staff exceed AU$500 000 annually. Workflow modifications that increase clicks should weigh the potential benefits of such changes against these costs. Future investigation of strategies to reduce low-value clicks may provide an avenue for health care savings.
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Affiliation(s)
- Stephen Bacchi
- Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Joshua Kovoor
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Aashray Gupta
- University of Adelaide, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide, South Australia, Australia
| | - Tony Sherbon
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Andrew Bersten
- Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Patrick G O'Callaghan
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Weng O Chan
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Gupta AK, Kleinig O, Tan S, Nagarathinam B, Kovoor JG, Bacchi S, Zaka A, He C, Stroebel A, Beltrame JF, Vallely MP, Bennetts JS, Maddern GJ. Lost in Translation: The Impact of Language Barriers on the Outcomes of Patients Receiving Coronary Artery Revascularization. Cardiovasc Revasc Med 2023; 52:94-98. [PMID: 36990850 DOI: 10.1016/j.carrev.2023.03.016] [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] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 03/28/2023]
Abstract
INTRODUCTION Clear and effective communication is vital in discussions regarding coronary revascularization. Language barriers may limit communication in healthcare settings. Previous studies on the influence of language barriers on the outcomes of patients receiving coronary revascularization have produced conflicting results. The aim of this systematic review was to evaluate and synthesise the existing evidence regarding the effects of language barrier on the outcomes of patients receiving coronary revascularization. METHODS A systematic review was conducted, including a search of the PubMed, EMBASE, Cochrane, and Google Scholar databases on 01/10/2022. The review was conducted in accordance with PRISMA guidelines. This review was also prospectively registered on PROSPERO. RESULTS Searches identified 3983 articles of which a total 12 studies were included in the review. Most studies describe that language barriers result in delayed presentation, but not delays in treatment following hospital arrival with respect to coronary revascularization. The findings with respect to the likelihood of receiving revascularization have varied significantly; however, some studies have indicated that those with language barriers may be less likely to receive revascularization. There have been some conflicting results with respect to the association between language barrier and mortality. However, most studies suggest that there is no association with increased mortality. In studies that evaluated length of stay variable results have been reported based on geographical location. Namely Australian studies have suggested no association between language barrier and length of stay, but Canadian studies support an association. Language barriers may also be associated with readmissions following discharge, and major adverse cardiovascular and cerebrovascular events (MACCE). CONCLUSION This study demonstrates that patients with language barriers may have poorer outcomes from coronary revascularization. Future interventional studies will be required to consider the sociocultural context of patients with language barriers, and may be targeted at timepoints including prior to, during, or after hospitalisation for coronary revascularization. Further examination of the adverse health outcomes of those with language barriers in fields outside of coronary revascularization are required in view of the stark inequities identified in this field.
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Affiliation(s)
- Aashray K Gupta
- University of Adelaide, Adelaide, Australia; Gold Coast University Hospital, Southport, Australia.
| | | | - Sheryn Tan
- University of Adelaide, Adelaide, Australia
| | | | - Joshua G Kovoor
- University of Adelaide, Adelaide, Australia; Royal Adelaide Hospital, Adelaide, Australia
| | - Stephen Bacchi
- University of Adelaide, Adelaide, Australia; Flinders University, Adelaide, Australia; Royal Adelaide Hospital, Adelaide, Australia
| | - Ammar Zaka
- Gold Coast University Hospital, Southport, Australia
| | - Cheng He
- Gold Coast University Hospital, Southport, Australia
| | | | - John F Beltrame
- University of Adelaide, Adelaide, Australia; Royal Adelaide Hospital, Adelaide, Australia
| | | | - Jayme S Bennetts
- Flinders University, Adelaide, Australia; Flinders Medical Centre, Adelaide, Australia
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27
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Tan S, Tang C, Ng JS, Ng C, Kovoor JG, Gupta AK, Ovenden C, Goh R, Courtney MR, Neal A, Whitham E, Frasca J, Abou-Hamden A, Bacchi S. Identifying epilepsy surgery candidates with natural language processing: A systematic review. J Clin Neurosci 2023; 114:104-109. [PMID: 37354663 DOI: 10.1016/j.jocn.2023.06.010] [Citation(s) in RCA: 4] [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] [Received: 03/04/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Epilepsy surgery is an underutilised, efficacious management strategy for selected individuals with drug-resistant epilepsy. Natural language processing (NLP) may aid in the identification of patients who are suitable to undergo evaluation for epilepsy surgery. The feasibility of this approach is yet to be determined. METHOD In accordance with the PRISMA guidelines, a systematic review of the databases PubMed, EMBASE and Cochrane library was performed. This systematic review was prospectively registered on PROSPERO. RESULTS 6 studies fulfilled inclusion criteria. The majority of included studies reported on datasets from only a single centre, with one study utilising data from two centres and one study six centres. The most commonly employed algorithms were support vector machines (5/6), with only one study utilising NLP strategies such as random forest models and gradient boosted machines. However, the results are promising, with all studies demonstrating moderate to high levels of performance in the identification of patients who may be suitable to undergo epilepsy surgery evaluation. Furthermore, multiple studies demonstrated that NLP could identify such patients 1-2 years prior to the treating clinicians instigating referral. However, no studies were identified that have evaluated the influence of implementing such algorithms on healthcare systems or patient outcomes. CONCLUSIONS NLP is a promising approach to aid in the identification of patients that may be suitable to undergo epilepsy surgery evaluation. Further studies are required examining diverse datasets with additional analytical methodologies. Studies evaluating the impact of implementation of such algorithms would be beneficial.
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Affiliation(s)
- Sheryn Tan
- University of Adelaide, Adelaide, SA 5005, Australia.
| | - Charis Tang
- University of Adelaide, Adelaide, SA 5005, Australia
| | - Jeng Swen Ng
- University of Adelaide, Adelaide, SA 5005, Australia
| | - Cleo Ng
- University of Adelaide, Adelaide, SA 5005, Australia
| | - Joshua G Kovoor
- University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, SA 5005, Australia; Gold Coast University Hospital, Southport, QLD 4215, Australia
| | - Christopher Ovenden
- University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Rudy Goh
- University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Merran R Courtney
- Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; Alfred Health, Melbourne, VIC 3004, Australia; Royal Melbourne Hospital, Parkville, VIC 3050, Australia
| | - Andrew Neal
- Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; Alfred Health, Melbourne, VIC 3004, Australia; Royal Melbourne Hospital, Parkville, VIC 3050, Australia
| | - Emma Whitham
- Flinders University and Medical Centre, Bedford Park, SA 5042, Australia
| | - Joseph Frasca
- Flinders University and Medical Centre, Bedford Park, SA 5042, Australia
| | - Amal Abou-Hamden
- University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Stephen Bacchi
- University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia; Flinders University and Medical Centre, Bedford Park, SA 5042, Australia
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James J, Tan S, Stretton B, Kovoor JG, Gupta AK, Gluck S, Gilbert T, Sharma Y, Bacchi S. Why do we evaluate 30-day readmissions in general medicine? A historical perspective and contemporary data. Intern Med J 2023; 53:1070-1075. [PMID: 37278138 DOI: 10.1111/imj.16115] [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] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/11/2023] [Indexed: 06/07/2023]
Abstract
Reducing preventable readmissions is important to help manage current strains on healthcare systems. The metric of 30-day readmissions is commonly cited in discussions regarding this topic. While such thresholds have contemporary funding implications, the rationale for individual cut-off points is partially historical in nature. Through the examination of the basis for the analysis of 30-day readmissions, greater insight into the possible benefits and limitations of such a metric may be obtained.
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Affiliation(s)
- Jonathan James
- Flinders University, Adelaide, South Australia, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide, South Australia, Australia
| | - Brandon Stretton
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Samuel Gluck
- University of Adelaide, Adelaide, South Australia, Australia
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Toby Gilbert
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Yogesh Sharma
- Flinders University, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Flinders University, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Madike R, Muecke T, Dishnica N, Zhu L, Tan S, Kovoor J, Stretton B, Gupta A, Harroud A, Bersten A, Schultz D, Bacchi S. A vital parameter? Systematic review of spirometry in evaluation for intensive care unit admission and intubation and ventilation for Guillain-Barré syndrome. J Clin Neurosci 2023; 113:13-19. [PMID: 37146475 DOI: 10.1016/j.jocn.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/09/2023] [Accepted: 04/28/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Patients with Guillain-Barré syndrome (GBS) may require intensive care unit (ICU) admission for intubation and ventilation (I + V). The means to predict which patients will require I + V include spirometry measures. The aims of this study were to determine, for adult patients with GBS, how effectively different spirometry parameter thresholds predict the need for ICU admission and the requirement for I + V; and what effects these different parameter thresholds have on GBS patient outcomes. METHOD A systematic review was conducted of the databases PubMed, EMBASE, and Cochrane library in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The systematic review was registered prospectively on PROSPERO. RESULTS Initial searches returned 1011 results, of which 8 fulfilled inclusion criteria. All included studies were observational in nature. Multiple studies suggest that a vital capacity below 60% of predicted value on admission is associated with the need for eventual I + V. No included studies evaluated peak expiratory flow rate, or interventions with different thresholds for ICU or I + V. CONCLUSIONS There is a relationship between vital capacity and the need for I + V. However, there is limited evidence supporting specific thresholds for I + V. In addition to evaluating these factors, future research may evaluate the effect of different patient characteristics, including clinical presentation, weight, age, and respiratory comorbidities, on the effectiveness of spirometry parameters in the prediction of the need for I + V.
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Affiliation(s)
- Reema Madike
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia.
| | - Thomas Muecke
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia
| | - Noel Dishnica
- Health and Information, Adelaide SA 5000, Australia; Flinders University, Bedford Park SA 5042, Australia
| | - Linyi Zhu
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia
| | - Joshua Kovoor
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia; Royal Adelaide Hospital, Adelaide SA 5000, Australia
| | - Brandon Stretton
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia; Royal Adelaide Hospital, Adelaide SA 5000, Australia
| | - Aashray Gupta
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia; Gold Coast University Hospital, Southport QLD 4215, Australia
| | - Adil Harroud
- McGill University, Montreal, Quebec H3A 0G4, Canada
| | | | - David Schultz
- Flinders University, Bedford Park SA 5042, Australia
| | - Stephen Bacchi
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia; Flinders University, Bedford Park SA 5042, Australia; Royal Adelaide Hospital, Adelaide SA 5000, Australia
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Zheng V, Wee IJY, Abdullah HR, Tan S, Tan EKW, Seow-En I. Same-day discharge (SDD) vs standard enhanced recovery after surgery (ERAS) protocols for major colorectal surgery: a systematic review. Int J Colorectal Dis 2023; 38:110. [PMID: 37121985 PMCID: PMC10149457 DOI: 10.1007/s00384-023-04408-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Accepted: 04/10/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) programs are well-established, resulting in improved outcomes and shorter length of hospital stay (LOS). Same-day discharge (SDD), or "hyper-ERAS", is a natural progression of ERAS. This systematic review aims to compare the safety and efficacy of SDD against conventional ERAS in colorectal surgery. METHODS The protocol was prospectively registered in PROSPERO (394793). A systematic search was performed in major databases to identify relevant articles, and a narrative systematic review was performed. Primary outcomes were readmission rates and length of hospital stay (LOS). Secondary outcomes were operative time and blood loss, postoperative pain, morbidity, nausea or vomiting, and patient satisfaction. Risks of bias was assessed using the ROBINS-I tool. RESULTS Thirteen studies were included, with five single-arm and eight comparative studies, of which one was a randomised controlled trial. This comprised a total of 38,854 patients (SDD: 1622; ERAS: 37,232). Of the 1622 patients on the SDD pathway, 1590 patients (98%) were successfully discharged within 24 h of surgery. While most studies had an overall low risk of bias, there was considerable variability in inclusion criteria, types of surgery or anaesthesia, and discharge criteria. SDD resulted in a significantly reduced postoperative LOS, without increasing risk of 30-day readmission. Intraoperative blood loss and postoperative morbidity rates were comparable between both groups. Operative duration was shorter in the SDD group. Patient-reported satisfaction was high in the SDD cohort. CONCLUSION SDD protocols appear to be safe and feasible in selected patients undergoing major colorectal operations. Randomised controlled trials are necessary to further substantiate these findings.
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Affiliation(s)
- V Zheng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - I J Y Wee
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore
| | - H R Abdullah
- Department of Anaesthesiology, Singapore General Hospital, Singapore City, Singapore
| | - S Tan
- Department of Anaesthesiology, Singapore General Hospital, Singapore City, Singapore
| | - E K W Tan
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore
| | - I Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore.
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Peng N, Chen Y, Chen YG, Tan S, Yao WB, Li YX, Yu JQ, Xiao CZ. Amplification of a terahertz wave via stimulated Raman scattering. Opt Lett 2023; 48:2433-2436. [PMID: 37126291 DOI: 10.1364/ol.484033] [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] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Extremely strong terahertz (THz) waves are desperately demanded for investigating nonlinear physics, spectroscopy, and imaging in the THz range. However, traditional crystal-/semiconductor-based THz sources have limitations of reaching extremely high amplitude due to the damage threshold of devices. Here, by introducing Raman amplification to the THz range, we propose a novel, to the best of our knowledge, scheme to amplify THz waves in plasma. A long-pulse CO2 pump laser transfers its energy to a multicycle, 10-THz seed in a two-step plasma. By one-dimensional simulations, a 0.87-GV/m, 1.2-ps-duration THz seed is amplified to 10 GV/m in a 5.7-mm-long plasma with an amplification efficiency approaching 1%. The method provides a new technology to manipulate the intensity of THz waves.
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Dishnica N, Vuong A, Xiong L, Tan S, Kovoor J, Gupta A, Stretton B, Goh R, Harroud A, Schultz D, Malycha J, Bacchi S. Single count breath test for the evaluation of respiratory function in Myasthenia Gravis: A systematic review. J Clin Neurosci 2023; 112:58-63. [PMID: 37094510 DOI: 10.1016/j.jocn.2023.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/30/2023] [Accepted: 04/17/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Myasthenia gravis (MG) can have a variety of respiratory presentations, ranging from mild symptoms through to respiratory failure. The evaluation of respiratory function in MG can be limited by accessibility to testing facilities, availability of medical equipment, and facial weakness. The single count breath test (SCBT) may be a useful adjunct in the evaluation of respiratory function in MG. METHOD A systematic review of the databases PubMed, EMBASE, and the Cochrane Library was conducted from inception to October 2022 in accordance with PRISMA guidelines and was registered on PROSPERO. RESULTS There were 6 studies that fulfilled the inclusion criteria. The described method of evaluating SCBT involves inhaling deeply, then counting at two counts per second, in English or Spanish, sitting upright, with normal vocal register, until another breath needs to be taken. The identified studies support that the SCBT has a moderate correlation with forced vital capacity. These results also support that SCBT can assist the identification of MG exacerbation, including via assessment over the telephone. The included studies support a threshold count of ≥ 25 as consistent with normal respiratory muscle function. Although further analysis is needed, the included studies describe the SCBT as a quick bedside tool that is inexpensive and well tolerated. CONCLUSIONS The results of this review support the clinical utility of the SCBT in assessing respiratory function in MG and describe the most current and effective methods of administration.
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Affiliation(s)
- Noel Dishnica
- Flinders University, Bedford Park, SA 5042, Australia.
| | - Alysha Vuong
- Flinders University, Bedford Park, SA 5042, Australia
| | - Lucy Xiong
- University of Adelaide, Adelaide, SA 5005, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide, SA 5005, Australia
| | - Joshua Kovoor
- University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia; Queen Elizabeth Hospital, Woodville, SA 5011, Australia
| | - Aashray Gupta
- University of Adelaide, Adelaide, SA 5005, Australia; Gold Coast University Hospital, Southport, QLD 4215, Australia
| | - Brandon Stretton
- University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia; Queen Elizabeth Hospital, Woodville, SA 5011, Australia
| | - Rudy Goh
- University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia; Lyell McEwin Hospital, Elizabeth Vale, SA 5112, Australia
| | - Adil Harroud
- McGill University, Montreal, Quebec H3A 0G4, Canada
| | - David Schultz
- Flinders University, Bedford Park, SA 5042, Australia
| | - James Malycha
- University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia; Queen Elizabeth Hospital, Woodville, SA 5011, Australia
| | - Stephen Bacchi
- Flinders University, Bedford Park, SA 5042, Australia; University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia
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Tan S, Zhou X, Xu X, Lu Y, Zeng X, Wu Q, Wang Y. Diagnostic Performance of High-Resolution Vessel Wall MR Imaging Combined with TOF-MRA in the Follow-up of Intracranial Vertebrobasilar Dissecting Aneurysms after Reconstructive Endovascular Treatment. AJNR Am J Neuroradiol 2023; 44:453-459. [PMID: 36958804 PMCID: PMC10084898 DOI: 10.3174/ajnr.a7838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/14/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND AND PURPOSE Few studies have reported the utility of high-resolution vessel wall MR imaging in the follow-up of endovascularly treated vertebrobasilar dissecting aneurysms. This study aimed to evaluate the diagnostic performance of high-resolution vessel wall MR imaging combined with TOF-MRA in the follow-up of intracranial vertebrobasilar dissecting aneurysms after reconstructive endovascular treatment. MATERIALS AND METHODS Patients with intracranial vertebrobasilar dissecting aneurysms with reconstructive endovascular treatment and followed up with TOF-MRA, high-resolution vessel wall MR imaging, and DSA were included. With DSA as the criterion standard, the diagnostic performance of TOF-MRA, high-resolution vessel wall MR imaging, and high-resolution vessel wall MR imaging combined with TOF-MRA in the evaluation of aneurysm occlusion status and parent artery patency was assessed. Visualization of the stented artery on TOF-MRA and high-resolution vessel wall MR imaging was rated on a 5-point scale. RESULTS Twenty-seven patients with 29 aneurysms were included. The sensitivity, specificity, positive predictive value, and negative predictive value of TOF-MRA, high-resolution vessel wall MR imaging, and high-resolution vessel wall MR imaging combined with TOF-MRA for diagnosing aneurysm remnants were 80.0%, 100.0%, 100.0%, and 82.4%; 53.3%, 100.0%, 100.0%, and 66.7%; and 93.3%, 100.0%, 100.0%, and 93.3%, respectively. For the visualization of the stented artery, the mean score of high-resolution vessel wall MR imaging was significantly higher than that of TOF-MRA (4.88 [SD, 0.32] versus 2.53 [SD, 1.25], P < .001). In the evaluation of parent artery patency (normal or pathologic), whereas TOF-MRA had a sensitivity, specificity, positive predictive value, and negative predictive value of 100.0%, 8.0%, 14.8%, and 100.0%, respectively, high-resolution vessel wall MR imaging was completely consistent with the DSA. CONCLUSIONS High-resolution vessel wall MR imaging combined with TOF-MRA at 3T showed good diagnostic performance in the follow-up of intracranial vertebrobasilar dissecting aneurysms after reconstructive endovascular treatment.
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Affiliation(s)
- S Tan
- From the Departments of Neurosurgery (S.T., Y.L., X. Zhou, Y.W.)
| | - X Zhou
- From the Departments of Neurosurgery (S.T., Y.L., X. Zhou, Y.W.)
| | - X Xu
- Department of Neurosurgery (X.X.), The First People's Hospital of Zhaoqing City, Zhaoqing, Guangdong Province, China
| | - Y Lu
- From the Departments of Neurosurgery (S.T., Y.L., X. Zhou, Y.W.)
| | - X Zeng
- Radiology (X. Zeng, Q.W.), The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi Province, China
| | - Q Wu
- Radiology (X. Zeng, Q.W.), The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi Province, China
| | - Y Wang
- Department of Neurosurgery (Y.W.), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- From the Departments of Neurosurgery (S.T., Y.L., X. Zhou, Y.W.)
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Bacchi S, Tan S, Goh R, Kovoor JG, Gupta AK, Jannes J, Kleinig T. Basilar artery occlusion presenting with reduced level of consciousness: a diagnosis not to miss. Intern Emerg Med 2023; 18:933-936. [PMID: 36750535 DOI: 10.1007/s11739-023-03212-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/23/2023] [Indexed: 02/09/2023]
Affiliation(s)
- Stephen Bacchi
- University of Adelaide, Adelaide, SA, 5005, Australia.
- Flinders University College of Medicine and Public Health, Bedford Park, SA, 5042, Australia.
- Neurology Department, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia.
- Health and Information, Adelaide, SA, 5000, Australia.
| | - Sheryn Tan
- University of Adelaide, Adelaide, SA, 5005, Australia
- Health and Information, Adelaide, SA, 5000, Australia
| | - Rudy Goh
- University of Adelaide, Adelaide, SA, 5005, Australia
- Neurology Department, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
- Health and Information, Adelaide, SA, 5000, Australia
- Lyell McEwin Hospital, Elizabeth Vale, SA, 5112, Australia
| | - Joshua G Kovoor
- University of Adelaide, Adelaide, SA, 5005, Australia
- Neurology Department, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
- Health and Information, Adelaide, SA, 5000, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, SA, 5005, Australia
- Health and Information, Adelaide, SA, 5000, Australia
- Gold Coast University Hospital, Southport, QLD, 4215, Australia
| | - Jim Jannes
- University of Adelaide, Adelaide, SA, 5005, Australia
- Neurology Department, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Timothy Kleinig
- University of Adelaide, Adelaide, SA, 5005, Australia
- Neurology Department, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
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Tan S, Huang Y, Xiong J, Gao X, Ren H, Gao S. Identification and Comparative Analysis of the miRNAs in Gonads of High-altitude Species, Batrachuperus tibetanus. Russ J Bioorg Chem 2022. [DOI: 10.1134/s1068162023010260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Choy S, Paolino A, Kim B, Lim S, Seo J, Tan S, Tan W, Corbett M, Barker J, Lynch M, Smith C, Mahil S. 100 Deep learning image analyses in dermatology, beyond skin lesions: a systematic review. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.110] [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: 11/19/2022]
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Ong S, Pasaribu S, Tan S, Aw T, Huang J, Woo M, Koh S, Khoo K. Quality Improvement at the Laboratory’s Specimen Reception Station. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
In our 1000-bed acute care tertiary hospital, physicians order laboratory tests via the computerized-provider-order-entry (CPOE) system and print barcode labels (patient demographics/tests ordered) at the computer-on-wheel printer. When tubes with unsuitable barcodes (misaligned, poor quality) are received at the laboratory specimen reception area a fresh barcode is re-printed by our laboratory staff. An incident involving a re- printed barcode label pasted on the wrong blood tube prompted an investigation into the quality of barcodes.
Methods/Case Report
We initiated ‘an opportunity for improvement (OFI) project’ at the laboratory specimen reception station. The OFI team involved Nursing, Information Technology (IT) and Pathology departments aimed to eliminate re-printing of barcode labels by 75% within 6 months. We collated and analyzed reasons for re-printing of barcodes on 3 separate 48-hour periods (27-28 April 2020, 24-25 June 2020, and 13-14 June 2022). A series of interventions and initiatives were implemented.
Results (if a Case Study enter NA)
Re-printed barcodes were from the Emergency Department (56%), Out-patient clinics (7%) and Wards (57%). Root cause analysis(RCA) using the “5 whys” technique categorized re-print causes into staff-related (misaligned barcodes) and printer-related (faint barcodes lines/truncated un-verifiable patient demographics). The team mass-emailed clinicians an educational “Do-You-Know” guide on proper pasting of barcodes on blood tubes and instructions on how to obtain help for printer rectification. These guide documents were placed in the hospital-wide document-sharing portal - Docupedia. Immediate close follow-up with sites that had poor barcodes was done in real-time. Barcode reprints decreased 83% within 2 months - from 174 (27-28 Apr 2020) to 30 (24-25 Jun 2020). A recent audit showed sustained elimination of barcode re-printing: 25 cases (13-14 Jun 2022).
Conclusion
The OFI project has successfully raised the quality of CPOE labels on specimen tubes contributing to process efficiency and safer patient care. Close communication with all care sites and their representatives on the OFI team are critical success factors.
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Affiliation(s)
- S Ong
- Pathology, Sengkang General Hospital , Singapore , Singapore
| | - S Pasaribu
- Pathology, Sengkang General Hospital , Singapore , Singapore
| | - S Tan
- Pathology, Sengkang General Hospital , Singapore , Singapore
| | - T Aw
- Pathology, Sengkang General Hospital , Singapore , Singapore
| | - J Huang
- Pathology, Sengkang General Hospital , Singapore , Singapore
| | - M Woo
- Information Technology, Sengkang General Hospital , Singapore , Singapore
| | - S Koh
- Nursing, Sengkang General Hospital , Singapore , Singapore
| | - K Khoo
- Nursing, Sengkang General Hospital , Singapore , Singapore
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Chan A, Gan S, Tan S, Lim A, Lee C. Prevalence of mosaicism in day 5 vs. day 6 human blastocysts. Reprod Biomed Online 2022. [DOI: 10.1016/j.rbmo.2022.08.028] [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: 10/07/2022]
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Wang C, Leng S, Tan R, Chai P, Fam J, Teo L, Chin C, Ong C, Baskaran L, Keng F, Low A, Chan M, Wong A, Chua T, Tan S, Lim S, Zhong L. 517 Computed Tomography Coronary Angiography Based Morphological Index Predicts Coronary Ischemia. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Yap H, Loong Y, Raffiee N, Elankovan A, Wang X, Leng S, Ng J, Zhong L, Tan S, Baskaran L. 511 Quantification Of Epicardial Adipose Tissue On Non-Contrast CT: Reproducibility In A Cohort Of 50 Asian Patients. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Bangash F, Collinson J, Dungu J, Gedela S, Westwood M, Manisty C, Farwell D, Tan S, Savage H, Vlachos K, Silberbauer J, Calvo J, Hunter R, Schilling R, Srinivasan N. Assessment of optimal thresholds for ventricular scar substrate characterization using the high density grid multipolar mapping catheter. Europace 2022. [DOI: 10.1093/europace/euac053.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Voltage thresholds for ventricular scar definition are based on historic data collected using catheters with widely spaced bipoles in the absence of contact force. Modern multipolar mapping catheters employ smaller electrodes and interelectrode spacing that theoretically allows for mapping with increased resolution and reduced far-field electrogram (EGM) component. Despite the advancement in technology, historic cut-offs of <0.5mV for dense scar and 0.5-1.5mV for scar borderzone continue to be used in contemporary electrophysiology.
Purpose
We aimed to assess the optimal voltage cut-offs for ventricular scar substrate characterization using the HD Grid multipolar mapping catheter. Voltage cut-offs were assessed against cardiac MRI derived scar. We compared optimal voltage cut-offs using conventional bipolar sampling, the Best Duplicate Algorithm and with the HD wave solution plus best duplicate algorithm on.
Methods
A multicentre study of twenty patients undergoing VT ablation was conducted. Substrate mapping was performed using the high-density HD-grid multipolar mapping catheter. Bipolar voltage maps were co-registered with cardiac MRI obtained prior to the procedure to assess the voltage characteristics of scar defined by cardiac MRI (CMR) (Figure 1). Pre-procedure contrast enhanced CMR data were analysed using ADAS software (Galgo medical). Data points were collected in regions of scar during (1) HD wave mapping with best duplicate algorithm on(Waveon), (2) Mapping with HD wave off and best duplicate on (Waveoff) and (3) with conventional bipolar mapping (Alloff).
Results
The median bipolar voltage for regions of dense CMR scar using (Waveon) HD wave solution and best duplicate algorithm was 0.27mV (IQR 0.14 – 0.46). The median voltage with (Waveoff) HD wave off was 0.29mV (0.15 – 0.45). The median voltage with (Alloff) HD wave off and best duplicate off was 0.32mV (0.19 – 0.5). ROC analysis using AUC suggested the optimal cut-off for endocardial dense scar using (Waveon) HD wave mapping and best duplicate algorithm was 0.30mV (sensitivity: 69.6%, specificity: 60.74%), (Waveoff) cut-off with the best duplicate and without the HD wave mapping was 0.34mV (sensitivity: 69.78%, specificity: 64.46%) and (Alloff) without wave mapping or best duplication was 0.36mV (sensitivity: 84%, specificity: 52%) Figure 2.
Conclusion
Ventricular substrate characterization with newer mapping technology using narrow electrode spacing and smaller electrode size suggests that traditional voltage cut-offs may need revision for delineation of scar characteristics. Additionally, the ability to repeat sample in a region to obtain the best signal (Best Duplicate), and the ability to obviate the effect of wavefront direction using the HD wave solution omnipolar technology, may further increase the fidelity of scar characterization. This has important implications for mapping VT and characterizing channels in order to identify VT circuits.
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Affiliation(s)
- F Bangash
- Royal Free London NHS Foundation Trust, Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - J Collinson
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom of Great Britain & Northern Ireland
| | - J Dungu
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom of Great Britain & Northern Ireland
| | - S Gedela
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom of Great Britain & Northern Ireland
| | - M Westwood
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - C Manisty
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - D Farwell
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom of Great Britain & Northern Ireland
| | - S Tan
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - H Savage
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom of Great Britain & Northern Ireland
| | - K Vlachos
- Onassis Cardiac Surgery Center, Athens, Greece
| | - J Silberbauer
- Sussex Cardiac Centre, Brighton, United Kingdom of Great Britain & Northern Ireland
| | - J Calvo
- Brighton & Sussex University Hospitals N H S Trust, Brighton, United Kingdom of Great Britain & Northern Ireland
| | - R Hunter
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - R Schilling
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - N Srinivasan
- Anglia Ruskin University, Chelmsford, United Kingdom of Great Britain & Northern Ireland
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Collinson J, Bangash F, Dungu J, Gedela S, Westwood M, Manisty C, Farwell D, Tan S, Savage H, Vlachos K, Schilling R, Hunter R, Srinivasan N. Integration of structural and functional data in VT ablation -- SENSE2 protocol mapping. Europace 2022. [DOI: 10.1093/europace/euac053.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
We have previously developed the sense protocol functional substrate mapping technique for VT ablation(1). However, functional substrate characterizaiton can involve protracted mapping time.
Purpose
We incorporated the integration of MRI data using ADAS-3D software into the mapping workflow, to integrate structural mapping information into the functional mapping substrate characterization, in order to improve procedural efficiency.
Methods
CMRs were performed in 20 patients with ischemic related VT and VT therapy in the previous 6 months. These were processed with the ADAS-3D software to characterize the extent of ventricular scars and also ADAS corridors which may correlate with VT channels. Focused substrate maps were then performed in patients, guided by the extent of ADAS scar and corridors, looking at the scar substrate in intrinsic rhythm and then functional channels using single extra pacing from the RV at 20ms above ERP (SENSE2 Protocol). Specifically healthy areas 2cm beyond the scar borderzone based on ADAS were not mapped, in order to reduce substrate mapping time and complete geometries were not created. Following delineation of functional channels pacemapping and entrainment mapping were used to confirm targets for ablation.
The ADAS 3D MRI was integrated into the into the VT substrate map on Ensite-Precision with alignment to the aorta, RV and PA (Figure 1). We compared our data with previous functional mapping data without the integration of MRI.
Results
20 patients (age 70 years; 19 male subjects) underwent ablation. Mean EF 28%. Median procedure time was 161 minutes compared with 246 minutes (in our previous study)(p=<0.001) Mean substrate mapping time was 32 mins vs 63 mins (p=<0.001). Mean ablation time was 22 mins vs 32 mins (p=0.11). 85% (17 of 20) patients were free from symptomatic VT/ anti-tachycardia pacing or implantable cardioverter defibrillator shocks at a median follow-up of 171 days. The mean VT burden was reduced from 22 events per patient in the 6 months’ pre-ablation to 1 event per patient in the median follow up period of 171 days post ablation (p=0.02). Mean shocks per-patient burden decreased from 3.5 to 0.08 in the same time period(p=0.03).
Conclusion
The SENSE2 protocol involves the integration of structural and functional data into the VT workflow for substrate characterization. It enables focused substrate maps to be performed without the need for complete geometry to be created in large ventricles. Outcomes compare favourably with our previous data but with significantly shorter procedure times. This streamlined workflow has the potential to improve care in VT ablation by shortening procedure times with similar outcomes which may reduce risks for the patient.
Figure 1: Comparison of Voltage Map with MRI scar & corridors using ADAS
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Affiliation(s)
- J Collinson
- Basildon and Thurrock University Hospital, Essex, United Kingdom of Great Britain & Northern Ireland
| | - F Bangash
- Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - J Dungu
- Basildon and Thurrock University Hospital, Essex, United Kingdom of Great Britain & Northern Ireland
| | - S Gedela
- Basildon and Thurrock University Hospital, Essex, United Kingdom of Great Britain & Northern Ireland
| | - M Westwood
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - C Manisty
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - D Farwell
- Basildon and Thurrock University Hospital, Essex, United Kingdom of Great Britain & Northern Ireland
| | - S Tan
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - H Savage
- Basildon and Thurrock University Hospital, Essex, United Kingdom of Great Britain & Northern Ireland
| | - K Vlachos
- Onassis Cardiac Surgery Center, Athens, Greece
| | - R Schilling
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - R Hunter
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - N Srinivasan
- Anglia Ruskin University, Chelmsford, United Kingdom of Great Britain & Northern Ireland
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Tan S. EduW 5 Clinical utility of procalcitonin as a diagnostic and prognostic biomarker. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.756] [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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Wu W, Huang J, Tan S, Wong MCS, Xu W. Screening methods for colorectal cancer in Chinese populations. Hong Kong Med J 2022; 28:183-185. [DOI: 10.12809/hkmj219917] [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: 11/05/2022] Open
Affiliation(s)
- W Wu
- Global Health Institute, School of Public Health, Fudan University, Shanghai, China
| | - J Huang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - S Tan
- Global Health Institute, School of Public Health, Fudan University, Shanghai, China
| | - Martin CS Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - W Xu
- Global Health Institute, School of Public Health, Fudan University, Shanghai, China
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Rabbath X, Pelletier-Galarneau M, Tremblay-Gravel M, Noly P, Racine N, Tan S. Value of Computed Tomography and Fluorodeoxyglucose-Positron Emission Tomography Imaging for Preoperative Screening in Advanced Heart Failure Therapies Candidates. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Cao N, Erickson D, Tan S, Argento D, Emery R, Kranz M, Rengan R, Ford E, Zeng J. FLASH Mechanisms Track (Oral Presentations) MOUSE ABDOMEN RADIATION USING A 50 MEV PROTON BEAM: FLASH VS. CONVENTIONAL DOSE RATE. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01463-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Lu J, He J, Xia H, Yang D, He W, Zhu X, Yan Y, Liu Z, Liu T, Yang J, Tan S, Jiang J, Hou X, Gao H, Ni L. Chemotherapy enhanced by ultrasonic cavitation in prostate cancer by opening the blood-prostate barrier. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00497-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mydin M, Splatt L, Abrahams T, Tan S, Pol D, Brown A. Predictive Utility of Reperfusion Criteria in Predicting Occluded Infarct-Related Artery in Patients With ST-Elevation Myocardial Infarction. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.362] [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: 10/16/2022]
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Li G, Xu J, Chen S, Tan S, Li H. Pigment concentrations in eggshell and their related gene expressions in uterus of Changshun blue eggshell chickens. Br Poult Sci 2021; 63:421-425. [PMID: 34585996 DOI: 10.1080/00071668.2021.1983919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
1. The goal of this study was to investigate the colour diversity of egg shells and expression of related genes in the uterus of chickens that produce eggs of different colours.2. Four colour types of Changshun blue-shell chickens, producing dark or light blue, greenish-brown and brown shelled eggs, were selected. The eggshell pigment concentration and colour values in each group were examined. The relative gene expression of solute carrier organic anion transporter family member 1C1 (SLCO1C1), ferrochelatase (FECH), haem oxygenase 1 (HO-1), ovotransferrin (OF) and biliverdin reductase A (BLVRA) in eggshell gland were measured.3. The Δb, ΔE and protoporphyrin in brown and greenish-brown groups were significantly higher in the blue egg group (P < 0.01), whereas ΔL was significantly lower than that in the blue eggs (P < 0.01). There was no significant difference in biliverdin concentration between the brown and blue groups.4. The Δa values, in descending order, were 8.27 ± 2.76 in the brown, -3.79 ± 2.39 in the greenish-brown and -7.29 ± 2.27 in the blue groups, respectively. The relative expression of HO-1 in the greenish-brown and light blue groups was significantly higher than in the dark blue and brown groups. The relative expression of FECH in the light blue group was significantly lower than that in the dark blue, greenish-brown or brown group (P < 0.01). The relative expression of HO-1 and BLVRA genes in the dark blue group was significantly higher than that in the light blue, greenish-brown and the brown group (P < 0.01).5. The Δa might provide a better index than protoporphyrin and biliverdin contents for eggshell colour breeding. Overall, HO-1 as well as BLVRA were important candidate genes for the selection of dark blue eggs.
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Affiliation(s)
- G Li
- Guangdong Provincial Key Laboratory of Animal Molecular Design and Precise Breeding, School of Life Science and Engineering, Foshan University, Foshan, China
| | - J Xu
- Guangdong Provincial Key Laboratory of Animal Molecular Design and Precise Breeding, School of Life Science and Engineering, Foshan University, Foshan, China
| | - S Chen
- Guangdong Provincial Key Laboratory of Animal Molecular Design and Precise Breeding, School of Life Science and Engineering, Foshan University, Foshan, China
| | - S Tan
- Guangdong Provincial Key Laboratory of Animal Molecular Design and Precise Breeding, School of Life Science and Engineering, Foshan University, Foshan, China
| | - H Li
- Guangdong Provincial Key Laboratory of Animal Molecular Design and Precise Breeding, School of Life Science and Engineering, Foshan University, Foshan, China.,Breeding Center, Guizhou Changshun Tinoo's Green Shell Laying Hen Industrial Co. Ltd, Changshun, China.,Research and Development Department, Xianxi Biotechnology Co. Ltd, Foshan, China
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Tan S, Thang YW, Mulley WR, Polkinghorne K, Ramkumar S, Cheng K, Rehmani H, Brown AJ, Moir S, Cameron JD, Nicholls SJ, Mottram PM, Nerlekar N. Long term prognostic utility of exercise capacity in renal transplant candidates. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Pharmacological stress testing is commonly performed for cardiovascular risk stratification in potential renal transplant candidates due to a perceived inability for these patients to exercise. We have previously reported that exercise stress testing is feasible in renal transplant candidates but the prognostic utility of exercise capacity in this patient group is not known.
Purpose
This study prospectively evaluated the effect of exercise capacity on the risk of major adverse cardiovascular events (MACE), defined as a composite of cardiac death, non-fatal myocardial infarction, and stroke, in renal transplant candidates undergoing exercise stress echocardiography (ESE) for pre-transplant cardiovascular assessment.
Methods
We evaluated 898 consecutive patients with chronic kidney disease stage 4/5 who underwent symptom-limited treadmill ESE over 5-year mean follow-up. Exercise capacity was measured by age and sex predicted metabolic equivalents (METs). The primary outcome was achievement of predicted METs with first MACE. Cox proportional hazard multivariable modelling was used to determine MACE predictors with transplantation treated as a time-varying covariate. We also performed secondary analysis using a 7 MET threshold.
Results
There were 106 MACE with an annual cumulative risk of 2.4%. During follow-up, 525 (58%) received transplantation. Achievement of predicted METs (48%) (hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.29–0.82, p=0.007) and transplantation (HR 0.52, 95% CI 0.30–0.91, p=0.02) were independently associated with reduced MACE. Similar results were observed using a 7 MET threshold achieved by 734 (82%) patients. Patients achieving predicted METs had no difference in MACE regardless of subsequent transplantation (HR 0.78, 95% CI 0.32–1.92, p=0.59). Patients who achieved predicted METs and did not receive transplantation had similar outcomes to those that did not achieve predicted METs and received transplantation (HR 0.97, 95% CI 0.42–2.25, p=0.95).
Conclusions
Exercise capacity is associated with reduced long-term MACE in renal transplant candidates undergoing ESE for pre-transplant cardiovascular assessment. Achievement of age and sex predicted METs confers excellent prognosis independent of subsequent transplantation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Tan
- Monash Heart, Melbourne, Australia
| | | | | | | | | | - K Cheng
- Monash Heart, Melbourne, Australia
| | | | | | - S Moir
- Monash Heart, Melbourne, Australia
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