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Ho G, Gill M, Grant-Kels J, Schwartz RJ, Pellacani G, Gonzalez S, Alessi-Fox C, Guitera P. International expert recommendations on image acquisition for in vivo reflectance confocal microscopy of cutaneous tumors. J Am Acad Dermatol 2024; 90:537-544. [PMID: 37898340 DOI: 10.1016/j.jaad.2023.09.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND No international recommendations exist for a minimum imaging requirement per lesion using reflectance confocal microscopy (RCM). This may be beneficial given the increasing use of remote RCM interpretation internationally. OBJECTIVE To develop international expert recommendations for image acquisition using tissue-coupled RCM for diagnosis of cutaneous tumors. METHODS Using a modified Delphi approach, a core group developed the scope and drafted initial recommendations before circulation to a larger group, the Cutaneous Imaging Expert Resource Group of the American Academy of Dermatology. Each review round consisted of a period of open comment, followed by revisions. RESULTS The recommendations were developed after 5 alternating rounds of review among the core group and the Cutaneous Imaging Expert Resource Group. These were divided into subsections of imaging personnel, recommended lesion criteria, clinical and lesion information to be provided, lesion preparation, image acquisition, mosaic cube settings, and additional captures based on lesion characteristics and suspected diagnosis. LIMITATIONS The current recommendations are limited to tissue-coupled RCM for diagnosis of cutaneous tumors. It is one component of the larger picture of quality assurance and will require ongoing review. CONCLUSIONS These recommendations serve as a resource to facilitate quality assurance, economical use of time, accurate diagnosis, and international collaboration.
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Menzies SW, Sinz C, Menzies M, Lo SN, Yolland W, Lingohr J, Razmara M, Tschandl P, Guitera P, Scolyer RA, Boltz F, Borik-Heil L, Herbert Chan H, Chromy D, Coker DJ, Collgros H, Eghtedari M, Corral Forteza M, Forward E, Gallo B, Geisler S, Gibson M, Hampel A, Ho G, Junez L, Kienzl P, Martin A, Moloney FJ, Regio Pereira A, Ressler JM, Richter S, Silic K, Silly T, Skoll M, Tittes J, Weber P, Weninger W, Weiss D, Woo-Sampson P, Zilberg C, Kittler H. Comparison of humans versus mobile phone-powered artificial intelligence for the diagnosis and management of pigmented skin cancer in secondary care: a multicentre, prospective, diagnostic, clinical trial. Lancet Digit Health 2023; 5:e679-e691. [PMID: 37775188 DOI: 10.1016/s2589-7500(23)00130-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Diagnosis of skin cancer requires medical expertise, which is scarce. Mobile phone-powered artificial intelligence (AI) could aid diagnosis, but it is unclear how this technology performs in a clinical scenario. Our primary aim was to test in the clinic whether there was equivalence between AI algorithms and clinicians for the diagnosis and management of pigmented skin lesions. METHODS In this multicentre, prospective, diagnostic, clinical trial, we included specialist and novice clinicians and patients from two tertiary referral centres in Australia and Austria. Specialists had a specialist medical qualification related to diagnosing and managing pigmented skin lesions, whereas novices were dermatology junior doctors or registrars in trainee positions who had experience in examining and managing these lesions. Eligible patients were aged 18-99 years and had a modified Fitzpatrick I-III skin type; those in the diagnostic trial were undergoing routine excision or biopsy of one or more suspicious pigmented skin lesions bigger than 3 mm in the longest diameter, and those in the management trial had baseline total-body photographs taken within 1-4 years. We used two mobile phone-powered AI instruments incorporating a simple optical attachment: a new 7-class AI algorithm and the International Skin Imaging Collaboration (ISIC) AI algorithm, which was previously tested in a large online reader study. The reference standard for excised lesions in the diagnostic trial was histopathological examination; in the management trial, the reference standard was a descending hierarchy based on histopathological examination, comparison of baseline total-body photographs, digital monitoring, and telediagnosis. The main outcome of this study was to compare the accuracy of expert and novice diagnostic and management decisions with the two AI instruments. Possible decisions in the management trial were dismissal, biopsy, or 3-month monitoring. Decisions to monitor were considered equivalent to dismissal (scenario A) or biopsy of malignant lesions (scenario B). The trial was registered at the Australian New Zealand Clinical Trials Registry ACTRN12620000695909 (Universal trial number U1111-1251-8995). FINDINGS The diagnostic study included 172 suspicious pigmented lesions (84 malignant) from 124 patients and the management study included 5696 pigmented lesions (18 malignant) from the whole body of 66 high-risk patients. The diagnoses of the 7-class AI algorithm were equivalent to the specialists' diagnoses (absolute accuracy difference 1·2% [95% CI -6·9 to 9·2]) and significantly superior to the novices' ones (21·5% [13·1 to 30·0]). The diagnoses of the ISIC AI algorithm were significantly inferior to the specialists' diagnoses (-11·6% [-20·3 to -3·0]) but significantly superior to the novices' ones (8·7% [-0·5 to 18·0]). The best 7-class management AI was significantly inferior to specialists' management (absolute accuracy difference in correct management decision -0·5% [95% CI -0·7 to -0·2] in scenario A and -0·4% [-0·8 to -0·05] in scenario B). Compared with the novices' management, the 7-class management AI was significantly inferior (-0·4% [-0·6 to -0·2]) in scenario A but significantly superior (0·4% [0·0 to 0·9]) in scenario B. INTERPRETATION The mobile phone-powered AI technology is simple, practical, and accurate for the diagnosis of suspicious pigmented skin cancer in patients presenting to a specialist setting, although its usage for management decisions requires more careful execution. An AI algorithm that was superior in experimental studies was significantly inferior to specialists in a real-world scenario, suggesting that caution is needed when extrapolating results of experimental studies to clinical practice. FUNDING MetaOptima Technology.
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Schwartz RJ, Ho G, Gouveia BM, Martin LK, Guitera P. An adapter window for precise skin marking during handheld reflectance confocal microscopic scanning. J Am Acad Dermatol 2023; 89:e125-e126. [PMID: 35085680 DOI: 10.1016/j.jaad.2021.11.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/06/2021] [Accepted: 11/25/2021] [Indexed: 10/19/2022]
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Cowan TL, Ho G, Daniel BS, Murrell DF. Use of a hybrid teledermatology model in an Australian tertiary hospital during the COVID-19 pandemic. JAAD Int 2023; 11:33-34. [PMID: 35474879 PMCID: PMC9023319 DOI: 10.1016/j.jdin.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/21/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022] Open
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Ho G, Kubušová V, Irabien C, Li V, Weinstein A, Chawla S, Yeung D, Mershin A, Zolotovsky K, Mogas-Soldevila L. Multiscale design of cell-free biologically active architectural structures. Front Bioeng Biotechnol 2023; 11:1125156. [PMID: 37064226 PMCID: PMC10100494 DOI: 10.3389/fbioe.2023.1125156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/27/2023] [Indexed: 03/30/2023] Open
Abstract
Cell-free protein expression systems are here combined with 3D-printed structures to study the challenges and opportunities as biofabrication enters the spaces of architecture and design. Harnessing large-scale additive manufacturing of biological materials, we examined the addition of cell-free protein expression systems ("TXTL" i.e., biological transcription-translation machinery without the use of living cells) to printed structures. This allowed us to consider programmable, living-like, responsive systems for product design and indoor architectural applications. This emergent, pluripotent technology offers exciting potential in support of health, resource optimization, and reduction of energy use in the built environment, setting a new path to interactivity with mechanical, optical, and (bio) chemical properties throughout structures. We propose a roadmap towards creating healthier, functional and more durable systems by deploying a multiscale platform containing biologically-active components encapsulated within biopolymer lattices operating at three design scales: (i) supporting cell-free protein expression in a biopolymer matrix (microscale), (ii) varying material properties of porosity and strength within two-dimensional lattices to support biological and structural functions (mesoscale), and (iii) obtaining folded indoor surfaces that are structurally sound at the meter scale and biologically active (we label that regime macroscale). We embedded commercially available cell-free protein expression systems within silk fibroin and sodium alginate biopolymer matrices and used green fluorescent protein as the reporter to confirm their compatibility. We demonstrate mechanical attachment of freeze-dried bioactive pellets into printed foldable fibrous biopolymer lattices showing the first steps towards modular multiscale fabrication of large structures with biologically active zones. Our results discuss challenges to experimental setup affecting expression levels and show the potential of robust cell-free protein-expressing biosites within custom-printed structures at scales relevant to everyday consumer products and human habitats.
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Ho G, Smith A, Cust AE, Melhoranse-Gouveia B, Collgros H, Martin L, Guitera P. Reflectance confocal microscopy in Australia: Perspectives on barriers to implementation and uptake. Australas J Dermatol 2023; 64:e109-e111. [PMID: 36412240 DOI: 10.1111/ajd.13954] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/25/2022] [Accepted: 10/30/2022] [Indexed: 11/23/2022]
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Ho G, Schwartz RJ, Melhoranse‐Gouveia B, Guitera P, O'Sullivan NA, Cheung VKY, Ch'ng S, Martin LK. Utility of optical coherence tomography in basal cell naevus syndrome: A case report. Australas J Dermatol 2022; 63:e331-e335. [PMID: 36125195 PMCID: PMC9826408 DOI: 10.1111/ajd.13921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 01/11/2023]
Abstract
Optical Coherence Tomography (OCT) is a useful non-invasive diagnostic tool for diagnosing and monitoring treatment of basal cell carcinomas. We describe the use of OCT in a patient with Basal Cell Naevus Syndrome. Through measuring tumour depth on OCT, management of individual tumours was triaged accordingly using 0.4 mm tumour depth as a cut-off for surgical and non-surgical management. OCT has potential to reduce unnecessary excisions and associated morbidity in this population of patients.
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Ho G, Gibson M, Kazemikhoo N, Murrell DF. Long-term follow up of Epidermolysis Bullosa in real practice shows stability of the EBDASI and improvement with some off-label therapies. JAAD Int 2022; 9:105-107. [PMID: 36248204 PMCID: PMC9558050 DOI: 10.1016/j.jdin.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ho G, Kurek C, Stewart D, Martin LK. An unusual growth in the nail matrix: A case of superficial acral fibromyxoma. SKIN HEALTH AND DISEASE 2022; 2:e121. [PMID: 36092267 PMCID: PMC9435459 DOI: 10.1002/ski2.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/21/2022] [Accepted: 04/23/2022] [Indexed: 11/12/2022]
Abstract
We describe a case of superficial acral fibromyxoma arising within the germinal matrix of the index finger. This is an uncommon localisation of this relatively newly described benign soft tissue tumour. Herein, we discuss the varied clinical presentation, distinguishing histopathological features and important differential diagnoses for this condition.
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Ho G, Schwartz RJ, Regio Pereira A, Dimitrou F, Paver E, McKenzie C, Saw RPM, Scolyer RA, Long GV, Guitera P. Reflectance confocal microscopy - a non-invasive tool for monitoring systemic treatment response in stage III unresectable primary scalp melanoma. J Eur Acad Dermatol Venereol 2022; 36:e583-e585. [PMID: 35285090 DOI: 10.1111/jdv.18076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/04/2022] [Indexed: 11/27/2022]
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Star P, Jackett LA, Cheung K, Wilmott JS, Ho G, Smith A, Long GV, Scolyer RA, Martin LK. Multiple eruptive squamoproliferative lesions during
anti‐PD1
immunotherapy for metastatic melanoma: pathogenesis, immunohistochemical analysis and treatment. Dermatol Ther 2022; 35:e15472. [DOI: 10.1111/dth.15472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/12/2022] [Accepted: 03/22/2022] [Indexed: 11/28/2022]
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Schwartz RJ, Ho G, Smith A, Collgros H, Regio Pereira A, Gouveia B, Long GV, Menzies AM, Potter AJ, Paver E, Star P, Scolyer RA, Martin LK. Successful treatment of eruptive keratoacanthomas with actitretin for patients on checkpoint inhibitor immunotherapy. J Eur Acad Dermatol Venereol 2022; 36:e445-e448. [PMID: 35043483 DOI: 10.1111/jdv.17940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
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Ho G, Murrell DF. Angiosarcoma presenting as unexplainable unilateral leg pain and purpuric toes. Med J Aust 2021; 215:456. [PMID: 34657290 DOI: 10.5694/mja2.51310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022]
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Ho G, Blake SC, Sheriff T, Daniel BS, Murrell DF. Impact of COVID-19 on inpatient dermatology consults in an Australian tertiary hospital. Australas J Dermatol 2021; 62:427-428. [PMID: 34129241 PMCID: PMC8441729 DOI: 10.1111/ajd.13649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Dau J, Ho G, Choi H, Schwab J, Kohler M. POS1150 ANATOMICAL LOCATIONS AND CORRELATES OF CALCIUM PYROPHOSPHATE CRYSTAL DEPOSITS OF THE SPINE – PATHOLOGIC EXAMINATION OF 77 SURGICAL CASES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.4313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Spinal involvement in calcium pyrophosphate deposition disease (CPPD) is thought to be a rare occurrence and is seen infrequently as crowned dens syndrome. Furthermore, data on anatomical locations and correlates of calcium pyrophosphate (CPP) deposits in spinal CPPD are scarce.Objectives:To describe the anatomical locations and correlates of pathologically confirmed CPPD of the spine.Methods:Consecutive patients with spinal CPPD were identified via retrospective chart review of individuals who underwent spine surgery for intractable chronic neck or back pain at Massachusetts General Hospital between 2009 and 2014. These deposits and surrounding anatomical structures were surgically resected and confirmed to have calcium pyrophosphate deposition upon pathologic review. We reviewed musculoskeletal imaging (CT, MRI, XR) and laboratory data from these pathologically confirmed cases.Results:From April 2009 to August 2014, we identified 77 individuals with pathologically confirmed CPPD of the spine. The mean age was 68 years; 41 (53%) were female; mean BMI was 28.7. Calcium pyrophosphate (CPP) was grossly identified intraoperatively by the surgeon in 38 cases (50%), typically as “chalky white deposits” (Figure 1). CPP deposits were seen most frequently in the ligamentum flavum (23%) and intervertebral disc (23%), followed by other less common locations (Table 1). Imaging findings in the soft tissue or intervertebral disc suggestive of CPPD were found in 5 cases (6%), whereas findings of spinal canal narrowing, facet arthropathy, or ligamentum flavum thickening were eventually correlative with CPP deposits in pathologic specimens. Only 7 (9%) experienced a prior episode of acute CPP arthritis (pseudogout). Chondrocalcinosis on x-ray was seen in 26 cases (34%), most commonly in the wrist and/or knees. Osteoarthritis was present in all spinal imaging, and 65% had comorbid scoliosis. Laboratory abnormalities associated with secondary causes of CPPD (hypercalcemia, hypomagnesemia, hyperparathyroidism) were not seen with spinal CPPD.Conclusion:Spinal CPPD may occur more frequently than previously perceived. The ligamentum flavum and intervertebral discs were common anatomical locations for spinal CPPD. Advanced imaging of the spine showed low sensitivity for detecting spinal CPPD. Only a small minority had typical peripheral joint involvement or imaging with peripheral joint chondrocalcinosis. Thus, without pathologic confirmation, the vast majority of cases would remain unidentified. These findings call for the need to seek pathologic confirmation to determine the robust epidemiology and also raise the potential role for preoperative CPPD treatment.Table 1.Spinal Anatomic Locations of Pathologically Confirmed CPPDSpinal Anatomic LocationNo. of Sites (%)*ligamentum flavum29 (23)Intervetebral Disc28 (23)Other Location19 (15)Posterior Elements18 (15)Facet14 (11)Synovium8 (6)Interspinous Ligament3 (2)Subarticular/Lateral Recess2 (2)Fibrocartilaginous Tissue1 (1)Inner Spine1 (1)Other Ligament1 (1)*Some patients had more than one anatomic location where CPP was isolatedFigure 1.Gross visualization of calcium pyrophosphate deposition (black arrow)Disclosure of Interests:Jonathan Dau: None declared, Gary Ho: None declared, Hyon Choi Consultant of: Ironwood, Selecta, Horizon, Takeda, Kowa, Vaxart, Grant/research support from: Ironwood, Horizon, Joseph Schwab: None declared, Minna Kohler Speakers bureau: Eli Lily, Consultant of: Novartis.
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Ho G, Sheriff T, Doria-Ruiz M, Loh Y, Murrell DF. Are biosimilars for pemphigus safe? Clin Exp Dermatol 2021; 46:942-943. [PMID: 33577125 DOI: 10.1111/ced.14610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 11/29/2022]
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Orsini S, Livi SA, Lichtenegger H, Barabash S, Milillo A, De Angelis E, Phillips M, Laky G, Wieser M, Olivieri A, Plainaki C, Ho G, Killen RM, Slavin JA, Wurz P, Berthelier JJ, Dandouras I, Kallio E, McKenna-Lawlor S, Szalai S, Torkar K, Vaisberg O, Allegrini F, Daglis IA, Dong C, Escoubet CP, Fatemi S, Fränz M, Ivanovski S, Krupp N, Lammer H, Leblanc F, Mangano V, Mura A, Nilsson H, Raines JM, Rispoli R, Sarantos M, Smith HT, Szego K, Aronica A, Camozzi F, Di Lellis AM, Fremuth G, Giner F, Gurnee R, Hayes J, Jeszenszky H, Tominetti F, Trantham B, Balaz J, Baumjohann W, Brienza D, Bührke U, Bush MD, Cantatore M, Cibella S, Colasanti L, Cremonese G, Cremonesi L, D'Alessandro M, Delcourt D, Delva M, Desai M, Fama M, Ferris M, Fischer H, Gaggero A, Gamborino D, Garnier P, Gibson WC, Goldstein R, Grande M, Grishin V, Haggerty D, Holmström M, Horvath I, Hsieh KC, Jacques A, Johnson RE, Kazakov A, Kecskemety K, Krüger H, Kürbisch C, Lazzarotto F, Leblanc F, Leichtfried M, Leoni R, Loose A, Maschietti D, Massetti S, Mattioli F, Miller G, Moissenko D, Morbidini A, Noschese R, Nuccilli F, Nunez C, Paschalidis N, Persyn S, Piazza D, Oja M, Ryno J, Schmidt W, Scheer JA, Shestakov A, Shuvalov S, Seki K, Selci S, Smith K, Sordini R, Svensson J, Szalai L, Toublanc D, Urdiales C, Varsani A, Vertolli N, Wallner R, Wahlstroem P, Wilson P, Zampieri S. SERENA: Particle Instrument Suite for Determining the Sun-Mercury Interaction from BepiColombo. SPACE SCIENCE REVIEWS 2021; 217:11. [PMID: 33487762 PMCID: PMC7803725 DOI: 10.1007/s11214-020-00787-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 12/03/2020] [Indexed: 06/12/2023]
Abstract
The ESA-JAXA BepiColombo mission to Mercury will provide simultaneous measurements from two spacecraft, offering an unprecedented opportunity to investigate magnetospheric and exospheric particle dynamics at Mercury as well as their interactions with solar wind, solar radiation, and interplanetary dust. The particle instrument suite SERENA (Search for Exospheric Refilling and Emitted Natural Abundances) is flying in space on-board the BepiColombo Mercury Planetary Orbiter (MPO) and is the only instrument for ion and neutral particle detection aboard the MPO. It comprises four independent sensors: ELENA for neutral particle flow detection, Strofio for neutral gas detection, PICAM for planetary ions observations, and MIPA, mostly for solar wind ion measurements. SERENA is managed by a System Control Unit located inside the ELENA box. In the present paper the scientific goals of this suite are described, and then the four units are detailed, as well as their major features and calibration results. Finally, the SERENA operational activities are shown during the orbital path around Mercury, with also some reference to the activities planned during the long cruise phase.
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Aldaas O, Lupercio F, Malladi C, Mylavarapu P, Darden D, Han F, Hoffmayer K, Krummen D, Ho G, Raissi F, Feld G, Hsu J. Catheter ablation of atrial fibrillation in patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Catheter ablation improves clinical outcomes in symptomatic atrial fibrillation (AF) patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, the role of catheter ablation in HF patients with a preserved ejection fraction (HFpEF) is less clear.
Purpose
To determine the efficacy of catheter ablation of AF in patients with HFpEF relative to those with HFrEF.
Methods
We performed an extensive literature search and systematic review of studies that compared AF recurrence at one year after catheter ablation of AF in patients with HFpEF versus those with HFrEF. Risk ratio (RR) 95% confidence intervals were measured using the Mantel-Haenszel method for dichotomous variables, where a RR<1.0 favors the HFpEF group.
Results
Four studies with a total of 563 patients were included, of which 312 had HFpEF and 251 had HFrEF. All patients included were undergoing first time catheter ablation of AF. Patients with HFpEF experienced similar recurrence of AF one year after ablation on or off antiarrhythmic drugs compared to those with HFrEF (RR 0.87; 95% CI 0.69–1.10, p=0.24), as shown in Figure 1. Recurrence of AF was assessed with electrocardiography, Holter monitoring, and/or event monitoring at scheduled follow-up visits and final follow-up.
Conclusion
Based on the results of this meta-analysis, catheter ablation of AF in patients with HFpEF appears as efficacious in maintaining sinus rhythm as in those with HFrEF.
Funding Acknowledgement
Type of funding source: None
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Ho G, Fung C, Cook D. A case of tattoo granulomas and uveitis. Australas J Dermatol 2020; 62:84-86. [PMID: 32955106 DOI: 10.1111/ajd.13440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/30/2020] [Accepted: 07/11/2020] [Indexed: 11/29/2022]
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Lee KH, Ho G, Wong WM, Lam HL, Lam PW. Imaging and Clinical Presentation of Caesarean Scar Pregnancy. HONG KONG JOURNAL OF RADIOLOGY 2019. [DOI: 10.12809/hkjr1916866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Lin A, Tran H, Hsu J, Hoffmayer K, Feld G, Adler E, Pretorius V, Krummen D, Ho G. Ventricular Arrhythmias in Patients with Biventricular Assist Devices. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Azhari H, King JA, Underwood F, Coward S, shah S, Ng S, Ho G, Chan C, Kaplan GG. A258 THE GLOBAL INCIDENCE OF PEPTIC ULCER DISEASE AT THE TURN OF THE 21ST CENTURY: A STUDY OF THE ORGANIZATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT (OECD). J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Oon HH, Ho G, Sandar H, Chee SP. Acute unilateral red eye in a patient with psoriasis. Clin Exp Dermatol 2019; 44:924-926. [PMID: 30746729 DOI: 10.1111/ced.13916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2018] [Indexed: 11/25/2022]
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Ho G, Carey KA, Cardamone M, Farrar MA. Myotonic dystrophy type 1: clinical manifestations in children and adolescents. Arch Dis Child 2019; 104:48-52. [PMID: 29871899 DOI: 10.1136/archdischild-2018-314837] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/14/2018] [Accepted: 05/11/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Myotonic dystrophy type 1 (DM1) is an autosomal-dominant neuromuscular disease with variable severity affecting all ages; however, current care guidelines are adult-focused. The objective of the present study was to profile DM1 in childhood and propose a framework to guide paediatric-focused management. DESIGN, SETTING AND PATIENTS 40 children with DM1 (mean age 12.8 years; range 2-19) were studied retrospectively for a total of 513 follow-up years at Sydney Children's Hospital. 143 clinical parameters were recorded. RESULTS The clinical spectrum of disease in childhood differs from adults, with congenital myotonic dystrophy (CDM1) having more severe health issues than childhood-onset/juvenile patients (JDM1). Substantial difficulties with intellectual (CDM1 25/26 96.2%; JDM1 9/10, 90.0%), fine motor (CDM1 23/30, 76.6%; JDM1 6/10, 60.0%), gastrointestinal (CDM1 17/30, 70.0%; JDM1 3/10, 30.0%) and neuromuscular function (CDM1 30/30, 100.0%; JDM1 25/30, 83.3%) were evident. CONCLUSION The health consequences of DM1 in childhood are diverse, highlighting the need for paediatric multidisciplinary management approaches that encompass key areas of cognition, musculoskeletal, gastrointestinal, respiratory, cardiac and sleep issues.
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Tse DML, Ho G, Tsang CP, Chan KH, Lee R. Delayed Cerebral Hyperperfusion with Subarachnoid Haemorrhage after Carotid Artery Stenting. HONG KONG JOURNAL OF RADIOLOGY 2018. [DOI: 10.12809/hkjr1816834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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