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Safarova M, Gorby L, Dutton J, Nugent A, Moriarty PM. Progression of carotid intima-media thickness in patients treated with lipoprotein apheresis: real-world evidence over 12 years. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The extent of intervention effects on carotid intima-media thickness (CIMT) can predict the degree of atherosclerotic cardiovascular disease (ASCVD) risk reduction. There is limited evidence of long-term effects of lipoprotein apheresis on the CIMT progression.
Purpose
We hypothesized that regular lipoprotein apheresis over the course of 10 years may slow down progression of CIMT in patients with severe hypercholesterolemia.
Methods
This case series describes ten Caucasian patients (mean age 60±9 years, 70% female, 80% statin intolerant) with familial hypercholesterolemia and/or hyperlipoproteinemia(a) treated with lipoprotein apheresis at a single academic center between 2005 and 2020. The mean and maximum diastolic CIMT of the distal 1 cm of the far wall of the right and left common carotid arteries was measured by the same, trained sonographer utilizing an automated border-detection algorithm.
Results
The median pre-treatment low-density lipoprotein cholesterol (LDL-C) level was 214 mg/dL (95% confidence interval, 145 to 248), lipoprotein(a), 26 mg/dL (15 to 109; 40% with lipoprotein(a) >60 mg/dL). Using the imputed trajectories, period-specific on-treatment time-weighted averages for LDL-C and lipoprotein(a) were 141 mg/dL (IQR, 89 to 152) and 24 mg/dL (IQR, 12 to 119), respectively. The baseline mean CIMT was 850±170μm and maximum CIMT was 1040±220μm across the age range of 46 to 70 years. Over a median duration of 12 years, regular treatment with lipoprotein apheresis resulted in an average reduction in the mean CIMT of −40μm (IQR, −50 to 20) and maximum CIMT −30μm (IQR, −60 to −10). Among tested lipid and lipoprotein fractions in this sample, the follow-up mean CIMT values strongly correlated only with the baseline lipoprotein(a) levels. Median CIMT progression rates were as follows: mean common carotid, −4μm/y (IQR, −9 to 1), mean common carotid, −12μm/3y (IQR, −26 to 4), maximal common carotid, −3μm/y (IQR, −8 to −1). This translated into 70% (7/10) of cases demonstrating composite mean CIMT below their expected chronologic age, gender and race-stratified vascular age. There was a strong direct correlation between the mean CIMT value at the end of the treatment period and the age of treatment initiation. In this cohort of primary and secondary prevention of patients with severe hypercholesterolemia, the overall rate of ASCVD was 37.5 per 1000 person-years while on lipoprotein apheresis.
Conclusions
Our observation performed in the clinical setting, demonstrated a real-world effectiveness of lipoprotein apheresis. This analysis supports implementation of aggressive lipid-modifying strategies across all ages. Surveillance with CIMT allows for continued monitoring of atherosclerosis progression and increases compliance with the lipid-modifying therapies in the high-risk patients with poor statin tolerance in the clinical setting.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): KUMC
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Dutton J, Zardab M, De Braal VJF, Hariharan D, MacDonald N, Hallworth S, Hutchins R, Bhattacharya S, Abraham A, Kocher HM, Yip VS. The accuracy of pre-operative (P)-POSSUM scoring and cardiopulmonary exercise testing in predicting morbidity and mortality after pancreatic and liver surgery: A systematic review. Ann Med Surg (Lond) 2020; 62:1-9. [PMID: 33489107 PMCID: PMC7804364 DOI: 10.1016/j.amsu.2020.12.016] [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: 11/09/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background Cardiopulmonary exercise-testing (CPET) and the (Portsmouth) Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity ((P)-POSSUM) are used as pre-operative risk stratification and audit tools in general surgery, however, both have been demonstrated to have limitations in major hepatopancreatobiliary (HPB) surgery. Materials and methods The aim of this review is to determine if CPET and (P)-POSSUM scoring systems accurately predict morbidity and mortality. Eligible articles were identified with an electronic database search. Analysis according to surgery type and tool used was performed. Results Twenty-five studies were included in the final review. POSSUM predicted morbidity demonstrated weighted O/E ratios of 0.75(95%CI0.57–0.97) in hepatic surgery and 0.85(95%CI0.8–0.9) in pancreatic surgery. P-POSSUM predicted mortality in pancreatic surgery demonstrated an O/E ratio of 0.75(95%CI0.27–2.13) and 0.94(95%CI0.57–1.55) in hepatic surgery. In both pancreatic and hepatic surgery an anaerobic threshold(AT) of between 9 0.5–11.5 ml/kg/min was predictive of post-operative complications, and in pancreatic surgery ventilatory equivalence of carbon dioxide(˙VE/˙VCO2) was predictive of 30-day mortality. Conclusion POSSUM demonstrates an overall lack of predictive fit for morbidity, whilst CPET variables provide some predictive power for post-operative outcomes. Development of a new HPB specific risk prediction tool would be beneficial; the combination of parameters from POSSUM and CPET, alongside HPB specific markers could overcome current limitations. Current pre-operative scoring for pancreatic and liver surgery is inaccurate. In pancreatic and liver surgery anaerobic threshold scores were predictive of complications. In pancreatic surgery ventilatory equivalence of carbon dioxide was predictive of mortality. P-POSSUM is inaccurate for predicting mortality and morbidity in pancreatic surgery.
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Dutton J, Zaleska-Kociecka M, Morosin M, Fernandez-Garda R, Garcia-Saez D, Simon A, Aw T, Lees N, Hurtado-Doce A. Heart transplantation outcomes in patients with continuous-flow left ventricular assist devices. J Cardiothorac Vasc Anesth 2019. [DOI: 10.1053/j.jvca.2019.07.084] [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: 11/11/2022]
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Giunta M, Morosin M, Dutton J, Recchia E, Lees N, Simon A, Scaramuzzi M. Cardiogenic shock treated with multiple mechanical circulatory support devices. J Cardiothorac Vasc Anesth 2019. [DOI: 10.1053/j.jvca.2019.07.044] [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: 11/11/2022]
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Dutton J, McLoughlin J, Garcia-Saez D, Lees N, Simon A, Hurtado-Doce A. Arrhythmias Following Lung Transplantation: A Single Centre Experience. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.811] [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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Player EL, Morris P, Thomas T, Chan WY, Vyas R, Dutton J, Tang J, Alexandre L, Forbes A. Bioelectrical impedance analysis (BIA)-derived phase angle (PA) is a practical aid to nutritional assessment in hospital in-patients. Clin Nutr 2018; 38:1700-1706. [PMID: 30170780 DOI: 10.1016/j.clnu.2018.08.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/01/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Nutritional status can be difficult to assess. Bioelectrical impedance analysis (BIA)-derived phase angle (PA), and the plasma markers citrulline and transthyretin (pre-albumin) have the potential to assist, but the protocol of fasting and resting for BIA renders the investigation impractical for routine use, especially so in populations at high risk of malnutrition. AIMS 1 To clarify whether starving and resting are necessary for reliable measurement of PA. 2 To identify whether PA, citrulline and transthyretin correlate with nutritional status. METHODS Eighty consenting adult in-patients were recruited. Nutritional status was determined by subjective global assessment (SGA) used as gold standard. The Malnutrition Universal Screening Tool (MUST) was used and anthropometric measurements were performed. Serum was analysed for citrulline and transthyretin. PA was measured using Bodystat 4000. The PA was considered to define malnutrition when lower than reference ranges for sex and age, and severe malnutrition if more than 2 integers below the lower limit. Anthropometric measurements were categorised according to WHO reference centiles. Ordinal logistic regression estimated the strength of association of PA, citrulline and transthyretin with SGA. PA values in the different metabolic states were compared using paired t tests. RESULTS All 80 subjects completed the BIA and the nutritional assessments in the 3 different states; 14 declined to provide blood samples for the biochemical assays. Malnutrition was identified in 32 cases, severe malnutrition in 14 cases, the remaining 34 cases were deemed not to be malnourished. PA was strongly inversely associated with SGA (Odds Ratio [OR] per unit increase = 0.21, CI 0.12-0.37, p < 0.001). PA was not influenced by exercise (p = 0.134) or food intake (p = 0.184). Transthyretin was inversely associated with malnourished/severely malnourished states (OR = 0.98, 95% CI 0.97-0.99, p = 0.001), but had poorer predictive values than PA. There was no significant association between citrulline concentration and SGA (OR = 1.01, 95% CI 0.99-1.04, p = 0.348). CONCLUSIONS The BIA-derived PA reliably identifies malnutrition. It is strongly associated with SGA but requires less skill and experience, and out-performs circulating transthyretin, rendering it a promising and less operator-dependent tool for assessing nutritional status in hospital patients. Our novel demonstration that fasting and bed-rest are unnecessary consolidates that position.
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Krishnathasan K, Ragavan A, Dutton J, Hernandez-Caballero C. P2479A retrospective review of patients requiring veno-arterial extracorporeal membrane oxygenation in a tertiary cardiothoracic centre. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2479] [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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Lenartova K, Dutton J, Moravcova S, Garcia Saez D, Simon A. Transplantation of hearts donated after circulatory death, single center experience. J Cardiothorac Vasc Anesth 2018. [DOI: 10.1053/j.jvca.2018.08.117] [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: 11/11/2022]
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Moriarty PM, Vaisar T, Dutton J, Denney LK, Hippe D, Heinecke JW, Zhao XQ. P5393The change in HDL proteomics following lipid-apheresis therapy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5393] [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: 11/13/2022] Open
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Sloan DJ, Mwandumba HC, Kamdolozi M, Shani D, Chisale B, Dutton J, Khoo SH, Allain TJ, Davies GR. Vitamin D deficiency in Malawian adults with pulmonary tuberculosis: risk factors and treatment outcomes. Int J Tuberc Lung Dis 2016; 19:904-11. [PMID: 26162355 PMCID: PMC4497634 DOI: 10.5588/ijtld.15.0071] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
SETTING: Vitamin D deficiency is common in African adults with tuberculosis (TB), and may be exacerbated by the metabolic effects of anti-tuberculosis drugs and antiretroviral therapy (ART). It is unclear whether vitamin D deficiency influences response to anti-tuberculosis treatment. OBJECTIVES: To describe risk factors for baseline vitamin D deficiency in Malawian adults with pulmonary TB, assess the relationship between serum 25-hydroxy vitamin D (25[OH]D) concentration and treatment response, and evaluate whether the administration of anti-tuberculosis drugs and ART is deleterious to vitamin D status during treatment. DESIGN: A prospective longitudinal cohort study. RESULTS: The median baseline 25(OH)D concentration of the 169 patients (58% human immunodeficiency virus [HIV] infected) recruited was 57 nmol/l; 47 (28%) had vitamin D deficiency (<50 nmol/l). Baseline 25(OH)D concentrations were lower during the cold season (P < 0.001), with food insecurity (P = 0.034) or in patients who consumed alcohol (P = 0.019). No relationship between vitamin D status and anti-tuberculosis treatment response was found. 25(OH)D concentrations increased during anti-tuberculosis treatment, irrespective of HIV status or use of ART. CONCLUSIONS: Vitamin D deficiency is common among TB patients in Malawi, but this does not influence treatment response. Adverse metabolic effects of drug treatment may be compensated by the positive impact of clinical recovery preventing exacerbation of vitamin D deficiency during anti-tuberculosis treatment.
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Sloan D, Guwende C, Banda G, Shani D, Kamdolozi M, Chisale B, Dutton J, Heyderman R, Butterworth A, Corbett E, Mwandumba H, Khoo S, Allain T, Davies G. S75 Risk Factors And Therapeutic Implications Of Vitamin D Deficiency In Malawian Adults With Pulmonary Tuberculosis. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Klot SV, Paciorek C, Melly S, Coull B, Dutton J, Peters A, Schwartz J. Association of daily temperature at residence with mortality in Eastern Massachusetts. DAS GESUNDHEITSWESEN 2010. [DOI: 10.1055/s-0030-1266354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hardy G, Worrell S, Hayes P, Barnett CM, Glass D, Pido-Lopez J, Imami N, Aspinall R, Dutton J, Gazzard B, Peters AM, Gotch FM. Evidence of thymic reconstitution after highly active antiretroviral therapy in HIV-1 infection. HIV Med 2004; 5:67-73. [PMID: 15012644 DOI: 10.1111/j.1468-1293.2004.00187.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We aimed to provide evidence of thymic reconstitution after highly active antiretroviral therapy (HAART) in HIV-1 infected patients and to correlate this with the restoration of peripheral naïve T cells. METHODS Positron emission tomography (PET) enables definitive evidence of thymic activity, indicating functional potential. In this case study, a single patient who initiated HAART demonstrated reconstitution of the naïve T-cell pool and underwent thymic PET scans at baseline and 2 and 6 months following initiation of therapy. Two patients who failed to demonstrate such reconstitution acted as controls. These patients (mean age 27 years) had chronic HIV infection with low CD4 T-cell counts (mean 82, range 9-160 cells/microL blood). Increased function of the thymus visualized by PET was correlated with phenotypic changes in CD4 and CD8 T cells in the periphery measured by flow cytometry, and with numbers of recent thymic emigrants measured by quantification of the numbers of T-cell receptor excision circles (TRECs) in peripheral cells. RESULTS In one patient, clear correlations could be drawn between visible activity within the thymus, as measured by increased [F18]fluorodeoxyglucose (FDG) uptake, and regeneration of naïve CD4 (CD45RA/CD62L) T cells, increased numbers of CD4 T cells, controlled viraemia and increased numbers of recent thymic emigrants. A second patient displayed no increase in peripheral CD4 count and no increase in thymic activity. The third patient elected to stop therapy following the 2-month time point. CONCLUSIONS The use of PET suggests that thymic activity may increase after HAART, indicating that the thymus has the potential to be functional even in HIV-1 infected persons with low CD4 T-cell counts.
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Baker JS, Bailey DM, Dutton J, Davies B. Catecholamine responses to high intensity cycle ergometer exercise: Body mass or body composition? J Physiol Biochem 2003; 59:77-83. [PMID: 14649873 DOI: 10.1007/bf03179873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to compare the sympathoadrenergic and metabolic responses following 30 s of maximal high intensity cycle ergometry exercise when cradle resistive forces were derived from total-body mass (TBM) or fat-free mass (FFM). Increases in peak power output (PPO) and pedal velocity were recorded when resistive forces reflected FFM (953 +/- 114 W vs 1020 +/- 134 W; 134 +/- 8 rpm vs 141 +/- 7 rpm ; P < 0.05). No differences were observed between mean power output (MPO), fatigue index (FI%), work done (WD) or heart rate (HR) when the TBM and FFM protocols were compared. There were no differences between the TBM and FFM protocols for adrenaline (A), noradrenaline (NA) or blood lactate concentrations ([La-]B) recorded at rest, immediately post or 24 h post exercise. However, increases in blood concentrations of A and NA (P < 0.05) were recorded for both the TBM and FFM protocol immediately post exercise. Significant correlations (P < 0.05) were recorded between PPOs, immediate post- exercise NA and [La-]B for both the TBM and FFM protocols. [La-]B levels were also significantly elevated (P < 0.01) immediately post exercise for both the TBM and FFM protocols. The results from this study suggest that greater peak power outputs are obtainable with no subsequent differences in neurophysiological or metabolic stress as determined by plasma A, NA and [La-]B concentrations when resistive forces reflect FFM and not TBM during loading procedures. The findings also indicate that immediate post exercise concentrations return to resting levels 24 h post exercise.
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Dutton J, Haydon SC, Jones FL. Formative time lags in the electrical breakdown of gases. ACTA ACUST UNITED AC 2002. [DOI: 10.1088/0508-3443/4/6/303] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Dutton J, Harris FM, Jones FL. The Determination of Attachment and Ionization Coefficients in Air. ACTA ACUST UNITED AC 2002. [DOI: 10.1088/0370-1328/81/1/311] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Dutton J, Jones FL, Palmer RW. Electrical Breakdown of Gases: Ionization Growth in Air at High Pressures. ACTA ACUST UNITED AC 2002. [DOI: 10.1088/0370-1328/78/4/310] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Davies DK, Dutton J, Jones FL. Secondary Ionization Processes in Hydrogen at High Gas Pressures. ACTA ACUST UNITED AC 2002. [DOI: 10.1088/0370-1328/72/6/315] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Dutton J, Evans NB, Morgan GB. Secondary ionization coefficients in oxygen at pressures up to atmospheric. ACTA ACUST UNITED AC 2002. [DOI: 10.1088/0508-3443/18/9/310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Dutton J, Morris WT. The mechanism of the electrical breakdown of air in uniform fields at voltages up to 400 kv. ACTA ACUST UNITED AC 2002. [DOI: 10.1088/0508-3443/18/8/311] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Dutton J, Hughes MH, Tan BC. Ionization coefficients in helium, neon and helium-neon mixtures. ACTA ACUST UNITED AC 2002. [DOI: 10.1088/0022-3700/2/8/310] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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