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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Varkoly K, Tan S, Beladi R, Fonseca D, Zanetti IR, Kraberger S, Shah C, Yaron JR, Zhang L, Juby M, Fath A, Ambadapadi S, House M, Maranian P, Pepine CJ, Varsani A, Moreb J, Schultz-Cherry S, Lucas AR. RNA Virus Gene Signatures Detected in Patients With Cardiomyopathy After Chemotherapy; A Pilot Study. Front Cardiovasc Med 2022; 9:821162. [PMID: 35360008 PMCID: PMC8962958 DOI: 10.3389/fcvm.2022.821162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Viral infections are pervasive and leading causes of myocarditis. Immune-suppression after chemotherapy increases opportunistic infections, but the incidence of virus-induced myocarditis is unknown. Objective An unbiased, blinded screening for RNA viruses was performed after chemotherapy with correlation to cardiac function. Methods High-throughput sequencing of RNA isolated from blood samples was analyzed following chemotherapy for hematological malignancies (N = 28) and compared with left ventricular ejection fraction (LVEF). Results On initial rigorous analysis, low levels of influenza orthomyxovirus and avian paramyxovirus sequences were detectable, but without significant correlation to LVEF (r = 0.208). A secondary broad data mining analysis for virus sequences, without filtering human sequences, detected significant correlations for paramyxovirus with LVEF after chemotherapy (r = 0.592, P < 0.0096). Correlations were similar for LVEF pre- and post- chemotherapy for orthomyxovirus (R = 0.483, P < 0.0421). Retrovirus detection also correlated with LVEF post (r = 0.453, p < 0.0591), but not pre-chemotherapy, but is suspect due to potential host contamination. Detectable phage and anellovirus had no correlation. Combined sequence reads (all viruses) demonstrated significant correlation (r = 0.621, P < 0.0078). Reduced LVEF was not associated with chemotherapy (P = NS). Conclusions This is the first report of RNA virus screening in circulating blood and association with changes in cardiac function among patients post chemotherapy, using unbiased, blinded, high-throughput sequencing. Influenza orthomyxovirus, avian paramyxovirus and retrovirus sequences were detectable in patients with reduced LVEF. Further analysis for RNA virus infections in patients with cardiomyopathy after chemotherapy is warranted.
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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] [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] [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] [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] [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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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] [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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Dickinson KJ, Caldwell KE, Graviss EA, Nguyen DT, Awad MM, Tan S, Winer JH, Pei KY. Assessing learner engagement with virtual educational events: Development of the Virtual In-Class Engagement Measure (VIEM). Am J Surg 2021; 222:1044-1049. [PMID: 34602277 DOI: 10.1016/j.amjsurg.2021.09.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The COVID-19 pandemic has necessitated virtual education, but effects on learner engagement are unknown. We developed a virtual in-class engagement measure (VIEM) to assess learner engagement in online surgical education events. METHODS Using the STROBE, an observer collected tool to document student engagement, as a template an ASE committee workgroup developed the VIEM. The VIEM had two parts: observer assessment and learner self-assessment of engagement. Trained observers collected engagement data from two institutions using the VIEM. Surgical attendings, fellows and residents were observed during virtual learning events. Educator attitudes towards online teaching were also assessed via survey. RESULTS 22 events with 839 learners were observed. VIEM distinguished between sessions with low and high engagement. 20% of learners pretended to participate. Half of instructors were comfortable with virtual teaching, but only 1/3 believed was as effective as in-person. 2/3 of teachers believed video learners were more engaged than audio learners. CONCLUSIONS Virtual platforms do not automatically translate into increased engagement. Standard tools such as VIEM may help with assessment of engagement during virtual education.
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Xiong J, Yang J, Li W, Xiong H, Liu G, Wu F, Fan N, Zeng X, Huang F, Yang L, Tu X, Shi C, Yi B, Ye J, Li P, Tang C, Huang J, Hou P, Zang W, Tan S. 1411P A prospective, multicenter, real-world study of apatinib in the treatment of gastric cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Hatirnaz S, Hatirnaz E, Dahan M, Ata B, Basbug A, Hatirnaz K, Tan S. P–709 Dual stimulation in-vitro-maturation (Duostim IVM) for overcoming oocyte maturation arrest, resulting in embryo transfer and livebirth. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Does luteal phase followed by follicular phase letrozole priming and dual oocyte retrieval for in-vitro maturation (IVM) overcome oocyte maturation arrest (OMA)?
Summary answer
Oocyte maturation, fertilization,embryo cryopreservation and livebirth can be achieved with letrozole priming IVM in rare cases of OMA.
What is known already
OMA is an intractable problem resulting in only immature oocytes being collected and to date no succesful treatment exists. Attempts to mature oocytes collected in stimulated IVF cycles with OMA have so far failed. Cases with OMA can be due to intrinsic oocyte defects, intrafollicular factors or resistance to stimulation.
Study design, size, duration
Six women with OMA in ≥ 2 prior stimulated IVF cycles were treated between March 2019 and December 2020.
Participants/materials, setting, methods
Participants had total of 18 (range 2 - 6) prior IVF cycles yielding only 166 immature oocytes. Letrozole 5mg was given days 15–18 of ovulatory cycle; SC decapeptyl 0.1mg trigger given at follicles 12 mm, 38 hours<OPU. After menstruation, letrozole 5mg days 3–7; SChCG 250ug when follicles=12 mm 38 hours<OPU. After in-vitro-maturation oocytes reaching MII were fertilized. Embryos from luteal collection were frozen and fresh embryo transfer was attempted after follicular phase collection.
Main results and the role of chance
Six women underwent DuoStim IVM, median (quartiles) 3.5 (0 - 9) GV and 0.5 (0 - 2) MI oocytes were collected from luteal phase OC and 0 (0 - 0) GV and 2(0 – 4.5) MI oocytes were collected from follicular phase OC. They had a total of 166 immature oocytes collected in prior IVF cycles. There were no MII oocytes at the time of collection in any cycles.0 (0 – 3.5) oocytes matured from luteal phase OC and 1 (0 – 4) from follicular phase OC. 0 (0 – 1.5) embryos were available from luteal phase and 0 (0 - 2) from follicular phase OC.Two subjects (29 and 33 years old) underwent fresh DET and the 29 year old with 2 previous failed IVF cycles achieved a livebirth (50% per ET and 16.7% per started cycle). None of the women who did not have an embryo for fresh transfer from the follicular phase collection had an embryo from the luteal phase collection. The same 29 year old has 2 luteal phase and 2 more follicular phase embryos vitrified.
Limitations, reasons for caution
OMA is a rare condition with a variety of etiologies. Different etiologies can require different managements.
Wider implications of the findings: It may be possible to overcome OMA with letrozole IVM in rare cases. This case is the first recorded live birth. The value of dual stimulation overcoming OMA remains uncertain.
Trial registration number
This study is approved by the local ethical commitee of Medicana Samsun International Hospital by a Grant number of 02/05.02.2020: registration is not required due to retrospective status
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Elerian S, Singh T, Jagodzinski NA, Norris R, Tan S, Power D, Jones J, Rajaratnam V. 173 Early Results of a Variable-Angle Volar Locking Plate for Distal Radius Fractures: A Bi-Centre Study. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
This study examines the clinical, functional and radiological outcomes of distal radius fracture fixation with the Aptus® (Medartis, Pennsylvania) locking plate in order to determine its efficacy and to identify notable findings related to treatment variations.
Method
This is a retrospective bi-centre study collecting patient details from a District General Hospital and a Regional Hand Unit. We assessed 61 consecutive patients with distal radius fractures (AO grade A = 19, B = 9, C = 33) fixed using Aptus® plate with a minimum of six months follow-up. Outcome measures included the DASH score, wrist range of movement and grip strength, and complications. Radiographs were reviewed to assess restoration of anatomy and union.
Results
All but two fractures united within six weeks. Mean ranges of movement were only mildly restricted compared to the normal wrist (flexion/extension = 102°; radial/ulna deviation = 53°; pronation/supination = 169°). Mean postoperative grip strength was 23.8kg which was comparable to the contralateral side at 31.5kg. The mean DASH score was 18.2. Seven patients had screws misplaced outside the distal radius although three of these remained asymptomatic.
Conclusions
Variable-angle locking systems benefit from flexibility of implant positioning and may allow enhanced inter-fragmentary reduction for accurate fixation of intra-articular fractures.
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Tan S, Hoggett L, Choudry Q, Aithal S, Bokhari A. P22: CONSERVATIVE MANAGEMENT OF NECK OF FEMUR FRACTURES. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
According to NICE CG124, the gold standard of treatment for neck of femur (NOF) fractures is operative management on the day or day after admission. In practice, this is not always achievable depending on various factors, e.g. patient preference, clinical condition and theatre availability, with a further subset of patients undergoing conservative management.
Method
A retrospective analysis was performed on all NOF fractures managed non-operatively at a single centre from January 2017 to August 2019 by case notes analysis and review of radiographical images. Demographics, fracture type, pre-fracture mobility status, co-morbidities, mortality and Nottingham Hip Fracture Score (NHFS) are reported. Where applicable, our dataset is correlated with the National Hip Fracture Database for comparison.
Result
24 patients were included in the study period, with a mean age of 79.9 years (range 54-99 years) and male:female ratio of 0.85:1. The mean NHFS (n=18) was 5.7 (range 3-8) and at least 62.5% (n=15) were deemed unfit for surgery or arrested pre-operatively. Conservatively managed NOF fractures are associated with a 30-day mortality of 41.7% compared to the centre average of 8.2% and national average of 6.9% for all NOF fractures. Overall mortality within 1 year is 95.5% (n=22).
Conclusion
Our study confirms that the conservative management of NOF fractures is associated with high mortality, however it may be the only treatment option acceptable in patients who are limited by unfavourable clinical conditions. Therefore, the decision for conservative management in NOF fractures requires careful consideration with the need for an established decision-making pathway.
Take-home message
The conservative management of neck of femur fractures is associated with high mortality, therefore requires careful consideration with the need for an established decision-making pathway.
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Shen X, Sha W, Yang C, Pan Q, Cohen T, Cheng S, Cai Q, Kan X, Zong P, Zeng Z, Tan S, Liang R, Bai L, Xia J, Wu S, Sun P, Wu G, Cai C, Wang X, Ai K, Liu J, Yuan Z. Continuity of TB services during the COVID-19 pandemic in China. Int J Tuberc Lung Dis 2021; 25:81-83. [PMID: 33384053 DOI: 10.5588/ijtld.20.0632] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Yang WW, Li L, Tan S, Liu ZY, Jiang Y. Correlation analysis of Helicobacter pylori infection, inflammatory activity and serum high sensitivity C-reactive protein level in elderly patients with chronic gastritis. J BIOL REG HOMEOS AG 2021; 34:1897-1900. [PMID: 33169600 DOI: 10.23812/20-353-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tan S, Moir S, Seneviratne S. Connective Tissue Disease Associated Myocarditis Manifesting as Myocardial Hypoattenuation on Coronary CTA. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Goel V, Spear E, Cameron W, Thakur U, Sultana N, Chan J, Tan S, Brown A, Nicholls S, Nerlekar N. Is Epicardial Adipose Tissue Associated With Breast Arterial Calcification? Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tan S, Thang Y, Chan J, Goel V, Mulley W, Polkinghorne K, Ramkumar S, Cheng K, Rehmani H, Brown A, Moir S, Cameron J, Nicholls S, Mottram P, Nerlekar N. Prognostic Value of Exercise Capacity in Renal Transplant Candidates. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tan S, Abrahams T, Splatt L, Ho B. Thrombosis of Mechanical Mitral Valve Prosthesis Treated With Fibrinolysis. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Splatt L, Abrahams T, Tan S, Pol D, Brown A. Outcomes of Patients with Complete Recanalisation Following Successful Thrombolysis for ST Elevation Myocardial Infarction. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tan S, Chan J, Thakur U, Thein P, Muthalaly R, Talman A, Dey D, Brown A, Wu A, Seneviratne S, Cameron J, Wong D, Nerlekar N. Inter-Software and Inter-Scan Variability Amongst Post-Processing Software Platforms in Measurement of Epicardial Adipose Tissue. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tan S, Zhou F, Zhang Z, Zhuang Q, Meng Q, Xi Q, Jiang Y, Wu G. Beta-1 blocker reduces inflammation and preserves intestinal barrier function after open abdominal surgery. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Chen XD, Liu SX, Shan YL, Cai W, Tan S, Hu MY, Lu ZZ. [The proatherogenic effect of high salt diet combined with focal hypoperfusion on spontaneous hypertension rat]. ZHONGHUA YI XUE ZA ZHI 2020; 100:3407-3413. [PMID: 33238670 DOI: 10.3760/cma.j.cn112137-20200806-02292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the histopathology, monocytes phenotypes and brain mRNA transcription of angiogenic and atherogenic factors preliminarily in spontaneous hypertensive rats (SHRs) fed with high salt diet and subjected to chronic focal hypoperfusion. Methods: A total of 21 SHRs were randomly assigned into SHR with normal diet (SHR-ND group, n=7), SHR fed with high salt (8%) chows (SHR-HSD group, n=14) groups. After induction of high salt diet for 20 weeks, unilateral carotid artery occlusion was applied to one half of SHR-HSD (SHR-HSD-UCAO, n=7) group for 10 weeks to mimic chronic focal cerebral hypoperfusion. The neuropathology, monocytes phenotypes and brain transcription of fibroblast growth factor (FGF-b), platelet-derived endothelial cell growth factor (PD-ECGF), angiogenin (ANG), transforming growth factor-β (TGF-β) and vascular endothelial growth factor A (VEGF-A) among three groups were compared. Results: The systolic blood pressure ((246±12) mmHg vs (220±16) mmHg, P=0.0291, 1 mmHg=0.133 kPa) and diastolic blood pressure ((189±15) mmHg vs (164±12) mmHg, P=0.0143) of SHR-HSD group were elevated significantly compared with those of SHR-ND group. Compared with normotensive Wistar-Kyoto (WKY), SHR-ND, SHR-HSD and SHR-HSD-UCAO groups demonstrated lipohyalinosis, vessel wall thickening, lumen narrowing and multiple enlarged perivascular space and diffuse disarrangement of nerve fiber and myelin vacuolation in corpus callosum pathologically. The ratio of CD11b(+) CD68(+) monocytes in peripheral blood of SHR-HSD group was higher compared with both SHR-ND and SHR-HSD-UCAO groups (P=0.000 8). The mean inflorescence index (MFI) of CD86 and CD206 showd considerable decline in SHR-HSD-UCAO group compared with those of SHR-HSD group (P=0.018 7 and 0.016 8, respectively). The CD86 MFI of CD11b+CD68+ monocytes in SHR-HSD-UCAO group was remarkably higher than that of SHR-ND and SHR-HSD groups (P=0.000 5). Compared with SHR-ND and SHR-HSD groups, the brain mRNA transcription of angiogenic factors including PD-ECGF and ANG were down-regulated (P=0.004 6 and 0.000 2, respectively), while the atherogenic factors including TGF-β and VEGF-A were up-regulated in SHR-HSD-UCAO group (P<0.000 1 and P=0.045, respectively). Conclusion: SHR-HSD-UCAO group shares the pathophysiological characteristics with advanced stage arteriosclerotic cerebral small vessel disease (aCSVD), including neuropathology, imbalanced circulating monocytes phenotypes and down-regulated angiogenic factors.
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Rashid H, Michail M, Khav N, Tan S, Nasis A, Cameron J, Nicholls S, Gooley R. Association between prosthesis geometry and leaflet thrombosis following transcatheter aortic valve replacement. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1929] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Leaflet thrombosis (LT) following transcatheter aortic valve replacement (TAVR) is a recognised condition. The association between prosthesis geometry [expansion, implant depth and commissural alignment (CA)] and LT is unclear.
Methods
Patients that received intra-annular TAVR prosthesis and post-procedure computed tomography (CT) with a 320-slice scanner were included. LT, defined as at least 50% restricted leaflet motion, was assessed with a dedicated 3Mensio workstation by two experienced CT readers. Prosthesis expansion was defined as actual divided by expected prosthesis area as a percentage of expected area whilst eccentricity was [(maximum diameter − minimum diameter) / maximum diameter) × 100%], both measured at prosthesis inflow, annulus and outflow. Implant depth was the average distance between prosthesis inflow and nadir of each cusp. CA was the average angle between each native and prosthesis leaflet coaptations. Significant commissural misalignment (CMA) was defined as CA greater than 30 degrees. To exclude anticoagulation bias, similar analysis was also performed in the cohort of non-anticoagulated patients.
Results
117 patients were included; the prevalence of LT was 13.7% [13/93 cases (14.0%) of Lotus valves and 3/24 cases (12.5%) of Sapien 3 valves]. Baseline demographics (age, STS score, cardiac risk factors) and procedural characteristics (access site, post-dilation, repositioning) were similar in both groups. None of the patients with LT were discharged on anticoagulation therapy (0.0% vs 22.8%, p<0.01). There were no differences in actual prosthesis area, perimeter or eccentricity at the three prosthesis levels. Patients with LT had reduced annulus expansion (89.3±9.8% vs 94.6±8.3%, p=0.02), lower implant depth (6.9±1.5mm vs 4.9±1.5mm, p<0.01) and more significant CMA (81.3% vs 48.5%, p=0.02). These findings were similar in patients that were not anticoagulated (94/117 patients).
Conclusion
Patients with LT had reduced annulus expansion, lower implant depth and greater CMA. These findings were not affected by presence or absence of anticoagulation. These factors may be important considerations during procedural planning for TAVR.
Graphical abstract
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Health and Medical Research Council (NHMRC). National Heart Foundation (NHF) Australia.
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Narasimhan V, Tan S, Kong J, Pham T, Michael M, Ramsay R, Warrier S, Heriot A. Prognostic factors influencing survival in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for isolated colorectal peritoneal metastases: a systematic review and meta-analysis. Colorectal Dis 2020; 22:1482-1495. [PMID: 32027455 DOI: 10.1111/codi.15003] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/15/2019] [Indexed: 12/13/2022]
Abstract
AIM Peritoneal metastases from colorectal cancer confer the worst survival among all metastatic sites. The adoption of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) can offer selected patients with isolated colorectal peritoneal metastases (CRPM) a favourable long-term survival. There are numerous factors postulated to influence survival in patients undergoing CRS and HIPEC. The aim of this study was to identify the key perioperative prognostic factors that influence survival in patients undergoing CRS and HIPEC for isolated CRPM. METHOD A systematic review and meta-analysis were conducted to evaluate prognostic factors influencing survival in patients undergoing CRS and HIPEC for isolated CRPM. RESULTS Thirty-three studies fitted the inclusion criteria for the systematic review, with 25 studies included in the meta-analysis. On pooled analysis, incomplete cytoreduction, increasing peritoneal carcinoma index (PCI) and lymph node involvement were significantly associated with a worse survival. Additionally, a rectal primary [hazard ratio (HR) 1.93, 95% CI 1.10-3.37], adjuvant chemotherapy (HR 0.71, 95% CI 0.54-0.93) and perioperative grade III/IV morbidity (HR 1.59, 95% CI 1.17-2.16) were also found to significantly influence survival. Notably, tumour differentiation and signet ring cell histology did not influence survival on pooled analysis. CONCLUSION This meta-analysis confirms that in patients undergoing CRS and HIPEC for isolated CRPM, incomplete cytoreduction, high PCI and lymph node involvement have a negative influence on survival. In addition, a rectal primary, adjuvant chemotherapy use and grade III/IV morbidity are important factors that also significantly influence survival.
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