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Wong S, Hirani S, Forbes A, Kumar N, Hariharan R, O'Driscoll J, Viswanathan A, Harvey G, Sekhar R, Jamous A. Effect of lactobacillus casei shirota in preventing antibiotic associated diarrhoea including clostridium difficile infection in patients with spinal cord injuries: a multicentre randomised, double-blinded, placebo-controlled trial. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.025] [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: 10/19/2022]
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Raposo N, Zanon Zotin MC, Schoemaker D, Xiong L, Fotiadis P, Charidimou A, Pasi M, Boulouis G, Schwab K, Schirmer MD, Etherton MR, Gurol ME, Greenberg SM, Duering M, Viswanathan A. Peak Width of Skeletonized Mean Diffusivity as Neuroimaging Biomarker in Cerebral Amyloid Angiopathy. AJNR Am J Neuroradiol 2021; 42:875-881. [PMID: 33664113 DOI: 10.3174/ajnr.a7042] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/20/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Whole-brain network connectivity has been shown to be a useful biomarker of cerebral amyloid angiopathy and related cognitive impairment. We evaluated an automated DTI-based method, peak width of skeletonized mean diffusivity, in cerebral amyloid angiopathy, together with its association with conventional MRI markers and cognitive functions. MATERIALS AND METHODS We included 24 subjects (mean age, 74.7 [SD, 6.0] years) with probable cerebral amyloid angiopathy and mild cognitive impairment and 62 patients with MCI not attributable to cerebral amyloid angiopathy (non-cerebral amyloid angiopathy-mild cognitive impairment). We compared peak width of skeletonized mean diffusivity between subjects with cerebral amyloid angiopathy-mild cognitive impairment and non-cerebral amyloid angiopathy-mild cognitive impairment and explored its associations with cognitive functions and conventional markers of cerebral small-vessel disease, using linear regression models. RESULTS Subjects with Cerebral amyloid angiopathy-mild cognitive impairment showed increased peak width of skeletonized mean diffusivity in comparison to those with non-cerebral amyloid angiopathy-mild cognitive impairment (P < .001). Peak width of skeletonized mean diffusivity values were correlated with the volume of white matter hyperintensities in both groups. Higher peak width of skeletonized mean diffusivity was associated with worse performance in processing speed among patients with cerebral amyloid angiopathy, after adjusting for other MRI markers of cerebral small vessel disease. The peak width of skeletonized mean diffusivity did not correlate with cognitive functions among those with non-cerebral amyloid angiopathy-mild cognitive impairment. CONCLUSIONS Peak width of skeletonized mean diffusivity is altered in cerebral amyloid angiopathy and is associated with performance in processing speed. This DTI-based method may reflect the degree of white matter structural disruption in cerebral amyloid angiopathy and could be a useful biomarker for cognition in this population.
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Affiliation(s)
- N Raposo
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts .,Department of Neurology (N.R.), Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse NeuroImaging Center (N.R.), Université de Toulouse, Institut National de la Santé et de la Recherche Médicale, Toulouse, UPS, France
| | - M C Zanon Zotin
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Center for Imaging Sciences and Medical Physics (M.C.Z.Z.). Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil;, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil
| | - D Schoemaker
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - L Xiong
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - P Fotiadis
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - A Charidimou
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - M Pasi
- Department of Neurology (M.P.), Centre Hospitalier Universitaire de Lille, Lille, France
| | - G Boulouis
- Department of Neuroradiology (G.B.), Centre Hospitalier Sainte-Anne, Université Paris-Descartes, Paris, France
| | - K Schwab
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - M D Schirmer
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Computer Science and Artificial Intelligence Lab (M.D.S.), Massachusetts Institute of Technology, Boston, Massachusetts.,Department of Population Health Sciences (M.D.S.), German Center for Neurodegenerative Diseases, Bonn, Germany
| | - M R Etherton
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - M E Gurol
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - S M Greenberg
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - M Duering
- Medical Image Analysis Center and Quantitative Biomedical Imaging Group (M.D.), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - A Viswanathan
- From the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Yu AT, Regenhardt RW, Whitney C, Schwamm LH, Patel AB, Stapleton CJ, Viswanathan A, Hirsch JA, Lev M, Leslie-Mazwi TM. CTA Protocols in a Telestroke Network Improve Efficiency for Both Spoke and Hub Hospitals. AJNR Am J Neuroradiol 2021; 42:435-440. [PMID: 33541900 DOI: 10.3174/ajnr.a6950] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/03/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Telestroke networks support screening for patients with emergent large-vessel occlusions who are eligible for endovascular thrombectomy. Ideal triage processes within telestroke networks remain uncertain. We characterize the impact of implementing a routine spoke hospital CTA protocol in our integrated telestroke network on transfer and thrombectomy patterns. MATERIALS AND METHODS A protocol-driven CTA process was introduced at 22 spoke hospitals in November 2017. We retrospectively identified prospectively collected patients who presented to a spoke hospital with National Institutes of Health Stroke Scale scores ≥6 between March 1, 2016 and March 1, 2017 (pre-CTA), and March 1, 2018 and March 1, 2019 (post-CTA). We describe the demographics, CTA utilization, spoke hospital retention rates, emergent large-vessel occlusion identification, and rates of endovascular thrombectomy. RESULTS There were 167 patients pre-CTA and 207 post-CTA. The rate of CTA at spoke hospitals increased from 15% to 70% (P < .001). Despite increased endovascular thrombectomy screening in the extended window, the overall rates of transfer out of spoke hospitals remained similar (56% versus 54%; P = .83). There was a nonsignificant increase in transfers to our hub hospital for endovascular thrombectomy (26% versus 35%; P = .12), but patients transferred >4.5 hours from last known well increased nearly 5-fold (7% versus 34%; P < .001). The rate of endovascular thrombectomy performed on patients transferred for possible endovascular thrombectomy more than doubled (22% versus 47%; P = .011). CONCLUSIONS Implementation of CTA at spoke hospitals in our telestroke network was feasible and improved the efficiency of stroke triage. Rates of patients retained at spoke hospitals remained stable despite higher numbers of patients screened. Emergent large-vessel occlusion confirmation at the spoke hospital lead to a more than 2-fold increase in thrombectomy rates among transferred patients at the hub.
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Affiliation(s)
- A T Yu
- From the Departments of Neurology (A.T.Y., R.W.R., C.W., L.H.S., A.V., T.M.L.-M.)
| | - R W Regenhardt
- From the Departments of Neurology (A.T.Y., R.W.R., C.W., L.H.S., A.V., T.M.L.-M.)
| | - C Whitney
- From the Departments of Neurology (A.T.Y., R.W.R., C.W., L.H.S., A.V., T.M.L.-M.)
| | - L H Schwamm
- From the Departments of Neurology (A.T.Y., R.W.R., C.W., L.H.S., A.V., T.M.L.-M.)
| | - A B Patel
- Neurosurgery (R.W.R., A.B.P., C.J.S., T.M.L.-M.)
| | | | - A Viswanathan
- From the Departments of Neurology (A.T.Y., R.W.R., C.W., L.H.S., A.V., T.M.L.-M.)
| | - J A Hirsch
- Department of Radiology (J.A.H., M.L.), Massachusetts General Hospital, Boston, Massachusetts
| | - M Lev
- Department of Radiology (J.A.H., M.L.), Massachusetts General Hospital, Boston, Massachusetts
| | - T M Leslie-Mazwi
- From the Departments of Neurology (A.T.Y., R.W.R., C.W., L.H.S., A.V., T.M.L.-M.).,Neurosurgery (R.W.R., A.B.P., C.J.S., T.M.L.-M.)
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Patel N, Viswanathan A, Lee J, Barrow S, Cant A, Sanghvi R, Deseta M, Layton J, Bhujel N, Sheehy EC. Paediatric dental A&E service during the COVID-19 pandemic in the Greater London area. Eur Arch Paediatr Dent 2021; 22:507-513. [PMID: 33389688 PMCID: PMC7778697 DOI: 10.1007/s40368-020-00589-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 09/19/2020] [Accepted: 11/18/2020] [Indexed: 10/26/2022]
Abstract
PURPOSE The UK government introduced a nationwide lockdown on the 23rd March 2020 to prevent the spread of COVID-19. All elective hospital and dental practice assessments and procedures were mandated to stop. Key hospital dental workers were required to work, and Guy's and St Thomas' NHS Foundation Trust became a designated Urgent Dental Care Centre (UDC) for the greater London area. The paediatric dental emergency walk-in service was suspended and replaced with a telephone triage system and evaluation of digital images sent by parents/carers when needed. The aim of this paper is to describe the emergency service provided by staff in the department of Paediatric Dentistry at St Thomas' Hospital during the first lockdown. METHODS A prospective service evaluation of the modified paediatric dental emergency service was carried out between 25th March and 29th May 2020. RESULTS Four-hundred and sixty-four patients accessed the paediatric dental emergency service via telephone during the service evaluation period. Of these, 192 (41%) had dental pain, 121 (26%) had pain and swelling of dental origin, and 89 (19%) had trauma. CONCLUSIONS Remote telephone consultations and digital photographs were useful to screen emergency paediatric dental patients, but lack of face-to-face consultations with radiographic assessment and access to general anaesthetic services were major limiting factors.
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Affiliation(s)
- N Patel
- Guy's and St Thomas' Hospitals NHS Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - A Viswanathan
- Guy's and St Thomas' Hospitals NHS Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - J Lee
- Guy's and St Thomas' Hospitals NHS Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - S Barrow
- Guy's and St Thomas' Hospitals NHS Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - A Cant
- Guy's and St Thomas' Hospitals NHS Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - R Sanghvi
- Guy's and St Thomas' Hospitals NHS Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - M Deseta
- Guy's and St Thomas' Hospitals NHS Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - J Layton
- Guy's and St Thomas' Hospitals NHS Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - N Bhujel
- Guy's and St Thomas' Hospitals NHS Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - E C Sheehy
- Guy's and St Thomas' Hospitals NHS Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
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Beavis A, Rositch A, Romero-Sackey A, Viswanathan A, Fader A, Stone R, Wethington S, Levinson K. The effect of multidisciplinary team integration on treatment completion disparities in women undergoing treatment for cervical cancer. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.272] [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: 11/29/2022]
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Chopra S, Mittal P, Viswanathan A, Tharavichitkul E, Zubizarreta E, Nout RA, Yap ML, Grover S, Rodin D, Rai B, Gondhowiardjo S, Shrivastava SK. Global Collaborations for Cervical Cancer: Can the East-West Alliance Facilitate Treatment for all? Clin Oncol (R Coll Radiol) 2019; 31:529-538. [PMID: 31229379 DOI: 10.1016/j.clon.2019.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 04/24/2019] [Revised: 05/11/2019] [Accepted: 05/28/2019] [Indexed: 12/20/2022]
Abstract
Despite the advances in the primary prevention of cervical cancer, there is an absolute increase in the incidence of cervical cancer as a result of an increase in world population. A vast majority of patients in low and low-middle income countries continue to present at a locally advanced stage, necessitating treatment with chemoradiation and brachytherapy. There is a dearth of equipment and trained professionals for the treatment of cervical cancer, especially in low and low-middle income countries. There is an urgent need to improve treatment availability and develop better treatments. Worldwide trends, however, reveal a low number of therapeutic and innovative research trials in cervical cancer. The present article elucidates the existing challenges and provides solutions to improve outcomes. The proposed strategies hinge on strengthening collaborations for global advocacy.
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Affiliation(s)
- S Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Navi Mumbai, India; Homi Bhabha National Institute, Mumbai, India.
| | - P Mittal
- Homi Bhabha National Institute, Mumbai, India; Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
| | - A Viswanathan
- Department of Radiation Oncology, Johns Hopkins University Medical Center, Baltimore, Maryland, USA
| | - E Tharavichitkul
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - E Zubizarreta
- Division of Human Health, International Atomic of Energy Agency - Vienna International Centre, Vienna, Austria
| | - R A Nout
- Department of Radiation Oncology, Leiden University Medical Center LUM, Leiden, the Netherlands
| | - M L Yap
- Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), Ingham Institute, UNSW Sydney, Liverpool, New South Wales, Australia; Liverpool and Macarthur Cancer Therapy Centres, Western Sydney University, Campbelltown, New South Wales, Australia; School of Public Health, The University of Sydney, Camperdown, Australia
| | - S Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA; Botswana-UPENN Partnership, University of Botswana, Gaborone, Botswana
| | - D Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - B Rai
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Gondhowiardjo
- Department of Radiotherapy, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - S K Shrivastava
- Department of Radiation Oncology, Apollo Hospital, Belapur, Navi Mumbai, India
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Chopra S, Viswanathan A, Mittal P, Laskar SG, Reddy VA, Nair R, Bajpai J, Chaukar D, Gupta S, Cruz AD, Badwe R. Reducing Gender Disparity in Oncologists in India: An Opportunity to Address Workforce Challenges. Clin Oncol (R Coll Radiol) 2018; 30:805-809. [PMID: 30243557 DOI: 10.1016/j.clon.2018.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/11/2018] [Accepted: 08/17/2018] [Indexed: 11/16/2022]
Affiliation(s)
- S Chopra
- Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India.
| | - A Viswanathan
- Johns Hopkins University Medical Centre, Baltimore, Maryland, USA
| | - P Mittal
- Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S G Laskar
- Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V A Reddy
- Apollo Cancer Hospital, Hyderabad, India
| | - R Nair
- Tata Medical Centre, Kolkata, India
| | - J Bajpai
- Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - D Chaukar
- Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Gupta
- Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - A D Cruz
- Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - R Badwe
- Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Redondo MJ, Geyer S, Steck AK, Sharp S, Wentworth JM, Weedon MN, Antinozzi P, Sosenko J, Atkinson M, Pugliese A, Oram RA, Antinozzi P, Atkinson M, Battaglia M, Becker D, Bingley P, Bosi E, Buckner J, Colman P, Gottlieb P, Herold K, Insel R, Kay T, Knip M, Marks J, Moran A, Palmer J, Peakman M, Philipson L, Pugliese A, Raskin P, Rodriguez H, Roep B, Russell W, Schatz D, Wherrett D, Wilson D, Winter W, Ziegler A, Benoist C, Blum J, Chase P, Clare-Salzler M, Clynes R, Eisenbarth G, Fathman C, Grave G, Hering B, Kaufman F, Leschek E, Mahon J, Nanto-Salonen K, Nepom G, Orban T, Parkman R, Pescovitz M, Peyman J, Roncarolo M, Simell O, Sherwin R, Siegelman M, Steck A, Thomas J, Trucco M, Wagner J, Greenbaum ,CJ, Bourcier K, Insel R, Krischer JP, Leschek E, Rafkin L, Spain L, Cowie C, Foulkes M, Krause-Steinrauf H, Lachin JM, Malozowski S, Peyman J, Ridge J, Savage P, Skyler JS, Zafonte SJ, Kenyon NS, Santiago I, Sosenko JM, Bundy B, Abbondondolo M, Adams T, Amado D, Asif I, Boonstra M, Bundy B, Burroughs C, Cuthbertson D, Deemer M, Eberhard C, Fiske S, Ford J, Garmeson J, Guillette H, Browning G, Coughenour T, Sulk M, Tsalikan E, Tansey M, Cabbage J, Dixit N, Pasha S, King M, Adcock K, Geyer S, Atterberry H, Fox L, Englert K, Mauras N, Permuy J, Sikes K, Berhe T, Guendling B, McLennan L, Paganessi L, Hays B, Murphy C, Draznin M, Kamboj M, Sheppard S, Lewis V, Coates L, Moore W, Babar G, Bedard J, Brenson-Hughes D, Henderson C, Cernich J, Clements M, Duprau R, Goodman S, Hester L, Huerta-Saenz L, Karmazin A, Letjen T, Raman S, Morin D, Henry M, Bestermann W, Morawski E, White J, Brockmyer A, Bays R, Campbell S, Stapleton A, Stone N, Donoho A, Everett H, Heyman K, Hensley H, Johnson M, Marshall C, Skirvin N, Taylor P, Williams R, Ray L, Wolverton C, Nickels D, Dothard C, Hsiao B, Speiser P, Pellizzari M, Bokor L, Izuora K, Abdelnour S, Cummings P, Paynor S, Leahy M, Riedl M, Shockley S, Karges C, Saad R, Briones T, Casella S, Herz C, Walsh K, Greening J, Hay F, Hunt S, Sikotra N, Simons L, Keaton N, Karounos D, Oremus R, Dye L, Myers L, Ballard D, Miers W, Sparks R, Thraikill K, Edwards K, Fowlkes J, Kinderman A, Kemp S, Morales A, Holland L, Johnson L, Paul P, Ghatak A, Phelen K, Leyland H, Henderson T, Brenner D, Law P, Oppenheimer E, Mamkin I, Moniz C, Clarson C, Lovell M, Peters A, Ruelas V, Borut D, Burt D, Jordan M, Leinbach A, Castilla S, Flores P, Ruiz M, Hanson L, Green-Blair J, Sheridan R, Wintergerst K, Pierce G, Omoruyi A, Foster M, Linton C, Kingery S, Lunsford A, Cervantes I, Parker T, Price P, Urben J, Doughty I, Haydock H, Parker V, Bergman P, Liu S, Duncum S, Rodda C, Thomas A, Ferry R, McCommon D, Cockroft J, Perelman A, Calendo R, Barrera C, Arce-Nunez E, Lloyd J, Martinez Y, De la Portilla M, Cardenas I, Garrido L, Villar M, Lorini R, Calandra E, D’Annuzio G, Perri K, Minuto N, Malloy J, Rebora C, Callegari R, Ali O, Kramer J, Auble B, Cabrera S, Donohoue P, Fiallo-Scharer R, Hessner M, Wolfgram P, Maddox K, Kansra A, Bettin N, McCuller R, Miller A, Accacha S, Corrigan J, Fiore E, Levine R, Mahoney T, Polychronakos C, Martin J, Gagne V, Starkman H, Fox M, Chin D, Melchionne F, Silverman L, Marshall I, Cerracchio L, Cruz J, Viswanathan A, Miller J, Wilson J, Chalew S, Valley S, Layburn S, Lala A, Clesi P, Genet M, Uwaifo G, Charron A, Allerton T, Milliot E, Cefalu W, Melendez-Ramirez L, Richards R, Alleyn C, Gustafson E, Lizanna M, Wahlen J, Aleiwe S, Hansen M, Wahlen H, Moore M, Levy C, Bonaccorso A, Rapaport R, Tomer Y, Chia D, Goldis M, Iazzetti L, Klein M, Levister C, Waldman L, Muller S, Wallach E, Regelmann M, Antal Z, Aranda M, Reynholds C, Leech N, Wake D, Owens C, Burns M, Wotherspoon J, Nguyen T, Murray A, Short K, Curry G, Kelsey S, Lawson J, Porter J, Stevens S, Thomson E, Winship S, Wynn L, O’Donnell R, Wiltshire E, Krebs J, Cresswell P, Faherty H, Ross C, Vinik A, Barlow P, Bourcier M, Nevoret M, Couper J, Oduah V, Beresford S, Thalagne N, Roper H, Gibbons J, Hill J, Balleaut S, Brennan C, Ellis-Gage J, Fear L, Gray T, Pilger J, Jones L, McNerney C, Pointer L, Price N, Few K, Tomlinson D, Denvir L, Drew J, Randell T, Mansell P, Roberts A, Bell S, Butler S, Hooton Y, Navarra H, Roper A, Babington G, Crate L, Cripps H, Ledlie A, Moulds C, Sadler K, Norton R, Petrova B, Silkstone O, Smith C, Ghai K, Murray M, Viswanathan V, Henegan M, Kawadry O, Olson J, Stavros T, Patterson L, Ahmad T, Flores B, Domek D, Domek S, Copeland K, George M, Less J, Davis T, Short M, Tamura R, Dwarakanathan A, O’Donnell P, Boerner B, Larson L, Phillips M, Rendell M, Larson K, Smith C, Zebrowski K, Kuechenmeister L, Wood K, Thevarayapillai M, Daniels M, Speer H, Forghani N, Quintana R, Reh C, Bhangoo A, Desrosiers P, Ireland L, Misla T, Xu P, Torres C, Wells S, Villar J, Yu M, Berry D, Cook D, Soder J, Powell A, Ng M, Morrison M, Young K, Haslam Z, Lawson M, Bradley B, Courtney J, Richardson C, Watson C, Keely E, DeCurtis D, Vaccarcello-Cruz M, Torres Z, Alies P, Sandberg K, Hsiang H, Joy B, 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Trunnel S, Transue D, Surhigh J, Bezzaire D, Moltz K, Zacharski E, Henske J, Desai S, Frizelis K, Khan F, Sjoberg R, Allen K, Manning P, Hendry G, Taylor B, Jones S, Couch R, Danchak R, Lieberman D, Strader W, Bencomo M, Bailey T, Bedolla L, Roldan C, Moudiotis C, Vaidya B, Anning C, Bunce S, Estcourt S, Folland E, Gordon E, Harrill C, Ireland J, Piper J, Scaife L, Sutton K, Wilkins S, Costelloe M, Palmer J, Casas L, Miller C, Burgard M, Erickson C, Hallanger-Johnson J, Clark P, Taylor W, Galgani J, Banerjee S, Banda C, McEowen D, Kinman R, Lafferty A, Gillett S, Nolan C, Pathak M, Sondrol L, Hjelle T, Hafner S, Kotrba J, Hendrickson R, Cemeroglu A, Symington T, Daniel M, Appiagyei-Dankah Y, Postellon D, Racine M, Kleis L, Barnes K, Godwin S, McCullough H, Shaheen K, Buck G, Noel L, Warren M, Weber S, Parker S, Gillespie I, Nelson B, Frost C, Amrhein J, Moreland E, Hayes A, Peggram J, Aisenberg J, Riordan M, Zasa J, Cummings E, Scott K, Pinto T, Mokashi A, McAssey K, Helden E, Hammond P, Dinning L, Rahman S, Ray S, Dimicri C, Guppy S, Nielsen H, Vogel C, Ariza C, Morales L, Chang Y, Gabbay R, Ambrocio L, Manley L, Nemery R, Charlton W, Smith P, Kerr L, Steindel-Kopp B, Alamaguer M, Tabisola-Nuesca E, Pendersen A, Larson N, Cooper-Olviver H, Chan D, Fitz-Patrick D, Carreira T, Park Y, Ruhaak R, Liljenquist D. A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk. Diabetes Care 2018; 41:1887-1894. [PMID: 30002199 PMCID: PMC6105323 DOI: 10.2337/dc18-0087] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/06/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals. RESEARCH DESIGN AND METHODS We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables. RESULTS Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002). CONCLUSIONS The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.
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Affiliation(s)
- Maria J. Redondo
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | | | - Andrea K. Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Seth Sharp
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | - John M. Wentworth
- Walter and Eliza Hall Institute of Medical Research and Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael N. Weedon
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | | | | | | | | | - Richard A. Oram
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
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Beavis A, Wethington S, Vitale M, Levinson K, Viswanathan A, Nickles Fader A, Stone R. A quality improvement initiative to determine and address psychosocial and basic resource needs of patients in the gynecologic oncology clinic. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.287] [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: 10/28/2022]
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Choudhury T, Davidson J, Viswanathan A, Strutt A. A-72Deep Brain Stimulation of the Anterior Limb of the Internal Capsule for Treatment of Therapy-refractory Obsessive Compulsive Disorder (OCD): A Case Study Highlighting Neurocognitive and Psychiatric Changes. Arch Clin Neuropsychol 2017. [DOI: 10.1093/arclin/acx076.72] [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: 11/12/2022] Open
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11
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Vedantam A, Hou P, Chi TL, Hess KR, Dougherty PM, Bruera E, Viswanathan A. Postoperative MRI Evaluation of a Radiofrequency Cordotomy Lesion for Intractable Cancer Pain. AJNR Am J Neuroradiol 2017; 38:835-839. [PMID: 28209581 DOI: 10.3174/ajnr.a5100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/09/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There are limited data on the use of postoperative imaging to evaluate the cordotomy lesion. We aimed to describe the cordotomy lesion by using postoperative MR imaging in patients after percutaneous cordotomy for intractable cancer pain. MATERIALS AND METHODS Postoperative MR imaging and clinical outcomes were prospectively obtained for 10 patients after percutaneous cordotomy for intractable cancer pain. Area, signal intensity, and location of the lesion were recorded. Clinical outcomes were measured by using the Visual Analog Scale and the Brief Pain Inventory-Short Form, and correlations with MR imaging metrics were evaluated. RESULTS Ten patients (5 men, 5 women; mean age, 58.5 ± 9.6 years) were included in this study. The cordotomy lesion was hyperintense with central hypointense foci on T2-weighted MR imaging, and it was centered in the anterolateral quadrant at the C1-C2 level. The mean percentage of total cord area lesioned was 24.9% ± 7.9%, and most lesions were centered in the dorsolateral region of the anterolateral quadrant (66% of the anterolateral quadrant). The number of pial penetrations correlated with the percentage of total cord area that was lesioned (r = 0.78; 95% CI, 0.44-0.89; P = .008) and the length of T2-weighted hyperintensity (r = 0.85; 95% CI, 0.54-0.89; P = .002). No significant correlations were found between early clinical outcomes and quantitative MR imaging metrics. CONCLUSIONS We describe qualitative and quantitative characteristics of a cordotomy lesion on early postoperative MR imaging. The size and length of the lesion on MR imaging correlate with the number of pial penetrations. Larger studies are needed to further investigate the clinical correlates of MR imaging metrics after percutaneous cordotomy.
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Affiliation(s)
- A Vedantam
- From the Department of Neurosurgery (A. Vedantam, A. Viswanathan), Baylor College of Medicine, Houston, Texas
| | - P Hou
- Departments of Imaging Physics (P.H.)
| | - T L Chi
- Diagnostic Radiology (T.L.C)
| | | | | | - E Bruera
- Palliative Care and Rehabilitation Medicine (E.B.), University of Texas MD Anderson Cancer Center, Houston, Texas
| | - A Viswanathan
- From the Department of Neurosurgery (A. Vedantam, A. Viswanathan), Baylor College of Medicine, Houston, Texas
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12
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Morotti A, Romero JM, Jessel MJ, Brouwers HB, Gupta R, Schwab K, Vashkevich A, Ayres A, Anderson CD, Gurol ME, Viswanathan A, Greenberg SM, Rosand J, Goldstein JN. Effect of CTA Tube Current on Spot Sign Detection and Accuracy for Prediction of Intracerebral Hemorrhage Expansion. AJNR Am J Neuroradiol 2016; 37:1781-1786. [PMID: 27197985 DOI: 10.3174/ajnr.a4810] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/17/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Reduction of CT tube current is an effective strategy to minimize radiation load. However, tube current is also a major determinant of image quality. We investigated the impact of CTA tube current on spot sign detection and diagnostic performance for intracerebral hemorrhage expansion. MATERIALS AND METHODS We retrospectively analyzed a prospectively collected cohort of consecutive patients with primary intracerebral hemorrhage from January 2001 to April 2015 who underwent CTA. The study population was divided into 2 groups according to the median CTA tube current level: low current (<350 mA) and high current (≥350 mA). CTA first-pass readings for spot sign presence were independently analyzed by 2 readers. Baseline and follow-up hematoma volumes were assessed by semiautomated computer-assisted volumetric analysis. Sensitivity, specificity, positive and negative predictive values, and accuracy of spot sign in predicting hematoma expansion were calculated. RESULTS This study included 709 patients (288 and 421 in the low- and high-current groups, respectively). A higher proportion of low-current scans identified at least 1 spot sign (20.8% versus 14.7%, P = .034), but hematoma expansion frequency was similar in the 2 groups (18.4% versus 16.2%, P = .434). Sensitivity and positive and negative predictive values were not significantly different between the 2 groups. Conversely, high-current scans showed superior specificity (91% versus 84%, P = .015) and overall accuracy (84% versus 77%, P = .038). CONCLUSIONS CTA obtained at high levels of tube current showed better diagnostic accuracy for prediction of hematoma expansion by using spot sign. These findings may have implications for future studies using the CTA spot sign to predict hematoma expansion for clinical trials.
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Affiliation(s)
- A Morotti
- From the Department of Clinical and Experimental Sciences (A.M.), Neurology Clinic, University of Brescia, Brescia, Italy
- J.P. Kistler Stroke Research Center (A.M., M.J.J., K.S., A. Vashkevich, A.A., C.D.A., M.E.G., A. Viswanathan, S.M.G., J.R., J.N.G.)
| | - J M Romero
- Neuroradiology Service, Department of Radiology (J.M.R., R.G.)
| | - M J Jessel
- J.P. Kistler Stroke Research Center (A.M., M.J.J., K.S., A. Vashkevich, A.A., C.D.A., M.E.G., A. Viswanathan, S.M.G., J.R., J.N.G.)
| | - H B Brouwers
- Department of Neurosurgery (H.B.B.), Brain Center Rudolf Magnus, University Medical Center, Utrecht, the Netherlands
| | - R Gupta
- Neuroradiology Service, Department of Radiology (J.M.R., R.G.)
| | - K Schwab
- J.P. Kistler Stroke Research Center (A.M., M.J.J., K.S., A. Vashkevich, A.A., C.D.A., M.E.G., A. Viswanathan, S.M.G., J.R., J.N.G.)
| | - A Vashkevich
- J.P. Kistler Stroke Research Center (A.M., M.J.J., K.S., A. Vashkevich, A.A., C.D.A., M.E.G., A. Viswanathan, S.M.G., J.R., J.N.G.)
| | - A Ayres
- J.P. Kistler Stroke Research Center (A.M., M.J.J., K.S., A. Vashkevich, A.A., C.D.A., M.E.G., A. Viswanathan, S.M.G., J.R., J.N.G.)
| | - C D Anderson
- J.P. Kistler Stroke Research Center (A.M., M.J.J., K.S., A. Vashkevich, A.A., C.D.A., M.E.G., A. Viswanathan, S.M.G., J.R., J.N.G.)
| | - M E Gurol
- J.P. Kistler Stroke Research Center (A.M., M.J.J., K.S., A. Vashkevich, A.A., C.D.A., M.E.G., A. Viswanathan, S.M.G., J.R., J.N.G.)
| | - A Viswanathan
- J.P. Kistler Stroke Research Center (A.M., M.J.J., K.S., A. Vashkevich, A.A., C.D.A., M.E.G., A. Viswanathan, S.M.G., J.R., J.N.G.)
| | - S M Greenberg
- J.P. Kistler Stroke Research Center (A.M., M.J.J., K.S., A. Vashkevich, A.A., C.D.A., M.E.G., A. Viswanathan, S.M.G., J.R., J.N.G.)
| | - J Rosand
- J.P. Kistler Stroke Research Center (A.M., M.J.J., K.S., A. Vashkevich, A.A., C.D.A., M.E.G., A. Viswanathan, S.M.G., J.R., J.N.G.)
- Division of Neurocritical Care and Emergency Neurology (J.R., J.N.G.)
| | - J N Goldstein
- J.P. Kistler Stroke Research Center (A.M., M.J.J., K.S., A. Vashkevich, A.A., C.D.A., M.E.G., A. Viswanathan, S.M.G., J.R., J.N.G.)
- Division of Neurocritical Care and Emergency Neurology (J.R., J.N.G.)
- Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Guthier C, Damato A, Viswanathan A, Hesser J, Cormack R. WE-DE-201-01: BEST IN PHYSICS (THERAPY): A Fast Multi-Target Inverse Treatment Planning Strategy Optimizing Dosimetric Measures for High-Dose-Rate (HDR) Brachytherapy. Med Phys 2016. [DOI: 10.1118/1.4957806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Gillan SN, Okhravi N, O'Sullivan F, Sullivan P, Viswanathan A, Saleh GM. Influence of medical student career aims on ophthalmic surgical simulator performance (part of the international forum for ophthalmic simulation studies). Br J Ophthalmol 2015; 100:411-4. [PMID: 26246344 DOI: 10.1136/bjophthalmol-2015-307127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/04/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND To evaluate whether medical students who have expressed a strong desire to pursue ophthalmology as a career perform simulated ophthalmic surgical tasks to a higher level than medical students whose interests lie elsewhere. METHODS All participants were fourth or fifth year students at University College London (UCL) Medical School, London, UK. One cohort was recruited from the Moorfields Academy, an ophthalmic forum designed to enhance collaboration and innovation within the specialty. These students were therefore seen as highly motivated, expressing a desire to pursue a career in ophthalmology. The other cohort of students was invited to participate during their fourth year UCL Ophthalmology attachment, but expressed interest in non-ophthalmic disciplines. Participants carried out a single attempt of three modules on the Eyesi Surgical Simulator, and total and mean scores were calculated out of 100. RESULTS 13 academy and 15 non-academy students were enrolled. The overall mean scores were 51/100 for the academy group, range 0-97, and 45.5/100 for the non-academy group, range 0-90 (p=0.49). Scores for precision testing, forceps training and capsulorrhexis training for academy versus non-academy were 45.8 versus 37.8 (p=0.61), 57.1 versus 52.3 (p=0.8) and 50.2 versus 46.4 (p=0.55), respectively. CONCLUSIONS This study is the first to suggest that medical students with a strong career interest in ophthalmology do not perform microsurgical tasks to a higher level than medical students who have no goal in this area. This also indicates variation in scores between novices, which may serve as a pitfall in the use of simulators as a tool for entry into training.
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Affiliation(s)
- S N Gillan
- Moorfields Eye Hospital NHS Foundation Trust, London, UK Department of Undergraduate Medical Education, Moorfields Eye Hospital, London, UK Ninewells Hospital, Dundee, UK
| | - N Okhravi
- Moorfields Eye Hospital NHS Foundation Trust, London, UK Department of Undergraduate Medical Education, Moorfields Eye Hospital, London, UK NIHR Biomedical Research Centre at Moorfields Eye Hospital, NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK UCL Medical School, London, UK
| | | | - P Sullivan
- Moorfields Eye Hospital NHS Foundation Trust, London, UK NIHR Biomedical Research Centre at Moorfields Eye Hospital, NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - A Viswanathan
- Moorfields Eye Hospital NHS Foundation Trust, London, UK NIHR Biomedical Research Centre at Moorfields Eye Hospital, NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - G M Saleh
- Moorfields Eye Hospital NHS Foundation Trust, London, UK NIHR Biomedical Research Centre at Moorfields Eye Hospital, NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
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Kuo L, Viswanathan A, Damato A. SU-E-T-310: Dosimetric Comparison of Tandem and Ovoid (TO) Vs. Tandem and Ring (TR) Applicators in High-Dose Rate (HDR) Brachytherapy (BT) for the Treatment of Locally-Advanced Cervical-Cancer. Med Phys 2015. [DOI: 10.1118/1.4924671] [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: 11/07/2022] Open
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16
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Tang A, Samost A, Viswanathan A, Cormack R, Damato A. WE-G-BRA-07: Analyzing the Safety Implications of a Brachytherapy Process Improvement Project Utilizing a Novel System-Theory-Based Hazard-Analysis Technique. Med Phys 2015. [DOI: 10.1118/1.4926077] [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: 11/07/2022] Open
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17
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Damato A, Bhagwat M, Buzurovic I, Cormack R, Lee L, Viswanathan A. SU-E-J-226: Efficient Use of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) for Cervical-Cancer Brachytherapy. Med Phys 2015. [DOI: 10.1118/1.4924312] [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: 11/07/2022] Open
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18
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Damato A, Viswanathan A, Cormack R. SU-F-BRA-01: A Procedure for the Fast Semi-Automatic Localization of Catheters Using An Electromagnetic Tracker (EMT) for Image-Guided Brachytherapy. Med Phys 2015. [DOI: 10.1118/1.4925212] [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: 11/07/2022] Open
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19
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Don S, Cormack R, Viswanathan A, Damato A. TU-AB-201-03: A Robot for the Automated Delivery of An Electromagnetic Tracking Sensor for the Localization of Brachytherapy Catheters. Med Phys 2015. [DOI: 10.1118/1.4925541] [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: 11/07/2022] Open
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20
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Reijmer YD, Schultz AP, Leemans A, O'Sullivan MJ, Gurol ME, Sperling R, Greenberg SM, Viswanathan A, Hedden T. Decoupling of structural and functional brain connectivity in older adults with white matter hyperintensities. Neuroimage 2015; 117:222-9. [PMID: 26025290 DOI: 10.1016/j.neuroimage.2015.05.054] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [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: 01/23/2015] [Revised: 03/30/2015] [Accepted: 05/09/2015] [Indexed: 12/23/2022] Open
Abstract
Age-related impairments in the default network (DN) have been related to disruptions in connecting white matter tracts. We hypothesized that the local correlation between DN structural and functional connectivity is negatively affected in the presence of global white matter injury. In 125 clinically normal older adults, we tested whether the relationship between structural connectivity (via diffusion imaging tractography) and functional connectivity (via resting-state functional MRI) of the posterior cingulate cortex (PCC) and medial prefrontal frontal cortex (MPFC) of the DN was altered in the presence of white matter hyperintensities (WMH). A significant correlation was observed between microstructural properties of the cingulum bundle and MPFC-PCC functional connectivity in individuals with low WMH load, but not with high WMH load. No correlation was observed between PCC-MPFC functional connectivity and microstructure of the inferior longitudinal fasciculus, a tract not passing through the PCC or MPFC. Decoupling of connectivity, measured as the absolute difference between structural and functional connectivity, in the high WMH group was related to poorer executive functioning and memory performance. These results suggest that such decoupling may reflect reorganization of functional networks in response to global white matter pathology and may provide an early marker of clinically relevant network alterations.
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Affiliation(s)
- Y D Reijmer
- Dept. of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - A P Schultz
- Dept. of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - A Leemans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M J O'Sullivan
- Dept. of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - M E Gurol
- Dept. of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - R Sperling
- Dept. of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Dept. of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA; Dept. of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - S M Greenberg
- Dept. of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - A Viswanathan
- Dept. of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - T Hedden
- Dept. of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
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Damato A, Cormack R, Bhagwat M, Buzurovic I, Lee L, Viswanathan A. WE-A-17A-05: Differences in Applicator Configuration and Dwell Loading Between Standard and Image-Guided Tandem and Ring (T&R) HDR Brachytherapy. Med Phys 2014. [DOI: 10.1118/1.4889375] [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: 11/07/2022] Open
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Wang W, Damato A, Penzkofer T, Pan L, Gilson W, Seethamraju R, Schmidt E, Viswanathan A, Cormack R. WE-G-17A-05: Real-Time Catheter Localization Using An Active MR Tracker for Interstitial Brachytherapy. Med Phys 2014. [DOI: 10.1118/1.4889507] [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: 11/07/2022] Open
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Damato A, Mehrtash A, Kapur T, Viswanathan A, Cormack R. SU-D-108-02: Applications of Electromagnetic Tracking Technology to High Dose Rate (HDR) Interstitial Brachytherapy. Med Phys 2013. [DOI: 10.1118/1.4814012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Damato A, Viswanathan A, Cormack R. SU-E-T-340: Predictive Models for Dosimetry of the Organs-At-Risk in Interstitial Gynecologic Brachytherapy. Med Phys 2013. [DOI: 10.1118/1.4814774] [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: 11/07/2022] Open
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Pernelle G, Kapur T, Mehrtash A, Penzkofer T, Damato A, Barber L, Schmidt E, Viswanathan A, Cormack R. SU-C-103-05: Automated Interstitial Brachytherapy Catheter Localization From Volumetric MR Data. Med Phys 2013. [DOI: 10.1118/1.4813972] [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: 11/07/2022] Open
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Damato A, Townamchai K, Kovacs A, Cormack R, Viswanathan A. Dosimetric Uncertainties Associated With Interobserver Contouring Variability in Gynecologic Interstitial Brachytherapy (GIB). Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.2096] [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: 11/26/2022]
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Damato A, Townamchai K, Kovacs A, Cormack R, Viswanathan A. Interfraction Uncertainties in Multifraction Gynecologic Interstitial Brachytherapy (MGIB). Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.2025] [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: 10/27/2022]
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Auriel E, Gurol E, Ayers A, Schwab K, Vashkevich A, Rosand J, Viswanathan A, Greenberg S. Ongoing Microinfarction in Patients with Intracerebral Hemorrhage (S23.002). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s23.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Martinez-Ramirez S, Ayres A, Gurol E, Rosand J, Greenberg S, Viswanathan A. Diagnostic Value of Lobar Microbleeds without Hemorrhagic Stroke: A Radiological-Pathological Correlation Study (S23.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s23.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Biffi A, Battey TWK, Ayres AM, Cortellini L, Schwab K, Gilson AJ, Rost NS, Viswanathan A, Goldstein JN, Greenberg SM, Rosand J. Warfarin-related intraventricular hemorrhage: imaging and outcome. Neurology 2011; 77:1840-6. [PMID: 22049204 DOI: 10.1212/wnl.0b013e3182377e12] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Oral anticoagulation therapy (OAT) with warfarin increases mortality and disability after intracerebral hemorrhage (ICH), the result of increased ICH volume and risk of hematoma expansion. We investigated whether OAT also influences risk of development of intraventricular hemorrhage (IVH), the volume of IVH and IVH expansion, and whether IVH is a substantive mediator of the overall effect of OAT on ICH outcome. METHODS We performed a retrospective analysis of a prospectively collected single-center cohort of 1,879 consecutive ICH cases (796 lobar, 865 deep, 153 cerebellar, 15 multiple location, 50 primary IVH) from 1999 to 2009. ICH and IVH volumes at presentation, as well as hematoma expansion (>33% or >6 mL increase) and IVH expansion (>2 mL increase), were determined using established semiautomated methods. Outcome was assessed at 90 days using either the modified Rankin Scale or Glasgow Outcome Scale. RESULTS Warfarin use was associated with IVH risk, IVH volume at presentation, and IVH expansion in both lobar and deep ICH (all p < 0.05) in a dose-response relationship with international normalized ratio. Warfarin was associated with poor outcome in both lobar and deep ICH (p < 0.01), and >95% of this effect was accounted for by baseline ICH and IVH volumes, as well as ICH and IVH expansion. CONCLUSION Warfarin increases IVH volume and risk of IVH expansion in lobar and deep ICH. These findings (along with effects on ICH volume and expansion) likely represent the mechanisms by which anticoagulation worsens ICH functional outcome.
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Affiliation(s)
- A Biffi
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
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Lee L, Tanaka C, Viswanathan A. Combined Modality Therapy Improves Survival in Uterine Papillary Serous Carcinoma with Omental Involvement. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.766] [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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Smith EE, Salat DH, Jeng J, McCreary CR, Fischl B, Schmahmann JD, Dickerson BC, Viswanathan A, Albert MS, Blacker D, Greenberg SM. Correlations between MRI white matter lesion location and executive function and episodic memory. Neurology 2011; 76:1492-9. [PMID: 21518999 DOI: 10.1212/wnl.0b013e318217e7c8] [Citation(s) in RCA: 175] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES MRI white matter hyperintensity (WMH) volume is associated with cognitive impairment. We hypothesized that specific loci of WMH would correlate with cognition even after accounting for total WMH volume. METHODS Subjects were identified from a prospective community-based study: 40 had normal cognition, 94 had mild impairment (defined here as a Clinical Dementia Rating [CDR] score of 0.5 without dementia), and 11 had mild Alzheimer's dementia. Factor analysis of a 22-item neuropsychological battery yielded 4 factors (episodic memory, executive function, spatial skills, and general knowledge). MRI WMH segmentation and analysis was performed using FreeSurfer software. RESULTS Higher WMH volume was independently associated with lower executive function and episodic memory factor scores. Voxel-based general linear models showed loci where WMH was strongly inversely associated with specific cognitive factor scores (p < 0.001), controlling for age, education, sex, APOE genotype, and total WMH volume. For episodic memory, clusters were observed in bilateral temporal-occipital and right parietal periventricular white matter, and the left anterior limb of the internal capsule. For executive function, clusters were observed in bilateral inferior frontal white matter, bilateral temporal-occipital and right parietal periventricular white matter, and the anterior limb of the internal capsule bilaterally. CONCLUSIONS Specific WMH loci are closely associated with executive function and episodic memory, independent of total WMH volume. The anatomic locations suggest that WMH may cause cognitive impairment by affecting connections between cortex and subcortical structures, including the thalamus and striatum, or connections between the occipital lobe and frontal or parietal lobes.
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Affiliation(s)
- E E Smith
- Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, Alberta, Canada.
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Biffi A, Devan WJ, Anderson CD, Ayres AM, Schwab K, Cortellini L, Viswanathan A, Rost NS, Smith EE, Goldstein JN, Greenberg SM, Rosand J. Statin use and outcome after intracerebral hemorrhage: case-control study and meta-analysis. Neurology 2011; 76:1581-8. [PMID: 21451150 DOI: 10.1212/wnl.0b013e3182194be9] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Intracerebral hemorrhage (ICH) is a highly lethal disease of the elderly. Use of statins is increasingly widespread among the elderly, and therefore common in patients who develop ICH. Accumulating data suggests that statins have neuroprotective effects, but their association with ICH outcome has been inconsistent. We therefore performed a meta-analysis of all available evidence, including unpublished data from our own institution, to determine whether statin exposure is protective for patients who develop ICH. METHODS In our prospectively ascertained cohort, we compared 90-day functional outcome in 238 pre-ICH statin cases and 461 statin-free ICH cases. We then meta-analyzed results from our cohort along with previously published studies using a random effects model, for a total of 698 ICH statin cases and 1,823 non-statin-exposed subjects. RESULTS Data from our center demonstrated an association between statin use before ICH and increased probability of favorable outcome (odds ratio [OR] = 2.08, 95% confidence interval [CI] 1.37-3.17) and reduced mortality (OR = 0.47, 95% CI 0.32-0.70) at 90 days. No compound-specific statin effect was identified. Meta-analysis of all published evidence confirmed the effect of statin use on good outcome (OR = 1.91, 95% CI 1.38-2.65) and mortality (OR = 0.55, 95% CI 0.42-0.72) after ICH. CONCLUSION Antecedent use of statins prior to ICH is associated with favorable outcome and reduced mortality after ICH. This phenomenon appears to be a class effect of statins. Further studies are required to clarify the biological mechanisms underlying these observations.
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Affiliation(s)
- A Biffi
- Center for Human Genetic Research, Massachusetts General Hospital, 185 Cambridge Street, CPZN-6818, Boston, MA 02114, USA
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Lim K, Fyles A, Portelance L, Creutzberg C, Jürgenliemk-Schulz I, Viswanathan A, Erickson B, Bosch W, El Naqa I, Varia M. Variability in Clinical Target Volume Delineation for Intensity Modulated Radiotherapy in Three Challenging Cervix Cancer Scenarios. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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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Biffi A, Halpin A, Towfighi A, Gilson A, Busl K, Rost N, Smith EE, Greenberg MS, Rosand J, Viswanathan A. Aspirin and recurrent intracerebral hemorrhage in cerebral amyloid angiopathy. Neurology 2010; 75:693-8. [PMID: 20733144 DOI: 10.1212/wnl.0b013e3181eee40f] [Citation(s) in RCA: 228] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To identify and compare clinical and neuroimaging predictors of primary lobar intracerebral hemorrhage (ICH) recurrence, assessing their relative contributions to recurrent ICH. METHODS Subjects were consecutive survivors of primary ICH drawn from a single-center prospective cohort study. Baseline clinical, imaging, and laboratory data were collected. Survivors were followed prospectively for recurrent ICH and intercurrent aspirin and warfarin use, including duration of exposure. Cox proportional hazards models were used to identify predictors of recurrence stratified by ICH location, with aspirin and warfarin exposures as time-dependent variables adjusting for potential confounders. RESULTS A total of 104 primary lobar ICH survivors were enrolled. Recurrence of lobar ICH was associated with previous ICH before index event (hazard ratio [HR] 7.7, 95% confidence interval [CI] 1.4-15.7), number of lobar microbleeds (HR 2.93 with 2-4 microbleeds present, 95% CI 1.3-4.0; HR = 4.12 when >or=5 microbleeds present, 95% CI 1.6-9.3), and presence of CT-defined white matter hypodensity in the posterior region (HR 4.11, 95% CI 1.01-12.2). Although aspirin after ICH was not associated with lobar ICH recurrence in univariate analyses, in multivariate analyses adjusting for baseline clinical predictors, it independently increased the risk of ICH recurrence (HR 3.95, 95% CI 1.6-8.3, p = 0.021). CONCLUSIONS Recurrence of lobar ICH is associated with previous microbleeds or macrobleeds and posterior CT white matter hypodensity, which may be markers of severity for underlying cerebral amyloid angiopathy. Use of an antiplatelet agent following lobar ICH may also increase recurrence risk.
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Affiliation(s)
- A Biffi
- Department of Neurology and Hemorrhagic Stroke Research Program, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA 02114, USA
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Razjouyan F, Kapoor A, Glossop N, Kruecker J, Xu S, Viswanathan A, Chiesa O, Karanian J, Pritchard W, Levy E, Venkatesan A, Solbiati L, Wood B. Abstract No. 118: A comparison of methods for tracking RFA probes and sensitivity to RF field and temperature. J Vasc Interv Radiol 2010. [DOI: 10.1016/j.jvir.2009.12.271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Rost NS, Masrur S, Pervez MA, Viswanathan A, Schwamm LH. Unsuspected coagulopathy rarely prevents IV thrombolysis in acute ischemic stroke. Neurology 2009; 73:1957-62. [PMID: 19940272 DOI: 10.1212/wnl.0b013e3181c5b46d] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND American Heart Association/American Stroke Association guidelines recommend initiating treatment with IV tissue plasminogen activator (tPA) in acute ischemic stroke patients without suspected coagulopathy prior to availability of clotting results; however, little or no data support this practice. We sought to identify how often blood clotting abnormalities were responsible for withholding IV tPA at our institution. METHODS We conducted a retrospective review of our prospectively acquired Get With the Guidelines Stroke database from January 2003 to April 2008. All patients underwent clinical evaluation by a neurologist, diagnostic neuroimaging, and laboratory testing on admission. We classified patients with absolute contraindications to IV tPA as ineligible, and those with warnings/relative contraindications or potentially treatable factors as potentially eligible. RESULTS Of 2,335 considered for analysis, 470 (20.1%) patients presented to our emergency department (ED) within 3 hours. Among these, 147 (31.3%) received IV tPA in our ED, 102 (21.7%) had an absolute contraindication, and 221 (47%) had a reason to consider withholding tPA. Only 30/470 (6.4%) of potential thrombolysis patients were discovered to have international normalized ratio > or =1.7 or platelets < or =100,000/microL, and of these, 28 were suspected a priori due to known coagulopathy from medication or illness. Only 2/470 (0.4%) patients had an unsuspected coagulopathy that ultimately prevented thrombolysis. CONCLUSIONS Based on the experience of a large thrombolysis referral center, stroke patients without suspected clotting abnormality can safely begin thrombolytic therapy before clotting results are available. These data support the current practice guidelines, and may reassure clinicians that the benefits of early administration greatly outweigh the risks due to an unsuspected bleeding diathesis.
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Affiliation(s)
- N S Rost
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.
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Düring M, Peters N, Zieren N, Mewald Y, O'Sullivan M, Saemann P, Herve D, Olart E, Viswanathan A, Pachai C, Chabriat H, Dichgans M. Voxelbasierte Identifizierung strategischer Lakunen für die subkortikale ischämische vaskuläre Demenz. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238710] [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: 10/20/2022]
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Kimberly WT, Gilson A, Rost NS, Rosand J, Viswanathan A, Smith EE, Greenberg SM. Silent ischemic infarcts are associated with hemorrhage burden in cerebral amyloid angiopathy. Neurology 2009; 72:1230-5. [PMID: 19349602 DOI: 10.1212/01.wnl.0000345666.83318.03] [Citation(s) in RCA: 169] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Neuropathologic studies suggest an association between cerebral amyloid angiopathy (CAA) and small ischemic infarctions as well as hemorrhages. We examined the prevalence and associated risk factors for infarcts detected by diffusion-weighted imaging (DWI). METHODS We performed retrospective analysis of MR images from 78 subjects with a diagnosis of probable CAA and a similar aged group of 55 subjects with Alzheimer disease or mild cognitive impairment (AD/MCI) for comparison. DWI and apparent diffusion coefficient (ADC) maps were inspected for acute or subacute infarcts. We also examined the association between DWI lesions and demographic variables, conventional vascular risk factors, and radiographic markers of CAA severity such as number of hemorrhages on gradient-echo MRI and volume of T2-hyperintense white matter lesions. RESULTS Twelve of 78 subjects with CAA (15%) had a total of 17 DWI-hyperintense lesions consistent with subacute cerebral infarctions vs 0 of 55 subjects with AD/MCI (p = 0.001). The DWI lesions were located primarily in cortex and subcortical white matter. CAA subjects with DWI lesions had a higher median number of total hemorrhages (22 vs 4, p = 0.025) and no difference in white matter hyperintensity volume or conventional vascular risk factors compared to subjects with CAA without lesions. CONCLUSIONS MRI evidence of small subacute infarcts is present in a substantial proportion of living patients with advanced cerebral amyloid angiopathy (CAA). The presence of these lesions is associated with a higher burden of hemorrhages, but not with conventional vascular risk factors. This suggests that advanced CAA predisposes to ischemic infarction as well as intracerebral hemorrhage.
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Affiliation(s)
- W T Kimberly
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Reyes S, Viswanathan A, Godin O, Dufouil C, Benisty S, Hernandez K, Kurtz A, Jouvent E, O'Sullivan M, Czernecki V, Bousser MG, Dichgans M, Chabriat H. Apathy: A major symptom in CADASIL. Neurology 2009; 72:905-10. [DOI: 10.1212/01.wnl.0000344166.03470.f8] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Viswanathan A, Raj S, Greenberg SM, Stampfer M, Campbell S, Hyman BT, Irizarry MC. Plasma Abeta, homocysteine, and cognition: the Vitamin Intervention for Stroke Prevention (VISP) trial. Neurology 2009; 72:268-72. [PMID: 19153374 DOI: 10.1212/01.wnl.0000339486.63862.db] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Amyloid-beta protein (Abeta) plays a key role in Alzheimer disease (AD) and is also implicated in cerebral small vessel disease. Serum total homocysteine (tHcy) is a risk factor for small vessel disease and cognitive impairment and correlates with plasma Abeta levels. To determine whether this association results from a common pathophysiologic mechanism, we investigated whether vitamin supplementation-induced reduction of tHcy influences plasma Abeta levels in the Vitamin Intervention in Stroke Prevention (VISP) study. METHODS Two groups of 150 patients treated with either the high-dose or low-dose formulation of pyridoxine, cobalamin, and folic acid in a randomized, double-blind fashion were selected among the participants in the VISP study without recurrent stroke during follow-up and in the highest 10% of the distribution for baseline tHcy levels. Concentrations of plasma Abeta with 40 (Abeta40) and 42 (Abeta42) amino acids were measured at baseline and at the 2-year visit. RESULTS tHcy levels significantly decreased with vitamin supplementation in both groups. tHcy were strongly correlated with Abeta40 but not Abeta42 concentrations. There was no difference in the change in Abeta40, Abeta42 (p = 0.40, p = 0.35), or the Abeta42/Abeta40 ratio over time (p = 0.86) between treatment groups. Abeta measures were not associated with cognitive change. CONCLUSIONS This double-blind randomized controlled trial of vitamin therapy demonstrates a strong correlation between serum tHcy and plasma Abeta40 concentrations in subjects with ischemic stroke. Treatment with high dose vitamins does not, however, influence plasma levels of Abeta, despite their effect on lowering tHcy. Our results suggest that although tHcy is associated with plasma Abeta40, they may be regulated by independent mechanisms.
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Affiliation(s)
- A Viswanathan
- Hemorrhagic Stroke Research Program, Massachusetts General Hospital Stroke Research Center, 175 Cambridge Street, Suite 300, Boston, MA 02114, USA.
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Nandigam RNK, Viswanathan A, Delgado P, Skehan ME, Smith EE, Rosand J, Greenberg SM, Dickerson BC. MR imaging detection of cerebral microbleeds: effect of susceptibility-weighted imaging, section thickness, and field strength. AJNR Am J Neuroradiol 2008; 30:338-43. [PMID: 19001544 DOI: 10.3174/ajnr.a1355] [Citation(s) in RCA: 279] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE The emergence of cerebral microbleeds (CMB) as common MR imaging findings raises the question of how MR imaging parameters influence CMB detection. To evaluate the effects of modified gradient recalled-echo (GRE) MR imaging methods, we performed an analysis of sequence, section thickness, and field strength on CMB imaging properties and detection in subjects with cerebral amyloid angiopathy (CAA), a condition associated with microhemorrhage. MATERIALS AND METHODS Multiple MR images were obtained from subjects with probable CAA, with varying sequences (GRE versus susceptibility-weighted imaging [SWI]), section thicknesses (1.2-1.5 versus 5 mm), and magnetic field strengths (1.5T versus 3T). Individual CMB were manually identified and analyzed for contrast index (lesion intensity normalized to normal-appearing white matter signal intensity) and diameter. CMB counts were compared between 1.5T thick-section GRE and thin-section SWI for 3 subjects who underwent both protocols in the same scanning session. RESULTS With other parameters constant, use of SWI, thinner sections, and a higher field strength yielded medium-to-large gains in CMB contrast index (CI; Cohen d 0.71-1.87). SWI was also associated with small increases in CMB diameter (Cohen d <0.3). Conventional thick-section GRE identified only 33% of CMB (103 of 310) seen on thin-section SWI. Lesions prospectively identified on GRE had significantly greater CI and diameter measured on the GRE image than those not prospectively identified. CONCLUSIONS The examined alternatives to conventional GRE MR imaging yield substantially improved CMB contrast and sensitivity for detection. Future studies based on these techniques will most likely yield even higher prevalence estimates for CMB.
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Affiliation(s)
- R N K Nandigam
- Hemorrhagic Stroke Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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Viswanathan A, Gschwendtner A, Guichard JP, Buffon F, Cumurciuc R, O'Sullivan M, Holtmannspötter M, Pachai C, Bousser MG, Dichgans M, Chabriat H. Lacunar lesions are independently associated with disability and cognitive impairment in CADASIL. Neurology 2007; 69:172-9. [PMID: 17620550 DOI: 10.1212/01.wnl.0000265221.05610.70] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary arteriopathy caused by mutations of the Notch3 gene. The disease is characterized by T2-hyperintense lesions (subcortical white matter lesions), T1-hypointense lesions (lacunar lesions), and T2*-weighted gradient-echo (GE) lesions (cerebral microhemorrhages [CMs]) visualized on clinical MRI sequences and is considered as a model of "pure" subcortical ischemic vascular dementia. Although numerous studies have investigated the impact of white matter lesions in patients with CADASIL, the clinical importance of lacunar lesions remains unknown. Our purpose was to examine the influence of the visible MRI markers in the disease, including the load of lacunar lesions on cognitive impairment and disability in CADASIL. METHODS We collected clinical data from 147 consecutive patients enrolled in an ongoing two-center prospective cohort study. Degree of disability was assessed by modified Rankin scale and Barthel index. Degree of cognitive impairment was assessed by Mattis Dementia Rating Scale and Mini-Mental Status Examination. T1-weighted, fluid-attenuated inversion recovery, and GE images were obtained on a 1.5-T MRI. Volume and location of lacunar lesions, white matter hyperintensities (WMHs), and CMs were assessed. RESULTS There was a significant independent association between age, volume of lacunar lesions, and global cognitive function scales when analyzed in a multivariable model. In contrast, WMHs and CMs had no independent influence on cognitive function. Disability in this cohort was associated with volume of lacunar lesions, CMs, systolic blood pressure, and age but not with WMHs. CONCLUSIONS Among the lesions observed on conventional MRI in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), the overall lacunar lesion burden seems to have the most important impact on cognitive function and disability. These findings suggest that preventive strategies to decrease the risk of lacunar lesions as observed on MRI may reduce disease-related impairment in CADASIL. These results suggest that lacunar lesions may also play a key role in disability and cognitive impairment in more common forms of small-vessel disease.
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Affiliation(s)
- A Viswanathan
- Departments of Neurology, Centre Hospitalier Universitaire Lariboisière, Assistance Publique des Hôpitaux de Paris, France
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Abstract
5535 Purpose: To analyze the impact of chemotherapy (Ch) and radiation therapy (RT) on relapse rates in patients with uterine papillary serous carcinoma (UPSC). Materials and Methods: The outcomes of 160 women with UPSC seen between 1980–2005 at the BW/DFCC were analyzed. Exclusion criteria included stage IVB disease, no hysterectomy, unknown stage, or unknown type of RT. Results: The median age was 67 years (range 31–90). FIGO Stage was IA (21), IB (28), IC (13), IIA (7), IIB (10), IIIA (42), IIIB (2), IIIC (21), and IVA (16). Treatment included none (40), Ch alone (20), Ch and whole abdominal radiation (WA) (11), Ch and pelvic radiation (P) (30), Ch and vaginal brachytherapy (VB) (2), WA alone (24), P alone (19), and VB alone (14). The median dose of RT was WA 30 Gy and P 45 Gy. Ch was given to 63 patients; the median number of cycles of Carboplatin, Adriamycin and Paclitaxel was 3. Overall survival (OS) and disease-free survival (DFS) for the entire group were 67% and 57% at 2 years, 62% and 51% at 3 years and 51% and 38% at 5 years. A total of 58 patients relapsed. Among those who received no RT or Ch, 48% (19/40) relapsed; among those treated with Ch only, 50% (10/20) relapsed; in the group treated with RT only, 26% (15/57) relapsed; and, in those treated with Ch and RT, 33% (14/43) relapsed. A significant difference in recurrence rate was seen in patients treated with RT compared to those who received no treatment (OR 0.40, p=0.03). This difference persisted after controlling for Stage, which did significantly affect the relationship between RT treatment and recurrence. Local recurrence (in an RT field) was a component of failure for 14% (14/100) treated with RT, versus 42% (25/59) that received no RT (OR 0.22, p=0.0001). Distant metastases were a component of first failure in 15% (9/61) that received Ch versus 11% (11/97) that did not; there was no significant difference in distant recurrence rate for patients treated with Ch (OR 1.35, p=0.53). Conclusion: This single-institution study represents the largest series of UPSC to date. The use of RT significantly decreases the overall recurrence rate of UPSC in this series and should be considered in patients with stages I-IVA UPSC. Future studies looking at the optimal type, dose and duration of chemotherapy, as well as the use of novel agents, are needed to improve outcomes in this population. No significant financial relationships to disclose.
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Affiliation(s)
- A. Viswanathan
- Brigham and Women’s Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - N. Horick
- Brigham and Women’s Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - C. Tanaka
- Brigham and Women’s Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - S. Campos
- Brigham and Women’s Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - U. Matulonis
- Brigham and Women’s Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - R. Berkowitz
- Brigham and Women’s Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA
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Lim WT, Zhang WH, Miller CR, Watters JW, Gao F, Viswanathan A, Govindan R, McLeod HL. PTEN and phosphorylated AKT expression and prognosis in early- and late-stage non-small cell lung cancer. Oncol Rep 2007. [PMID: 17342327 DOI: 10.3892/or.17.4.853] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is the commonest cause of cancer mortality worldwide. Growth factor receptor signalling pathways constitute an important mediator for tumor growth and proliferation. PTEN and pAKT play important roles in regulating signal transduction along this pathway. Separate cohorts of stage I (n=25) and stage IV (n=34) NSCLC were examined by immunohistochemistry for PTEN and pAKT expression. There was no correlation between PTEN expression and pAKT expression and neither were associated with age, sex or smoking status. Patients with stage IV disease who overexpressed pAKT (at least 2+) or were PTEN-null had poorer overall survival and progression-free survival. This suggests that PTEN-null or pAKT-positive tumors constitute more aggressive tumors whose clinical course is not altered by therapy. There was no difference in the clinical outcome for stage I disease by PTEN or pAKT expression. A greater proportion of the stage IV patients had PTEN-null disease compared to the stage I cohort, suggesting that loss of PTEN is important in the tumor biology of advanced disease. Loss of PTEN or overexpression of pAKT predicts for an aggressive subset of lung tumors that have a poor prognosis. This will allow identification of a poor prognosis subset that can be targeted with novel treatments that either restore PTEN function or target activated AKT, mTOR and other downstream signal transduction molecules.
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Affiliation(s)
- W T Lim
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore 169610, Republic of Singapore.
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Lim WT, Zhang WH, Miller CR, Watters JW, Gao F, Viswanathan A, Govindan R, McLeod HL. PTEN and phosphorylated AKT expression and prognosis in early- and late-stage non-small cell lung cancer. Oncol Rep 2007; 17:853-7. [PMID: 17342327] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) is the commonest cause of cancer mortality worldwide. Growth factor receptor signalling pathways constitute an important mediator for tumor growth and proliferation. PTEN and pAKT play important roles in regulating signal transduction along this pathway. Separate cohorts of stage I (n=25) and stage IV (n=34) NSCLC were examined by immunohistochemistry for PTEN and pAKT expression. There was no correlation between PTEN expression and pAKT expression and neither were associated with age, sex or smoking status. Patients with stage IV disease who overexpressed pAKT (at least 2+) or were PTEN-null had poorer overall survival and progression-free survival. This suggests that PTEN-null or pAKT-positive tumors constitute more aggressive tumors whose clinical course is not altered by therapy. There was no difference in the clinical outcome for stage I disease by PTEN or pAKT expression. A greater proportion of the stage IV patients had PTEN-null disease compared to the stage I cohort, suggesting that loss of PTEN is important in the tumor biology of advanced disease. Loss of PTEN or overexpression of pAKT predicts for an aggressive subset of lung tumors that have a poor prognosis. This will allow identification of a poor prognosis subset that can be targeted with novel treatments that either restore PTEN function or target activated AKT, mTOR and other downstream signal transduction molecules.
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Affiliation(s)
- W T Lim
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore 169610, Republic of Singapore.
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Sullivan M, Ngo E, Viswanathan A, Jouvent E, Gschwendtner A, Saemann P, Duering M, Pachai C, Bousser M, Chabriat H, Dichgans M. Hippocampal volume is an independent predictor of global cognitive performance in pure cerebral small vessel disease. Akt Neurol 2007. [DOI: 10.1055/s-2007-988009] [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: 10/21/2022]
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