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Zhang C, Calderon E, Chang YH, Lu P, Durant AM, Villa EL, Katariya NN, Jadlowiec C, Reddy KS, Moss A, Mathur AK. Portal vein thrombosis and donation after cardiac death liver transplantation: Pre-perfusion data implications for the perfusion era. Am J Surg 2024; 228:301-304. [PMID: 37777377 DOI: 10.1016/j.amjsurg.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Chi Zhang
- Transplant Center, Mayo Clinic Arizona, Phoenix, AZ, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester, MN, USA
| | | | - Yu-Hui Chang
- Quantitative Health Sciences, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Patricia Lu
- Transplant Center, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Adri M Durant
- Transplant Center, Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | | | | | - Kunam S Reddy
- Transplant Center, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Adyr Moss
- Transplant Center, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Amit K Mathur
- Transplant Center, Mayo Clinic Arizona, Phoenix, AZ, USA.
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Me HM, Budhiraja P, Nair S, Kodali L, Ryan M, Khamash H, Heilman R, Wagler J, Ruch B, Jadlowiec CC, Moss A, Reddy KS. Utilizing kidneys from a donor with bile-cast nephropathy. Am J Transplant 2024; 24:141-144. [PMID: 37633448 DOI: 10.1016/j.ajt.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
Here we discuss the successful utilization of a pair of deceased donor kidneys with bile-cast nephropathy. The donor had a kidney donor profile index of 48% and an acute kidney injury requiring continuous renal replacement therapy. Peak donor bilirubin was 40.5 mg/dL, and renal wedge biopsies showed bile-cast nephropathy. Both recipients had delayed graft function lasting up to 4 weeks. The 4-month biopsies showed mild interstitial fibrosis, tubular atrophy, and a resolution of bile casts. These kidney allografts showed the reversible course of cholemic nephropathy and the potential for increasing the utilization of previously discarded kidneys.
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Affiliation(s)
- Hay Me Me
- Division of Nephrology, Mayo Clinic, Phoenix, Arizona, USA.
| | | | - Sumi Nair
- Division of Nephrology, Mayo Clinic, Phoenix, Arizona, USA
| | - Lavanya Kodali
- Division of Nephrology, Mayo Clinic, Phoenix, Arizona, USA
| | - Margaret Ryan
- Division of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, Arizona, USA
| | - Hasan Khamash
- Division of Nephrology, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Josiah Wagler
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Brianna Ruch
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Caroline C Jadlowiec
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Adyr Moss
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Kunam S Reddy
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona, USA
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3
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Jadlowiec CC, Brooks A, Pont K, Macdonough E, Buckner Petty S, Valenti K, Lizaola-Mayo B, Frasco P, Aqel B, Mathur AK, Moss A, Reddy KS. Liver transplant outcomes using late allocation grafts. Liver Transpl 2023; 29:1323-1329. [PMID: 37432903 DOI: 10.1097/lvt.0000000000000208] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/14/2023] [Indexed: 07/13/2023]
Abstract
Post-cross clamp late allocation (LA) liver allografts are at increased risk for discard for many reasons including logistical complexity. Nearest neighbor propensity score matching was used to match 2 standard allocation (SA) offers to every 1 LA liver offer performed at our center between 2015 and 2021. Propensity scores were based on a logistic regression model including recipient age, recipient sex, graft type (donation after circulatory death vs. donation after brain death), Model for End-stage Liver Disease (MELD), and DRI score. During this time, 101 liver transplants (LT) were performed at our center using LA offers. In comparing LA and SA offers, there were no differences in recipient characteristics including indication for transplant ( p = 0.29), presence of PVT ( p = 0.19), TIPS ( p = 0.83), and HCC status ( p = 0.24). LA grafts came from younger donors (mean age 43.6 vs. 48.9 y, p = 0.009) and were more likely to come from regional or national Organ Procurement Organizations (OPOs) ( p < 0.001). Cold ischemia time was longer for LA grafts (median 8.5 vs 6.3 h, p < 0.001). Following LT, there were no differences between the 2 groups in intensive care unit ( p = 0.22) and hospital ( p = 0.49) lengths of stay, need for endoscopic interventions ( p = 0.55), or biliary strictures ( p = 0.21). Patient (HR 1.0, 95% CI, 0.47-2.15, p = 0.99) and graft (HR 1.23, 95% CI, 0.43-3.50, p = 0.70) survival did not vary between the LA and SA cohorts. One-year LA and SA patient survival was 95.1% and 95.0%; 1-year graft survival was 93.1% and 92.1%, respectively. Despite the additional logistical complexity and longer cold ischemia time, LT outcomes utilizing LA grafts are similar to those allocated by means of SA. Improving allocation policies specific to LA offers, as well as the sharing of best practices between transplant centers and OPOs, are opportunities to further help minimize unnecessary discards.
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Affiliation(s)
- Caroline C Jadlowiec
- Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Abigail Brooks
- Department of Surgery, Division of Surgery, Montefiore Medical Center, New York City, New York, USA
| | - Kylie Pont
- Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Elizabeth Macdonough
- Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona, USA
| | - Skye Buckner Petty
- Department of Research and Biostatistics, Division of Research Biostatistics, Mayo Clinic, Phoenix, Arizona, USA
| | - Kristi Valenti
- Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Blanca Lizaola-Mayo
- Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona, USA
| | - Peter Frasco
- Department of Anesthesiology, Division of Anesthesiology, Mayo Clinic, Phoenix, Arizona, USA
| | - Bashar Aqel
- Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona, USA
| | - Amit K Mathur
- Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Adyr Moss
- Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Kunam S Reddy
- Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona, USA
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Mills T, Grimes J, Caddick E, Jenkins CL, Evans J, Moss A, Wills J, Sykes S. 'Odds Are: They Win': a disruptive messaging innovation for challenging harmful products and practices of the gambling industry. Public Health 2023; 224:41-44. [PMID: 37714065 PMCID: PMC10627150 DOI: 10.1016/j.puhe.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE This paper presents an evidence informed rationale for focussing on harmful gambling products and industry practices in public health messaging through the example of a recent innovation called 'Odds Are: They Win'. METHODS 'Odds Are: They Win' was initially developed through coproduction involving public health professionals and people with lived experience of gambling harms and implemented across a city-region area. A review of relevant evidence was undertaken, upon which the research team reflected to draw out the implications of 'Odds Are: They Win' for gambling harms messaging. RESULTS Evidence is mounting that safer gambling campaigns framed in terms of individual responsibility are ineffective and can generate stigma. 'Odds Are: They Win' presents an alternative focus that is not anti-gambling but raises awareness of industry manipulation of the situational and structural context of gambling. This is in-keeping with historical lessons from the stop smoking field and emerging research in critical health literacy. The latter highlights the potential of education on the social and commercial determinants of health to stimulate behaviour change and collective action. CONCLUSION 'Odds Are: They Win' is a potentially disruptive innovation for the gambling harms field. Research is required to robustly evaluate this intervention across diverse criteria, target audiences, and delivery settings.
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Affiliation(s)
- T Mills
- PHIRST South Bank, London South Bank University, 103 Borough Rd, London SE1 0AA, UK.
| | - J Grimes
- Gambling with Lives - The Circle, 33 Rockingham Lane, Sheffield S1 4FW, UK
| | - E Caddick
- Greater Manchester Combined Authority - Tootal, 56 Oxford St, Manchester M1 6EU, UK
| | - C L Jenkins
- PHIRST South Bank, London South Bank University, 103 Borough Rd, London SE1 0AA, UK
| | - J Evans
- Greater Manchester Combined Authority - Tootal, 56 Oxford St, Manchester M1 6EU, UK
| | - A Moss
- PHIRST South Bank, London South Bank University, 103 Borough Rd, London SE1 0AA, UK
| | - J Wills
- PHIRST South Bank, London South Bank University, 103 Borough Rd, London SE1 0AA, UK
| | - S Sykes
- PHIRST South Bank, London South Bank University, 103 Borough Rd, London SE1 0AA, UK
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Egbert LK, Ohara SY, Das D, Brooks A, Mahdi G, Aqel B, Buckner Petty SA, Mathur AK, Moss A, Reddy KS, Jadlowiec CC. Expanding Liver Transplant Opportunities in Older Patients With Nonconventional Grafts. J Surg Res 2023; 288:140-147. [PMID: 36966594 DOI: 10.1016/j.jss.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/06/2023] [Accepted: 01/30/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Broader use of donation after circulatory death (DCD) and nonconventional grafts for liver transplant helps reduce disparities in organ availability. Limited data, however, exists on outcomes specific to nonconventional graft utilization in older patients. As such, this study aimed to investigate outcomes specific to conventional and nonconventional graft utilization in recipients > 70 y of age. METHODS 1-to-3 matching based on recipient sex, Model for End-Stage Liver Disease score, and donor type was performed on patients ≥70 and <70 y of age who underwent liver transplant alone at Mayo Clinic Arizona between 2015 and 2020. Primary outcomes were posttransplant patient and liver allograft survival for recipients greater than or less than 70 y of age. Secondary outcomes included grafts utilization patterns, hospital length of stay, need for reoperation, biliary complications and disposition at time of hospital discharge. RESULTS In this cohort, 36.1% of grafts came from DCD donors, 17.4% were postcross clamp offers, and 20.8% were nationally allocated. Median recipient ages were 59 and 71 y (P < 0.01). Recipients had similar Intensive care unit (P = 0.82) and hospital (P = 0.14) lengths of stay, and there were no differences in patient (P = 0.68) or graft (P = 0.38) survival. When comparing donation after brain death and DCD grafts in those >70 y, there were no differences in patient (P = 0.89) or graft (P = 0.71) survival. CONCLUSIONS Excellent outcomes can be achieved in older recipients, even with use of nonconventional grafts. Expanded use of nonconventional grafts can help facilitate transplant opportunities in older patients.
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Affiliation(s)
- Lena K Egbert
- Department of Surgery, Mayo Clinic, Phoenix, Arizona
| | - Stephanie Y Ohara
- Division of Surgery, Valleywise Health Medical Center, Creighton University, Phoenix, Arizona
| | - Devika Das
- Division of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Abigail Brooks
- Division of Surgery, Montefiore Medical Center, New York City, New York
| | - Giyth Mahdi
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Bashar Aqel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona
| | | | - Amit K Mathur
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona
| | - Adyr Moss
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona
| | - Kunam S Reddy
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona
| | - Caroline C Jadlowiec
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona.
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Seston EM, Willis SC, Fenton C, Hindi AMK, Moss A, Stearns S, Astbury J, Jacobs S, McDermott I, Schafheutle EI. Implementation of behaviour change training in practice amongst pharmacy professionals in primary care settings: Analysis using the COM-B model. Res Social Adm Pharm 2023:S1551-7411(23)00239-5. [PMID: 37121797 DOI: 10.1016/j.sapharm.2023.04.123] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND The Pharmacy Integration Fund (PhIF) was established in England in 2016, with funded learning programmes or 'pathways' designed to support the development of clinical pharmacy practice in a range of settings. Despite pharmacy staff being well positioned to provide more clinical work, limited research has investigated behaviour change training targeted at widespread practice transformation. OBJECTIVE(S) To investigate implementation of PhIF learning in practice, using the COM-B model of behaviour change. METHODS An online survey distributed in February and October 2020 included questions on motivations for learning, confidence in target behaviours and impact of PhIF training on behaviour. The October 2020 survey also included questions exploring the effect of the COVID-19 pandemic. Quantitative data were analysed in SPSS. v.27 (IBM). Inferential statistics were used to compare between the pathways (Primary care pathways [PCP], Post-registration pathway [PRP] and Accuracy Checking Pharmacy Technician [ACPT] pathway). Free text comments were categorised and themed. RESULTS Three-hundred and eighty-three responses were received (49% PRP learners, 39% PCP learners and 12% ACPT learners). Learners generally had the capacity and opportunities to apply learning, and were strongly motivated to implement behaviours in practice, although learners based in community pharmacy (those on the PRP) were less likely to report receiving employer support. Enhanced knowledge/skills (capacity) were more commonly reported than change to patient-facing activities, leading clinical services and conducting medication reviews with patients with complex needs (clinical practice behaviours targeted by the pathways). The COVID-19 pandemic heightened barriers to implementing practice change. CONCLUSIONS Implementation of a range of clinical practice behaviours following at scale training appears to have been largely successful. Despite this, the community pharmacy context, where funded service opportunities may be lacking, continues to present challenges to workforce transformation plans. More work is needed to understand how training can be implemented to promote practice change for pharmacy professionals in all settings.
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Affiliation(s)
- E M Seston
- Centre for Pharmacy Workforce Studies Division of Pharmacy & Optometry Faculty of Biology, Medicine and Health Stopford Building, University of Manchester, M13 9PT, UK
| | - S C Willis
- Innovation Management and Policy Division, Alliance Manchester Business School, The University of Manchester, Booth Street West, Manchester, M15 6PB, UK.
| | - C Fenton
- ICF, Riverscape, 3rd Floor, 10 Queens Street Place, London, EC4R 1BE, UK
| | - A M K Hindi
- Centre for Pharmacy Workforce Studies Division of Pharmacy & Optometry Faculty of Biology, Medicine and Health Stopford Building, University of Manchester, M13 9PT, UK
| | - A Moss
- ICF, Riverscape, 3rd Floor, 10 Queens Street Place, London, EC4R 1BE, UK
| | - S Stearns
- ICF, Riverscape, 3rd Floor, 10 Queens Street Place, London, EC4R 1BE, UK
| | - J Astbury
- Centre for Pharmacy Workforce Studies Division of Pharmacy & Optometry Faculty of Biology, Medicine and Health Stopford Building, University of Manchester, M13 9PT, UK
| | - S Jacobs
- Centre for Pharmacy Workforce Studies Division of Pharmacy & Optometry Faculty of Biology, Medicine and Health Stopford Building, University of Manchester, M13 9PT, UK
| | - I McDermott
- Centre for Pharmacy Workforce Studies Division of Pharmacy & Optometry Faculty of Biology, Medicine and Health Stopford Building, University of Manchester, M13 9PT, UK
| | - E I Schafheutle
- Centre for Pharmacy Workforce Studies Division of Pharmacy & Optometry Faculty of Biology, Medicine and Health Stopford Building, University of Manchester, M13 9PT, UK
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Kohli DR, Aqel BA, Segaran NL, Harrison ME, Fukami N, Faigel DO, Moss A, Mathur A, Hewitt W, Katariya N, Pannala R. Outcomes of endoscopic retrograde cholangiography and percutaneous transhepatic biliary drainage in liver transplant recipients with a Roux-en-Y biliary-enteric anastomosis. Ann Hepatobiliary Pancreat Surg 2023; 27:49-55. [PMID: 36245257 PMCID: PMC9947378 DOI: 10.14701/ahbps.22-037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 02/16/2023] Open
Abstract
Backgrounds/Aims Data regarding outcomes of endoscopic retrograde cholangiography (ERC) in liver transplant (LT) recipients with biliary-enteric (BE) anastomosis are limited. We report outcomes of ERC and percutaneous transhepatic biliary drainage (PTBD) as first-line therapies in LT recipients with BE anastomosis. Methods All LT recipients with Roux-BE anastomosis from 2001 to 2020 were divided into ERC and PTBD subgroups. Technical success was defined as the ability to cannulate the bile duct. Clinical success was defined as the ability to perform cholangiography and therapeutic interventions. Results A total of 36 LT recipients (25 males, age 53.5 ± 13 years) with Roux-BE anastomosis who underwent biliary intervention were identified. The most common indications for a BE anastomosis were primary sclerosing cholangitis (n = 14) and duct size mismatch (n = 10). Among the 29 patients who initially underwent ERC, technical success and clinical success were achieved in 24 (82.8%) and 22 (75.9%) patients, respectively. The initial endoscope used for the ERC was a single balloon enteroscope in 16 patients, a double balloon enteroscope in 7 patients, a pediatric colonoscope in 5 patients, and a conventional reusable duodenoscope in 1 patient. Among the 7 patients who underwent PTBD as the initial therapy, six (85.7%) achieved technical and clinical success (p = 0.57). Conclusions In LT patients with Roux-BE anastomosis requiring biliary intervention, ERC with a balloon-assisted enteroscope is safe with a success rate comparable to PTBD. Both ERC and PTBD can be considered as first-line therapies for LT recipients with a BE anastomosis.
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Affiliation(s)
- Divyanshoo Rai Kohli
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, United States,Pancreas and Liver Clinic, Providence Sacred Heart Medical Center, Spokane, WA, United States,Corresponding author: Divyanshoo Rai Kohli, MD Pancreas and Liver Clinic, Providence Sacred Heart Medical Center, 105 W 8th Ave Suite 7050, Spokane, WA 99204, United States Tel: +1-509-252-1711, Fax: +1-509-747-0416, E-mail: ORCID: https://orcid.org/0000-0002-7801-0044
| | - Bashar A. Aqel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, United States
| | - Nicole L. Segaran
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, United States
| | - M. Edwyn Harrison
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, United States
| | - Norio Fukami
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, United States
| | - Douglas O. Faigel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, United States
| | - Adyr Moss
- Department of Surgery, Mayo Clinic Transplant Center, Phoenix, AZ, United States
| | - Amit Mathur
- Department of Surgery, Mayo Clinic Transplant Center, Phoenix, AZ, United States
| | - Winston Hewitt
- Department of Surgery, Mayo Clinic Transplant Center, Phoenix, AZ, United States
| | - Nitin Katariya
- Department of Surgery, Mayo Clinic Transplant Center, Phoenix, AZ, United States
| | - Rahul Pannala
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, United States
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Jadlowiec CC, Macdonough E, Pont K, Valenti K, Lizaola‐Mayo B, Brooks A, Das D, Heilman R, Mathur AK, Hewitt W, Moss A, Aqel B, Reddy KS. Donation after circulatory death transplant outcomes using livers recovered by local surgeons. Liver Transpl 2022; 28:1726-1734. [PMID: 35332655 PMCID: PMC9790574 DOI: 10.1002/lt.26461] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 09/27/2021] [Revised: 02/26/2022] [Accepted: 03/19/2022] [Indexed: 12/30/2022]
Abstract
Donation after circulatory death (DCD) liver transplantation (LT) outcomes have been attributed to multiple variables, including procurement surgeon recovery techniques. Outcomes of 196 DCD LTs at Mayo Clinic Arizona were analyzed based on graft recovery by a surgeon from our center (transplant procurement team [TPT]) versus a local procurement surgeon (non-TPT [NTPT]). A standard recovery technique was used for all TPT livers. The recovery technique used by the NTPT was left to the discretion of that surgeon. A total of 129 (65.8%) grafts were recovered by our TPT, 67 (34.2%) by the NTPT. Recipient age (p = 0.43), Model for End-Stage Liver Disease score (median 17 vs. 18; p = 0.22), and donor warm ischemia time (median 21.0 vs. 21.5; p = 0.86) were similar between the TPT and NTPT groups. NTPT livers had longer cold ischemia times (6.5 vs. 5.0 median hours; p < 0.001). Early allograft dysfunction (80.6% vs. 76.1%; p = 0.42) and primary nonfunction (0.8% vs. 0.0%; p = 0.47) were similar. Ischemic cholangiopathy (IC) treated with endoscopy occurred in 18.6% and 11.9% of TPT and NTPT grafts (p = 0.23). At last follow-up, approximately half of those requiring endoscopy were undergoing a stent-free trial (58.3% TPT; 50.0% NTPT; p = 0.68). IC requiring re-LT in the first year occurred in 0.8% (n = 1) of TPT and 3.0% (n = 2) of NTPT grafts (p = 0.23). There were no differences in patient (hazard ratio [HR], 1.95; 95% confidence interval [CI], 0.76-5.03; p = 0.23) or graft (HR, 1.99; 95% CI, 0.98-4.09; p = 0.10) survival rates. Graft survival at 1 year was 91.5% for TPT grafts and 95.5% for NTPT grafts. Excellent outcomes can be achieved using NTPT for the recovery of DCD livers. There may be an opportunity to expand the use of DCD livers in the United States by increasing the use of NTPT.
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Affiliation(s)
| | | | - Kylie Pont
- Division of Transplant SurgeryDepartment of SurgeryMayo ClinicPhoenixArizonaUSA
| | - Kristi Valenti
- Division of Transplant SurgeryDepartment of SurgeryMayo ClinicPhoenixArizonaUSA
| | | | - Abigail Brooks
- Tel Aviv University School of MedicineTel Aviv‐YafoIsrael
| | - Devika Das
- Division of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | | | - Amit K. Mathur
- Division of Transplant SurgeryDepartment of SurgeryMayo ClinicPhoenixArizonaUSA
| | - Winston Hewitt
- Division of Transplant SurgeryDepartment of SurgeryMayo ClinicPhoenixArizonaUSA
| | - Adyr Moss
- Division of Transplant SurgeryDepartment of SurgeryMayo ClinicPhoenixArizonaUSA
| | - Bashar Aqel
- Division of Gastroenterology and HepatologyMayo ClinicPhoenixArizonaUSA
| | - Kunam S. Reddy
- Division of Transplant SurgeryDepartment of SurgeryMayo ClinicPhoenixArizonaUSA
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9
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Alfuhied A, Ayton S, Gulsin GS, Parke KS, Wormleighton JV, Moss A, Graham-Brown MPM, Arnold JR, McCann GP, Singh A. Inter-field strength agreement of left atrial assessment at 1.5T and 3T. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The agreement of left atrial (LA) volumetric and strain parameters between 1.5 and 3-tesla cardiovascular magnetic resonance (CMR) is not known. We aimed to investigate inter-field strength agreement of LA measurements in healthy volunteers scanned at both field strengths on the same day.
Methods
22 healthy volunteers were prospectively recruited and randomized to undergo scanning at either 1.5T or 3T first, immediately crossing over to the other field strength and scanned by the same radiographer. Steady-state free precession cines were analyzed blinded using Medis Suite. LA volumes and LA emptying fraction (LAEF) were calculated using the biplane area length method. LA strain (LAS) was assessed on 4- and 2-chamber and average values were calculated for LA reservoir, conduit, and booster pump function. Data were compared with paired t-tests and agreement was assessed by Bland-Altman plots and intra-class correlation coefficients (ICC).
Results
The median age was 32.5 (IQR 27.5, 42.5) and 45% were male. Key results are shown in the table and figure. There were no significant differences in the LA volumetric or strain mean values between 1.5T and 3T, although Bland-Altman analysis demonstrated a slightly positive bias at 1.5T for LAVmax, LAEF and LAS parameters. The inter-field strength agreement was excellent for LA volumes, reservoir and conduit strain (ICC >0.85, p<0.001), whilst LAEF showed good agreement (ICC=0.77, p=0.001). LAS at booster pump showed poor agreement, with the lowest ICC. The limits of agreement on Bland-Altman analysis were comparable for LAEF and LAS at reservoir.
Conclusion
There was excellent inter-field strength agreement for LA volumes, reservoir and conduit strain, suggesting that measurements can be used interchangeably between field strengths. Booster pump LAS had poor agreement, which is likely due to the fact that this measurement is less reproducible than volumes and reservoir/conduit LAS.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National Institute for Health Research (NIHR)
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Affiliation(s)
- A Alfuhied
- Cardiovascular Sciences, University of Leicester, National Institute for Health Research (NIHR) Leicester Biomedical Research , Leicester , United Kingdom
| | - S Ayton
- Cardiovascular Sciences, University of Leicester, National Institute for Health Research (NIHR) Leicester Biomedical Research , Leicester , United Kingdom
| | - G S Gulsin
- Cardiovascular Sciences, University of Leicester, National Institute for Health Research (NIHR) Leicester Biomedical Research , Leicester , United Kingdom
| | - K S Parke
- Cardiovascular Sciences, University of Leicester, National Institute for Health Research (NIHR) Leicester Biomedical Research , Leicester , United Kingdom
| | - J V Wormleighton
- Cardiovascular Sciences, University of Leicester, National Institute for Health Research (NIHR) Leicester Biomedical Research , Leicester , United Kingdom
| | - A Moss
- Cardiovascular Sciences, University of Leicester, National Institute for Health Research (NIHR) Leicester Biomedical Research , Leicester , United Kingdom
| | - M P M Graham-Brown
- Cardiovascular Sciences, University of Leicester, National Institute for Health Research (NIHR) Leicester Biomedical Research , Leicester , United Kingdom
| | - J R Arnold
- Cardiovascular Sciences, University of Leicester, National Institute for Health Research (NIHR) Leicester Biomedical Research , Leicester , United Kingdom
| | - G P McCann
- Cardiovascular Sciences, University of Leicester, National Institute for Health Research (NIHR) Leicester Biomedical Research , Leicester , United Kingdom
| | - A Singh
- Cardiovascular Sciences, University of Leicester, National Institute for Health Research (NIHR) Leicester Biomedical Research , Leicester , United Kingdom
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Jayasekera CR, Vikram HR, Rifat Z, Wagler J, Okubo K, Braaksma BR, Harbell JW, Jadlowiec CC, Katariya NN, Mathur AK, Moss A, Reddy KS, Singer A, Orenstein R, Saling CF, Seville MT, Mour GK, Vargas HE, Byrne TJ, Hewitt WR, Aqel BA. Solid Organ Transplantation From SARS-CoV-2-infected Donors to Uninfected Recipients: A Single-center Experience. Transplant Direct 2022; 8:e1286. [PMID: 35047665 PMCID: PMC8759616 DOI: 10.1097/txd.0000000000001286] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The risk of donor-derived severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in solid organ (heart, lung, liver, kidney, pancreas, and intestine) transplant recipients is poorly understood. Since hematogenous transmission of SARS-CoV-2 has not been documented to date, nonlung solid organs might be suitable for transplantation since they likely portend a low risk of viral transmission. METHODS Abdominal solid organs from SARS-CoV-2-infected donors were transplanted into uninfected recipients. RESULTS Between April 18, 2021, and October 30, 2021, we performed transplants of 2 livers, 1 simultaneous liver and kidney, 1 kidney, and 1 simultaneous kidney and pancreas from SARS-CoV-2-infected donors into 5 uninfected recipients. None of the recipients developed SARS-CoV-2 infection or coronavirus disease 2019, and when tested, allograft biopsies showed no evidence of SARS-CoV-2 RNA. CONCLUSIONS Transplanting nonlung organs from SARS-CoV-2-infected donors into uninfected recipients demonstrated no evidence of virus transmission.
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Affiliation(s)
- Channa R. Jayasekera
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ
| | | | - Zeeshan Rifat
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Josiah Wagler
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Keita Okubo
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Brandon R. Braaksma
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Jack W. Harbell
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Caroline C. Jadlowiec
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Nitin N. Katariya
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Amit K. Mathur
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Adyr Moss
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - K. Sudhakar Reddy
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Andrew Singer
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Robert Orenstein
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ
| | - Christopher F. Saling
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ
| | - Maria T. Seville
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ
| | - Girish K. Mour
- Division of Nephrology, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ
| | - Hugo E. Vargas
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ
| | - Thomas J. Byrne
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ
| | - Winston R. Hewitt
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Bashar A. Aqel
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ
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11
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Sussman J, Calderon E, Ubl DS, Croome KP, Taner CB, Heimbach JK, Moss A, Habermann EB, Mathur AK. Variation in opioid prescribing patterns after abdominal transplant surgery. Clin Transplant 2021; 35:e14439. [PMID: 34297440 DOI: 10.1111/ctr.14439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/01/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Opioids are associated with negative transplant outcomes. We sought to identify patient and center effects on over-prescribing of opioids (> 200 OME (oral morphine equivalents)). STUDY DESIGN Clinical and opioid prescription data (2014-2017) were collected from three academic transplant centers for kidney (KT), liver (LT), and simultaneous liver-kidney transplant (SLK) patients. Multivariable models were used to identify predictors of opioid over-prescribing at discharge and the occurrence of refill prescriptions at 90 days. RESULTS Three-thousand seven-hundred and two patients underwent transplant in the cohort (KT: n = 2358, LT: n = 1221, SLK: n = 123). More than 80% of recipients were over-prescribed opioids at discharge (Median OME (mOME) = 300 (IQR 225-375). LT and SLK had the largest prescription size (LT mOME 338 (IQR 300-450); SLK mOME 338 (IQR 225-450) and refill rate (LT: 64%, SLK 59%) (all, P < .001). Multivariable analysis indicated that transplant center was a significant predictor of opioid over-prescription after KT and LT (all, P < .001); older age (in KT) and length of stay (LOS) (in LT) were protective factors (both, P < .05). Refill occurrence was associated with initial prescription size and was reduced by older age and initial LOS (all, P < .05). CONCLUSIONS The wide variation in opioid prescribing patterns has implications for transplant practice innovation, guideline development, and further study.
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Affiliation(s)
- Jon Sussman
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - Esteban Calderon
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Daniel S Ubl
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA
| | - Kristopher P Croome
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - C Burcin Taner
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Julie K Heimbach
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Adyr Moss
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Elizabeth B Habermann
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA.,Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Amit K Mathur
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA.,Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
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12
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Tzolos E, Williams M, McElhinney P, Lin A, Grodecki K, Guadalupe F, Cadet S, Kwiecinski J, Doris M, Adamson P, Moss A, Alam S, Hunter A, Shah A, Mills N, Pawade T, Wang C, Weir-McCall J, Roditi G, van Beek E, Shaw L, Nicol E, Berman D, Slomka P, Dweck M, Newby D, Dey D. Pericoronary Adipose Tissue Attenuation, Low Attenuation Plaque Burden And 5-year Risk Of Myocardial Infarction. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Williams M, Kwiecinski J, Doris M, McElhinney P, Cadet S, Adamson P, Moss A, Alam S, Hunter A, Shah A, Mills N, Pawade T, Wang C, Weir-McCall J, Roditi G, van Beek E, Shaw L, Nicol E, Berman D, Slomka P, Newby D, Dweck M, Dey D. Sex-specific CT Coronary Plaque Characterization And Risk Of Myocardial Infarction. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Ninan J, Smith ML, Mathur AK, Harbell JW, Jadlowiec CC, Nair SS, Moss A, Reddy KS, Heilman RL. Correlation of Chronic Histologic Changes on Preimplantation Frozen Section Biopsy With Transplant Outcomes After Deceased Donor Kidney Transplantation. Arch Pathol Lab Med 2021; 146:205-212. [PMID: 34086859 DOI: 10.5858/arpa.2020-0675-oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— It is unclear if preimplantation frozen section biopsy correlates with outcomes after deceased donor kidney transplantation. OBJECTIVE.— To assess if chronic histologic changes on the preimplant frozen section correlates with graft loss and estimated glomerular filtration rate independently of kidney donor profile index (KDPI). DESIGN.— Seven hundred three preimplantation biopsies were reviewed and a Banff sum score was calculated using glomerular sclerosis, interstitial fibrosis, vascular intimal thickening, and arteriolar hyalinosis. The posttransplant outcomes were compared for preimplantation biopsy Banff sum 0-1, 2-3, and 4-9. The cohort was also stratified by KDPI 85 or less versus more than 85. RESULTS.— For the entire biopsy cohort, graft survival, estimated glomerular filtration rate at 1 year and chronic changes on a 1-year posttransplant biopsy were superior in the group with preimplantation Banff sum 0-1. After stratifying by KDPI, the Banff sum no longer correlated with graft survival. In a univariate mode, using the Banff sum score as a continuous variable, a higher Banff sum score was significantly associated with graft failure (P = .03); however, after adjusting the KDPI, the Banff sum score no longer correlated with graft failure (P = .45). The 1-year estimated glomerular filtration rate and 1 year biopsy changes were superior in the group with Banff sum 0-1 only in the cohort with KDPI 85 or less. CONCLUSIONS.— In donor kidneys used for transplant, preimplantation biopsy chronic changes correlate with estimated glomerular filtration rate and biopsy findings at 1 year, but biopsies with mostly mild chronicity and sum scores less than or equal to 5 did not impact graft survival beyond KDPI.
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Affiliation(s)
- Jacob Ninan
- From the Department of Medicine (Ninan, Nair, Heilman), Mayo Clinic Arizona Phoenix, Arizona
| | - Maxwell L Smith
- Department of Laboratory Medicine and Pathology (Smith), Mayo Clinic Arizona Phoenix, Arizona
| | - Amit K Mathur
- the Department of Surgery (Mathur, Harbell, Jadlowiec, Moss, Reddy), Mayo Clinic Arizona Phoenix, Arizona
| | - Jack W Harbell
- the Department of Surgery (Mathur, Harbell, Jadlowiec, Moss, Reddy), Mayo Clinic Arizona Phoenix, Arizona
| | - Caroline C Jadlowiec
- the Department of Surgery (Mathur, Harbell, Jadlowiec, Moss, Reddy), Mayo Clinic Arizona Phoenix, Arizona
| | - Sumi Sukumaran Nair
- From the Department of Medicine (Ninan, Nair, Heilman), Mayo Clinic Arizona Phoenix, Arizona
| | - Adyr Moss
- the Department of Surgery (Mathur, Harbell, Jadlowiec, Moss, Reddy), Mayo Clinic Arizona Phoenix, Arizona
| | - Kunam S Reddy
- the Department of Surgery (Mathur, Harbell, Jadlowiec, Moss, Reddy), Mayo Clinic Arizona Phoenix, Arizona
| | - Raymond L Heilman
- From the Department of Medicine (Ninan, Nair, Heilman), Mayo Clinic Arizona Phoenix, Arizona
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15
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Jadlowiec CC, Hanna WA, Ninan J, Ryan MS, Das DM, Smith M, Khamash H, Mathur AK, Singer A, Moss A, Reddy KS, Heilman RL. Transplant outcomes using kidneys from high KDPI acute kidney injury donors. Clin Transplant 2021; 35:e14279. [PMID: 33690907 DOI: 10.1111/ctr.14279] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/11/2021] [Accepted: 02/27/2021] [Indexed: 11/28/2022]
Abstract
Kidney transplant (KT) outcomes from high kidney donor profile index (KDPI ≥85%) donors with acute kidney injury (AKI) remain underreported. KT from 172 high KDPI Acute Kidney Injury Network (AKIN) stage 0-1 donors and 76 high KDPI AKIN stage 2-3 donors from a single center were retrospectively assessed. The AKIN 2-3 cohort had more delayed graft function (71% vs. 37%, p < .001). At one year, there were no differences in the estimated glomerular filtration rate (44 ± 17 vs. 46 ± 18, p = .42) or fibrosis on protocol biopsy (ci, p = .85). Donor terminal creatinine (p = .59) and length of delayed graft function (p = .39) did not impact one-year eGFR. There were more primary nonfunction (PNF) events in the high KDPI AKIN 2-3 group (5.3% vs. 0.6%, p = .02). With a median follow-up of 3.8 years, one-year death-censored graft failure was 3.5% for AKIN 0-1 and 14.5% for AKIN 2-3 (HR 2.40, 95% CI 1.24-4.63, p = .01). Although AKIN stage 2-3 high KDPI kidneys had comparable one-year eGFR to AKIN stage 0-1 high KDPI kidneys, there were more PNF occurrences and one-year death-censored graft survival was reduced. Given these findings, additional precautions should be undertaken when assessing and utilizing kidneys from severe AKI high KDPI donors.
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Affiliation(s)
| | - Wael A Hanna
- Division of Nephrology, Mayo Clinic, Phoenix, AZ, USA
| | - Jacob Ninan
- Division of Nephrology, Mayo Clinic, Phoenix, AZ, USA
| | - Margaret S Ryan
- Division of Anatomic Pathology, Mayo Clinic, Phoenix, AZ, USA
| | - Devika M Das
- Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Maxwell Smith
- Division of Anatomic Pathology, Mayo Clinic, Phoenix, AZ, USA
| | - Hasan Khamash
- Division of Nephrology, Mayo Clinic, Phoenix, AZ, USA
| | - Amit K Mathur
- Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Andrew Singer
- Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Adyr Moss
- Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Kunam S Reddy
- Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA
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Fletcher A, Lembo M, Syed MBJ, Kwiencinski J, Tzolos E, Moss A, Adamson PD, Walker NL, Slomka PJ, Van Beek EJR, Newby DE, Dweck MR. Hybrid 18f-sodium fluoride PET/CT of the thoracic aorta identifies patients at increased risk of stroke. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): British Heart Foundation Clinical Research Training Fellowship
Background
Calcification of the thoracic aorta is associated with poor vessel wall health. Early detection of this disease process may highlight those at risk of future cardiovascular events.
Purpose
To investigate the potential of hybrid 18F-sodium fluoride (18F-NaF, a marker of vascular disease and microcalcification activity) positron emission tomography/computed tomography (PET/CT) to predict aortic disease progression and adverse cardiovascular events in patients with established risk factors.
Methods
Between 2015 and 2017, 197 patients underwent 18F-NaF PET/CT of the thoracic aorta as part of a randomised controlled trial. Baseline 18F-NaF aortic microcalcification activity (AMA) was calculated as the cumulative uptake in a standardised volume of interest of the arch and ascending aorta. Thirty-seven patients underwent follow up CT enabling aortic calcium score progression calculation. Fatal/non-fatal stroke (primary endpoint) and fatal/non-fatal myocardial infarction (MI, secondary endpoint) were recorded up to May 2020. The association between baseline AMA and both the progression of aortic calcium score and defined endpoints was analysed. AMA was stratified into tertiles (low, moderate or high). Data is presented as mean(SD) or median [IQR].
Results
18F-NaF AMA correlated with the progression of aortic calcium score (R = 0.42, P = 0.01). During 3.8 (0.9) years of follow up, 14 patients experienced the primary (stroke, n = 5) or secondary (MI, n = 9) endpoint. Patients who experienced stroke had higher AMA (171 [162-176] vs 150 [141 - 157], P = 0.0015). Increased cumulative incidence of stroke was seen in the highest AMA tertile (Figure, P = 0.019). There was no association between AMA and MI (P > 0.05).
Conclusion
Aortic microcalcification activity, as measured using 18F-NaF PET/CT, predicts the progression of aortic wall calcification and is associated with an increased risk of stroke but not MI. Consolidating these findings in further studies will improve stroke risk prediction using 18F-NaF PET/CT.
Table Baseline characteristics Overall n = 197 Low AMA (<144) n = 66 Moderate AMA (144-155) n = 66 High AMA (>155) n = 65 p-value (ANOVA / X2) Age (±sd) 65.17 (8.30) 64.02 (9.43) 65.47 (7.40) 66.03 (7.95) 0.364 Male Sex (%) 157 (80.5) 54 (83.1) 52 (78.8) 51 (79.7) 0.808 Ever Smoked (%) 101 (60.5) 37 (71.2) 32 (56.1) 32 (55.2) 0.164 Hypertension (%) 110 (56.4) 31 (47.7) 35 (53.0) 44 (68.8) 0.043 High Cholesterol (%) 188 (96.4) 60 (92.3) 65 (98.5) 63 (98.4) 0.093 Type II Diabetes (%) 37 (19.0) 16 (24.6) 9 (13.6) 12 (18.8) 0.277 AMA = aortic microcalcification activity, MI = myocardial infarction, sd = standard deviation, TIA = transient ischaemic attack, X2 = Chi squared Abstract Figure: AMA and Stroke
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Affiliation(s)
- A Fletcher
- University of Edinburgh, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - M Lembo
- Federico II University of Naples, Naples, Italy
| | - MBJ Syed
- University of Edinburgh, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - J Kwiencinski
- Institute of Cardiology, Department of Interventional Cardiology, Warsaw, Poland
| | - E Tzolos
- Cedars-Sinai Medical Center, Department of Imaging (Division of Nuclear Cardiology), Los Angeles, United States of America
| | - A Moss
- University of Edinburgh, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - PD Adamson
- University of Otago Christchurch, Christchurch Heart Institute, Christchurch, New Zealand
| | - NL Walker
- University of Edinburgh, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - PJ Slomka
- Cedars-Sinai Medical Center, Department of Imaging (Division of Nuclear Cardiology), Los Angeles, United States of America
| | - EJR Van Beek
- University of Edinburgh, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - DE Newby
- Cedars-Sinai Medical Center, Department of Imaging (Division of Nuclear Cardiology), Los Angeles, United States of America
| | - MR Dweck
- University of Edinburgh, Edinburgh, United Kingdom of Great Britain & Northern Ireland
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Pezzanite L, Frank C, Koch D, Moss A, Landolt G. Abdominal aortic thromboembolism and subsequent pelvic limb myositis secondary to colitis and septicaemia in a 5‐day‐old Oldenburg colt. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L. Pezzanite
- Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences Colorado State University Fort Collins ColoradoUSA
| | - C. Frank
- Department of Microbiology, Immunology, and Pathology College of Veterinary Medicine and Biological Sciences Colorado State University Fort Collins Colorado USA
| | - D. Koch
- Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences Colorado State University Fort Collins ColoradoUSA
| | - A. Moss
- Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences Colorado State University Fort Collins ColoradoUSA
| | - G. Landolt
- Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences Colorado State University Fort Collins ColoradoUSA
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18
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Moss A. Mechanisms underlying hydroxyapatite deposition in human coronary atherosclerosis using 18F-fluoride. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kloefkorn H, Aiani LM, Lakhani A, Nagesh S, Moss A, Goolsby W, Rehg JM, Pedersen NP, Hochman S. Noninvasive three-state sleep-wake staging in mice using electric field sensors. J Neurosci Methods 2020; 344:108834. [PMID: 32619585 PMCID: PMC7454007 DOI: 10.1016/j.jneumeth.2020.108834] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 03/09/2020] [Revised: 06/22/2020] [Accepted: 06/26/2020] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE Validate a novel method for sleep-wake staging in mice using noninvasive electric field (EF) sensors. METHODS Mice were implanted with electroencephalogram (EEG) and electromyogram (EMG) electrodes and housed individually. Noninvasive EF sensors were attached to the exterior of each chamber to record respiration and other movement simultaneously with EEG, EMG, and video. A sleep-wake scoring method based on EF sensor data was developed with reference to EEG/EMG and then validated by three expert scorers. Additionally, novice scorers without sleep-wake scoring experience were self-trained to score sleep using only the EF sensor data, and results were compared to those from expert scorers. Lastly, ability to capture three-state sleep-wake staging with EF sensors attached to traditional mouse home-cages was tested. RESULTS EF sensors quantified wake, rapid eye movement (REM) sleep, and non-REM sleep with high agreement (>93%) and comparable inter- and intra-scorer error as EEG/EMG. Novice scorers successfully learned sleep-wake scoring using only EF sensor data and scoring criteria, and achieved high agreement with expert scorers (>91%). When applied to traditional home-cages, EF sensors enabled classification of three-state (wake, NREM and REM) sleep-wake independent of EEG/EMG. CONCLUSIONS EF sensors score three-state sleep-wake architecture with high agreement to conventional EEG/EMG sleep-wake scoring 1) without invasive surgery, 2) from outside the home-cage, and 3) and without requiring specialized training or equipment. EF sensors provide an alternative method to assess rodent sleep for animal models and research laboratories in which EEG/EMG is not possible or where noninvasive approaches are preferred.
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Affiliation(s)
- H Kloefkorn
- Department of Physiology, School of Medicine, Emory University, Atlanta, GA, USA.
| | - L M Aiani
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA
| | - A Lakhani
- Department of Physiology, School of Medicine, Emory University, Atlanta, GA, USA
| | - S Nagesh
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - A Moss
- Department of Physiology, School of Medicine, Emory University, Atlanta, GA, USA
| | - W Goolsby
- Department of Physiology, School of Medicine, Emory University, Atlanta, GA, USA
| | - J M Rehg
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, USA
| | - N P Pedersen
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA.
| | - S Hochman
- Department of Physiology, School of Medicine, Emory University, Atlanta, GA, USA
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20
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Croome KP, Mathur AK, Mao S, Aqel B, Piatt J, Senada P, Heimbach JK, Moss A, Rosen CB, Taner CB. Perioperative and long-term outcomes of utilizing donation after circulatory death liver grafts with macrosteatosis: A multicenter analysis. Am J Transplant 2020; 20:2449-2456. [PMID: 32216008 DOI: 10.1111/ajt.15877] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 11/30/2019] [Revised: 02/04/2020] [Accepted: 03/10/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Given the potentially additive risk from using donor livers that are both steatotic and from a donation after circulatory death (DCD) donor, there is a paucity of data on the outcome of DCD liver transplantation (LT) utilizing livers with macrosteatosis. METHODS All DCD LT performed at Mayo Clinic-Florida, Mayo Clinic-Arizona, and Mayo Clinic-Rochester from 1999 to 2019 were included (N = 714). Recipients of DCD LT were divided into 3 groups: those with moderate macrosteatosis (30%-60%), mild macrosteatosis (5%-30%), and no steatosis (<5%). RESULTS Patients with moderate macrosteatosis had a higher rate of postreperfusion syndrome (PRS; 53.9% vs 26.2%; P = .002), postreperfusion cardiac arrest (7.7% vs 0.3%; P < .001), primary nonfunction (PNF; 7.7% vs 1.0%; P = .003), early allograft dysfunction (EAD; 70.8% vs 45.6% and 8.3%; P = .02), and acute kidney injury (AKI; 39.1% vs 19.4%; P = .02) than patients with no steatosis. No difference in any of the perioperative complications was seen between the mild macrosteatosis and the no steatosis groups except for the rate of EAD (56.8% vs 45.6%; P = .04). No difference in ischemic cholangiopathy (IC), vascular thrombosis/stenosis or graft, and patient survival was seen between the 3 groups. CONCLUSION DCD donors with mild macrosteatosis < 30% can be utilized with no increase in perioperative complications and similar patient and graft survival compared to DCD donors with no steatosis. When utilizing DCD donors with moderate macrosteatosis higher rates of PRS, PNF, postreperfusion cardiac arrest, EAD, and AKI should be anticipated.
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Affiliation(s)
| | - Amit K Mathur
- Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Shennen Mao
- Department of Transplant, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Bashar Aqel
- Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Jacob Piatt
- Department of Transplant, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Peter Senada
- Department of Transplant, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Julie K Heimbach
- Department of Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Adyr Moss
- Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Charles B Rosen
- Department of Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - C Burcin Taner
- Department of Transplant, Mayo Clinic Florida, Jacksonville, Florida, USA
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Webb C, Cronin P, Gupta N, Verhey J, Calderon E, Moss A, Mathur AK, Pockaj B, Wasif N, Stucky CC. Is thyroid cancer prognosis affected by solid organ transplantation? Surgery 2020; 169:58-62. [PMID: 32814633 DOI: 10.1016/j.surg.2020.06.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/14/2020] [Accepted: 06/26/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Thyroid nodules discovered incidentally during transplant may prolong time to transplantation. Although data suggest that incidence of thyroid cancer increases after solid organ transplantation, the impact on prognosis in differentiated thyroid cancer is not well characterized. METHODS We performed a retrospective review of patients with history of thyroid cancer and solid organ transplantation at our institution. RESULTS A total of 13,037 patients underwent solid organ transplantation of which there were 94 patients with differentiated thyroid cancer (0.7%). Of these, 50 patients (53%) had cancer pre-solid organ transplantation, whereas 44 patients (47%) developed cancer post-solid organ transplantation. Papillary histology was most common (88%), followed by follicular (3%), Hurthle cell (3%), and medullary (2%) carcinomas. One patient in the post-transplant cohort died from metastatic thyroid cancer 11.8 years after transplantation. There were 5 patients in the pre-transplant group and 4 patients in the post-transplant group who had recurrent thyroid disease. There were no patients treated for differentiated thyroid cancer pre-solid organ transplantation that experienced disease recurrence after transplantation. Disease-free survival at 5 and 10 years was 95.8% and 92.1% (confidence interval 84.9-99.2%, 80.0-97.4%) in the pre-solid organ transplantation group vs 89.7% and 84.4% in the post (confidence interval: 80.0-96.3% and 79.0-93.1%, P = .363), respectively. CONCLUSION Survival outcomes and recurrence rates in patients with thyroid cancer are not significantly affected by solid organ transplantation. A history of thyroid cancer or discovery of thyroid nodules during transplant screening should not be a contraindication for transplant listing.
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Affiliation(s)
- Christopher Webb
- Department of Surgery, Division of Surgical Oncology, Mayo Clinic, Phoenix, AZ.
| | - Patricia Cronin
- Department of Surgery, Division of Surgical Oncology, Mayo Clinic, Phoenix, AZ
| | | | - Jens Verhey
- Mayo Clinic School of Medicine, Scottsdale AZ
| | - Esteban Calderon
- Department of Surgery, Division of Surgical Oncology, Mayo Clinic, Phoenix, AZ
| | - Adyr Moss
- Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ
| | - Amit K Mathur
- Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ
| | - Barbara Pockaj
- Department of Surgery, Division of Surgical Oncology, Mayo Clinic, Phoenix, AZ
| | - Nabil Wasif
- Department of Surgery, Division of Surgical Oncology, Mayo Clinic, Phoenix, AZ
| | - Chee-Chee Stucky
- Department of Surgery, Division of Surgical Oncology, Mayo Clinic, Phoenix, AZ
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Levitsky J, Asrani SK, Schiano T, Moss A, Chavin K, Miller C, Guo K, Zhao L, Kandpal M, Bridges N, Brown M, Armstrong B, Kurian S, Demetris AJ, Abecassis M. Discovery and validation of a novel blood-based molecular biomarker of rejection following liver transplantation. Am J Transplant 2020; 20:2173-2183. [PMID: 32356368 PMCID: PMC7496674 DOI: 10.1111/ajt.15953] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 09/25/2019] [Revised: 02/28/2020] [Accepted: 04/13/2020] [Indexed: 02/06/2023]
Abstract
Noninvasive biomarker profiles of acute rejection (AR) could affect the management of liver transplant (LT) recipients. Peripheral blood was collected following LT for discovery (Northwestern University [NU]) and validation (National Institute of Allergy and Infectious Diseases Clinical Trials in Organ Transplantation [CTOT]-14 study). Blood gene profiling was paired with biopsies showing AR or ADNR (acute dysfunction no rejection) as well as stable graft function samples (Transplant eXcellent-TX). CTOT-14 subjects had serial collections prior to AR, ADNR, TX, and after AR treatment. NU cohort gene expression (46 AR, 45 TX) was analyzed using random forest models to generate a classifier training set (36 gene probe) distinguishing AR vs TX (area under the curve 0.92). The algorithm and threshold were locked and tested on the CTOT-14 validation cohort (14 AR, 50 TX), yielding an accuracy of 0.77, sensitivity 0.57, specificity 0.82, positive predictive value (PPV) 0.47, and negative predictive value (NPV) 0.87 for AR vs TX. The probability score line slopes were positive preceding AR, and negative preceding TX and non-AR (TX + ADNR) (P ≤ .001) and following AR treatment. In conclusion, we have developed a blood biomarker diagnostic for AR that can be detected prior to AR-associated graft injury as well a normal graft function (non-AR). Further studies are needed to evaluate its utility in precision-guided immunosuppression optimization following LT.
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Affiliation(s)
- Josh Levitsky
- Comprehensive Transplant CenterNorthwestern University Feinberg School of MedicineChicagoIllinois,Division of Gastroenterology and HepatologyDepartment of MedicineNorthwestern University Feinberg School of MedicineChicagoIllinois
| | - Sumeet K. Asrani
- Annette C. and Harold C. Simmons Transplant InstituteBaylor University Medical CenterDallasTexas
| | | | | | | | | | - Kexin Guo
- Comprehensive Transplant CenterNorthwestern University Feinberg School of MedicineChicagoIllinois,Biostatistics Collaboration CenterDepartment of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIllinois
| | - Lihui Zhao
- Comprehensive Transplant CenterNorthwestern University Feinberg School of MedicineChicagoIllinois,Biostatistics Collaboration CenterDepartment of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIllinois
| | - Manoj Kandpal
- Comprehensive Transplant CenterNorthwestern University Feinberg School of MedicineChicagoIllinois,Biostatistics Collaboration CenterDepartment of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIllinois
| | - Nancy Bridges
- Division of Allergy, Immunology, and TransplantationNational Institute of Allergy and Infectious DiseasesBethesdaMaryland
| | - Merideth Brown
- Division of Allergy, Immunology, and TransplantationNational Institute of Allergy and Infectious DiseasesBethesdaMaryland
| | | | - Sunil Kurian
- The Scripps Research InstituteLa JollaCalifornia
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Kohli DR, Harrison ME, Mujahed T, Fukami N, Faigel DO, Pannala R, Moss A, Aqel BA. Outcomes of endoscopic therapy in donation after cardiac death liver transplant biliary strictures. HPB (Oxford) 2020; 22:979-986. [PMID: 31676256 DOI: 10.1016/j.hpb.2019.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 08/22/2019] [Accepted: 10/03/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Biliary strictures after donation-after-cardiac-death (DCD) liver transplantation (LT) require multiple endoscopic retrograde cholangiopancreatographies (ERCP). The outcomes of endoscopic dilation and maximal stenting are not well-characterized in this high-risk population. METHODS DCD LT recipients who underwent LT and ERCP from 2012-2018 were selected. Anastomotic and non-anastomotic strictures were treated with balloon dilation and maximal stenting. A successful stent-free trial was defined as absence of biochemical, clinical or imaging evidence of strictures on follow-up exceeding 6 months. Adverse events were defined as unplanned admission or inpatient evaluation within 7 days of ERCP. RESULTS Forty-nine DCD LT recipients underwent ERCP and 34 patients were diagnosed with strictures (20 anastomotic). Stent-free trial was successful in 27 patients. Adverse events occurred after 20 ERCPs. Patients with anastomotic strictures required fewer stents (1.43 ± 1.37 vs 2.63 ± 1.66; P < 0.001), shorter procedure and fluoroscopy times (34.15 ± 20.9 vs 59.6 ± 30.7 minutes, P < 0.001; 5.99 ± 7.4 vs 14.73 ± 10.74 minutes, P < 0.001), fewer relapses (10% vs 57%, P = 0.003), shorter intervals between initial ERCP and stent-free success (136.9 ± 118.3 vs 399.56 ± 234.7; P = 0.003), and between LT and stent-free success (227.8 ± 171.9 vs 464.1 ± 224.6 days; P = 0.005) compared to non-anastomotic strictures. CONCLUSION Endoscopic dilation and maximal stenting resolves biliary strictures in DCD LT recipients with sustained success and relatively few adverse events.
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Affiliation(s)
- Divyanshoo R Kohli
- Division of Gastroenterology and Hepatology, Mayo Clinic, AZ, United States; Division of Gastroenterology and Hepatology, Kansas City VA Medical Center, MO, United States.
| | - M E Harrison
- Division of Gastroenterology and Hepatology, Mayo Clinic, AZ, United States
| | - Tala Mujahed
- Mayo Clinic School of Medicine, Mayo Clinic, AZ, United States
| | - Norio Fukami
- Division of Gastroenterology and Hepatology, Mayo Clinic, AZ, United States
| | - Douglas O Faigel
- Division of Gastroenterology and Hepatology, Mayo Clinic, AZ, United States
| | - Rahul Pannala
- Division of Gastroenterology and Hepatology, Mayo Clinic, AZ, United States
| | - Adyr Moss
- Department of Surgery, Mayo Clinic, AZ, United States
| | - Bashar A Aqel
- Division of Gastroenterology and Hepatology, Mayo Clinic, AZ, United States
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Williams M, Weir-McCall J, Moss A, Schmitt M, Stirrup J, Holloway B, Gopalan D, Deshpande A, Morgan Hughes G, Agrawal B, Nicol E, Roditi G, Shambrook J, Bull R. Radiologist Opinions Regarding Reporting Incidental Coronary And Cardiac Calcification On Thoracic CT. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Liebing J, Völker I, Curland N, Wohlsein P, Baumgärtner W, Braune S, Runge M, Moss A, Rautenschlein S, Jung A, Ryll M, Raue K, Strube C, Schulz J, Heffels-Redmann U, Fischer L, Gethöffer F, Voigt U, Lierz M, Siebert U. Health status of free-ranging ring-necked pheasant chicks (Phasianus colchicus) in North-Western Germany. PLoS One 2020; 15:e0234044. [PMID: 32544211 PMCID: PMC7297342 DOI: 10.1371/journal.pone.0234044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/17/2020] [Indexed: 01/28/2023] Open
Abstract
Being a typical ground-breeding bird of the agricultural landscape in Germany, the pheasant has experienced a strong and persistent population decline with a hitherto unexplained cause. Contributing factors to the ongoing negative trend, such as the effects of pesticides, diseases, predation, increase in traffic and reduced fallow periods, are currently being controversially discussed. In the present study, 62 free-ranging pheasant chicks were caught within a two-year period in three federal states of Germany; Lower Saxony, North Rhine-Westphalia and Schleswig-Holstein. The pheasant chicks were divided into three age groups to detect differences in their development and physical constitution. In addition, pathomorphological, parasitological, virological, bacteriological and toxicological investigations were performed. The younger chicks were emaciated, while the older chicks were of moderate to good nutritional status. However, the latter age group was limited to a maximum of three chicks per hen, while the youngest age class comprised up to ten chicks. The majority of chicks suffered from dermatitis of the periocular and caudal region of the head (57-94%) of unknown origin. In addition, intestinal enteritis (100%), pneumonia (26%), hepatitis (24%), perineuritis (6%), tracheitis (24%), muscle degeneration (1%) and myositis (1%) were found. In 78% of the cases, various Mycoplasma spp. were isolated. Mycoplasma gallisepticum (MG) was not detected using an MG-specific PCR. Parasitic infections included Philopteridae (55%), Coccidia (48%), Heterakis/Ascaridia spp. (8%) and Syngamus trachea (13%). A total of 8% of the chicks were Avian metapneumovirus (AMPV) positive using RT-PCR, 16% positive for infectious bronchitis virus (IBV) using RT-PCR, and 2% positive for haemorrhagic enteritis virus (HEV) using PCR. All samples tested for avian encephalomyelitis virus (AEV), infectious bursal disease virus (IBDV) or infectious laryngotracheitis virus (ILTV) were negative. The pool samples of the ten chicks were negative for all acid, alkaline-free and derivative substances, while two out of three samples tested were positive for the herbicide glyphosate. Pheasant chick deaths may often have been triggered by poor nutritional status, probably in association with inflammatory changes in various tissues and organs as well as bacterial and parasitic pathogens. Theses impacts may have played a major role in the decline in pheasant populations.
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Affiliation(s)
- J. Liebing
- Institute for Terrestrial and Aquatic Wildlife Research, University of Veterinary Medicine Hannover, Hannover, Germany
| | - I. Völker
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - N. Curland
- Institute for Terrestrial and Aquatic Wildlife Research, University of Veterinary Medicine Hannover, Hannover, Germany
| | - P. Wohlsein
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - W. Baumgärtner
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - S. Braune
- Lower Saxony State Office for Consumer Protection and Food Safety (LAVES), Food and Veterinary Institute Braunschweig/Hannover, Hannover, Germany
| | - M. Runge
- Lower Saxony State Office for Consumer Protection and Food Safety (LAVES), Food and Veterinary Institute Braunschweig/Hannover, Hannover, Germany
| | - A. Moss
- Lower Saxony State Office for Consumer Protection and Food Safety (LAVES), Food and Veterinary Institute Oldenburg, Oldenburg, Germany
| | - S. Rautenschlein
- Clinic for Poultry, University of Veterinary Medicine Hannover, Hannover, Germany
| | - A. Jung
- Clinic for Poultry, University of Veterinary Medicine Hannover, Hannover, Germany
| | - M. Ryll
- Clinic for Poultry, University of Veterinary Medicine Hannover, Hannover, Germany
| | - K. Raue
- Institute for Parasitology, Centre for Infection Medicine, University of Veterinary Medicine Hannover, Hannover, Germany
| | - C. Strube
- Institute for Parasitology, Centre for Infection Medicine, University of Veterinary Medicine Hannover, Hannover, Germany
| | - J. Schulz
- Institute for Animal Hygiene, Animal Welfare and Farm Animal Behaviour, University of Veterinary Medicine Hannover, Hannover, Germany
| | - U. Heffels-Redmann
- Clinic for Birds, Reptiles, Amphibians and Fish, Justus Liebig University Giessen, Giessen, Germany
| | - L. Fischer
- Clinic for Birds, Reptiles, Amphibians and Fish, Justus Liebig University Giessen, Giessen, Germany
| | - F. Gethöffer
- Institute for Terrestrial and Aquatic Wildlife Research, University of Veterinary Medicine Hannover, Hannover, Germany
| | - U. Voigt
- Institute for Terrestrial and Aquatic Wildlife Research, University of Veterinary Medicine Hannover, Hannover, Germany
| | - M. Lierz
- Clinic for Birds, Reptiles, Amphibians and Fish, Justus Liebig University Giessen, Giessen, Germany
| | - U. Siebert
- Institute for Terrestrial and Aquatic Wildlife Research, University of Veterinary Medicine Hannover, Hannover, Germany
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Levitsky J, Asrani SK, Klintmalm G, Schiano T, Moss A, Chavin K, Miller C, Guo K, Zhao L, Jennings LW, Brown M, Armstrong B, Abecassis M. Discovery and Validation of a Biomarker Model (PRESERVE) Predictive of Renal Outcomes After Liver Transplantation. Hepatology 2020; 71:1775-1786. [PMID: 31509263 PMCID: PMC7883482 DOI: 10.1002/hep.30939] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/05/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS A high proportion of patients develop chronic kidney disease (CKD) after liver transplantation (LT). We aimed to develop clinical/protein models to predict future glomerular filtration rate (GFR) deterioration in this population. APPROACH AND RESULTS In independent multicenter discovery (CTOT14) and single-center validation (BUMC) cohorts, we analyzed kidney injury proteins in serum/plasma samples at month 3 after LT in recipients with preserved GFR who demonstrated subsequent GFR deterioration versus preservation by year 1 and year 5 in the BUMC cohort. In CTOT14, we also examined correlations between serial protein levels and GFR over the first year. A month 3 predictive model was constructed from clinical and protein level variables using the CTOT14 cohort (n = 60). Levels of β-2 microglobulin and CD40 antigen and presence of hepatitis C virus (HCV) infection predicted early (year 1) GFR deterioration (area under the curve [AUC], 0.814). We observed excellent validation of this model (AUC, 0.801) in the BUMC cohort (n = 50) who had both early and late (year 5) GFR deterioration. At an optimal threshold, the model had the following performance characteristics in CTOT14 and BUMC, respectively: accuracy (0.75, 0.8), sensitivity (0.71, 0.67), specificity (0.78, 0.88), positive predictive value (0.74, 0.75), and negative predictive value (0.76, 0.82). In the serial CTOT14 analysis, several proteins, including β-2 microglobulin and CD40, correlated with GFR changes over the first year. CONCLUSIONS We have validated a clinical/protein model (PRESERVE) that early after LT can predict future renal deterioration versus preservation with high accuracy. This model may help select recipients at higher risk for subsequent CKD for early, proactive renal sparing strategies.
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Affiliation(s)
- Josh Levitsky
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | | | | | - Kexin Guo
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lihui Zhao
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Merideth Brown
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, Bethesda, MD
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Jadlowiec C, Smith M, Neville M, Mao S, Abdelwahab D, Reddy K, Moss A, Aqel B, Taner T. Acute Kidney Injury Patterns Following Transplantation of Steatotic Liver Allografts. J Clin Med 2020; 9:jcm9040954. [PMID: 32235545 PMCID: PMC7230326 DOI: 10.3390/jcm9040954] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 02/29/2020] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 01/01/2023] Open
Abstract
Background: Steatotic grafts are increasingly being used for liver transplant (LT); however, the impact of graft steatosis on renal function has not been well described. Methods: A total of 511 allografts from Mayo Clinic Arizona and Minnesota were assessed. We evaluated post-LT acute kidney injury (AKI) patterns, perioperative variables and one-year outcomes for patients receiving moderately steatotic allografts (>30% macrovesicular steatosis, n = 40) and compared them to non-steatotic graft recipients. Results: Post-LT AKI occurred in 52.5% of steatotic graft recipients versus 16.7% in non-steatotic recipients (p < 0.001). Ten percent of steatotic graft recipients required new dialysis post-LT (p = 0.003). At five years, there were no differences for AKI vs. no AKI patient survival (HR 0.95, 95% CI 0.08–10.6, p = 0.95) or allograft survival (HR 1.73, 95% CI 0.23–13.23, p = 0.59) for those using steatotic grafts. Lipopeliosis on biopsy was common in those who developed AKI (61.0% vs. 31.6%, p = 0.04), particularly when the Model for End-Stage Liver Disease (MELD) was ≥20 (88.9%; p = 0.04). Lipopeliosis was a predictor of post-LT AKI (OR 6.0, 95% CI 1.1–34.6, p = 0.04). Conclusion: One-year outcomes for moderately steatotic grafts are satisfactory; however, a higher percentage of post-LT AKI and initiation of dialysis can be expected. Presence of lipopeliosis on biopsy appears to be predictive of post-LT AKI.
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Affiliation(s)
- Caroline Jadlowiec
- Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ 85054, USA
- Correspondence: ; Tel.: +1-480-3421010; Fax: +1-480-3422324
| | - Maxwell Smith
- Division of Anatomic Pathology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Matthew Neville
- Instructor in Biostatistics, Mayo Clinic College of Medicine, Phoenix, AZ 85054, USA
| | - Shennen Mao
- Division of Transplant Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Kunam Reddy
- Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Adyr Moss
- Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Bashar Aqel
- Division of Transplant Hepatology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Timucin Taner
- Division of Transplant Surgery, William J von Liebig Transplant Center, Rochester, MN 55902, USA
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Affiliation(s)
- J. Holley
- Sections of Nephrology and Gastroenterology West Virginia University
| | - D. Seibert
- Sections of Nephrology and Gastroenterology West Virginia University
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29
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Moss A, Dweck MR, Doris MK, Andrews JPM, Bing R, Raftis J, Williams MC, Van Beek EJR, Forsyth L, Lewis SC, Lee R, Newby DE, Adamson PD. 1269Dual antiplatelet therapy to inhibit myocardial injury in patients with high-risk coronary artery plaque: a randomized controlled trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
High-risk coronary atherosclerotic plaque is associated with higher plasma troponin concentrations suggesting ongoing myocardial injury that may be a target for dual antiplatelet therapy.
Purpose
To determine whether ticagrelor reduces high-sensitivity troponin I concentrations in patients with established coronary artery disease and high-risk coronary plaque with 18F-fluoride uptake.
Methods
In a randomized double-blind placebo-controlled trial, patients with multivessel coronary artery disease underwent coronary 18F-fluoride positron emission tomography-computed tomography and measurement of high-sensitivity cardiac troponin I and were randomized (1:1) to ticagrelor 90 mg twice daily or matched placebo. The primary endpoint was troponin I concentration at 30 days in patients with increased coronary 18F-fluoride uptake.
Results
In total, 202 patients were randomized and 191 met the pre-specified criteria for inclusion in the primary analysis. In patients with increased coronary 18F-fluoride uptake (n=120/191) there was no evidence that ticagrelor had an effect on plasma troponin concentrationsat 30 days (ratio of geometric means for ticagrelor versusplacebo, 1.11, [95% confidence interval 0.90 to 1.36], p=0.32) (Table 1). Over 1 year, ticagrelor had no effect on troponin concentrations in patients with increased coronary 18F-fluoride uptake (ratio of geometric means, 0.86, 95% confidence interval 0.63 to 1.17, p=0.33).
Table 1 Adjusted Geometric Mean (GSE) Ratio of Geometric Means p-value Ticagrelor Placebo (95% CI) Cardiac troponin I, ng/L (18F-fluoride activity) 3.8 (1.1) 3.4 (1.1) 1.11 (0.90 to 1.36) 0.32 Cardiac Troponin I, ng/L (No 18F-fluoride activity) 2.4 (1.1) 2.3 (1.1) 1.02 (0.80 to 1.31) 0.87 Plasma high-sensitivity cardiac troponin I concentration (ng/L) at 30 days for the per-protocol population.Estimates are back transformed estimates from analysis of log transformed values at 30 days adjusting for age, sex and log transformed baseline troponin. Ratio of geometric means is Ticagrelor divided by Placebo. GSE, geometric standard error.
Conclusions
Dual antiplatelet therapy with ticagrelor does not reduce plasma troponin concentrations in patients with coronary 18F-fluoride uptake. This suggests that subclinical plaque thrombosis does not contribute to ongoing myocardial injury in this setting.
Clinical Trials Study ID: NCT02110303Study ID: NCT02110303
Acknowledgement/Funding
Wellcome Trust Senior Investigator Award WT103782AIA
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Affiliation(s)
- A Moss
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - M R Dweck
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - M K Doris
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - J P M Andrews
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - R Bing
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - J Raftis
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - M C Williams
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - E J R Van Beek
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - L Forsyth
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - S C Lewis
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - R Lee
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - D E Newby
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - P D Adamson
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
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Harries IB, Williams M, Weir-Mccall J, Vedwan K, Shambrook J, Roditi G, Nicol E, Moss A. 189CT TAVR assessment in the United Kingdom: insights from a national BSCI/BSCCT survey. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- I B Harries
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - M Williams
- University of Edinburgh, Edinburgh Imaging Facility, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - J Weir-Mccall
- University of Cambridge, School of Clinical Medicine, Biomedical Research Centre, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - K Vedwan
- University of Southampton, Department of Cardiothoracic Radiology, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - J Shambrook
- University of Southampton, Department of Cardiothoracic Radiology, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - G Roditi
- University of Glasgow, Institute of Clinical Sciences, Glasgow, United Kingdom of Great Britain & Northern Ireland
| | - E Nicol
- Royal Brompton Hospital, Departments of Cardiology and Radiology, London, United Kingdom of Great Britain & Northern Ireland
| | - A Moss
- University of Edinburgh, Edinburgh Imaging Facility, Edinburgh, United Kingdom of Great Britain & Northern Ireland
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Andrews J, Macnaught G, Robson P, Moss A, Doris M, Pawade T, Adamson P, Fayad Z, Lucatelli C, Newby DE, Dweck M. 54518F-sodium fluoride positron emission tomography-magnetic resonance in valvular and coronary artery disease; a validation study with positron emission tomography-computerised tomograph. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez104.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Andrews
- University of Edinburgh, Cardiology, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - G Macnaught
- University of Edinburgh, Cardiology, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - P Robson
- Mount Sinai School of Medicine, New York, United States of America
| | - A Moss
- University of Edinburgh, Cardiology, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - M Doris
- University of Edinburgh, Cardiology, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - T Pawade
- University of Edinburgh, Cardiology, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - P Adamson
- University of Edinburgh, Cardiology, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - Z Fayad
- Mount Sinai School of Medicine, New York, United States of America
| | - C Lucatelli
- University of Edinburgh, Cardiology, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - D E Newby
- University of Edinburgh, Cardiology, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - M Dweck
- University of Edinburgh, Cardiology, Edinburgh, United Kingdom of Great Britain & Northern Ireland
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Loganath K, Shambrook J, Moss A. 178How did that get there? coronary thrombosis with a bioprosthetic valve. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Loganath
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - J Shambrook
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - A Moss
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
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Krege S, Eckoldt F, Richter-Unruh A, Köhler B, Leuschner I, Mentzel HJ, Moss A, Schweizer K, Stein R, Werner-Rosen K, Wieacker P, Wiesemann C, Wünsch L, Richter-Appelt H. Variations of sex development: The first German interdisciplinary consensus paper. J Pediatr Urol 2019; 15:114-123. [PMID: 30713084 DOI: 10.1016/j.jpurol.2018.10.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/10/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The term variations of sex development subsumes a large number of congenital conditions including chromosomal mosaics and variations of chromosomal, gonadal, and phenotypic sex. A situation of this nature may cause severe distress to both, parents and affected persons. One of the reasons for this is the binary form of gender classification in the society. In the past, because of a fear of possible stigmatization and an inability to cope with complex situations, it has been medical policy and practice for newborns to undergo early, mostly 'feminizing' elective surgery with the aim of achieving an outer genital appearance that is unambiguously male or female. Protests by advocacy groups for the most part as well as the results of outcome studies have shown that the development of affected persons may be very different to what has been expected and often does not result in the intended clear female or male gender identity as had been intended. It, therefore, seemed a matter of urgency to implement this new awareness as well as the ethical and personal human rights perspectives in the recommendations for the medical and psychosocial management of diverse sex development (DSD) in the future. STUDY DESIGN In 2012, an interdisciplinary group of German academics engaged in the field of DSD decided to work on a consensus paper for this topic. It involved the participation of all faculties and non-scientific groups dealing with DSD, in particular advocacy and service-user groups. In a structured consensus, process recommendations were developed based on scientific literature as well as personal experiences of clinicians and affected individuals. RESULTS Finally, 37 recommendations were agreed on. The strength of consensus is reflected in the degree of agreement as expressed in percentages. CONCLUSION The introduction of the consensus paper reflects on the emerging paradigm shift and the necessity for a more open view of gender within society. The paper is intended to aid the performance of appropriate diagnostics in DSD-affected newborns and especially to help parents and affected persons cope with the biological and social consequences of DSD. With regard to medical or surgical therapy, it gives information about the most recent treatment trends.
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Affiliation(s)
- S Krege
- Dept. of Urology, Kliniken Essen-Mitte, Germany.
| | - F Eckoldt
- Dept. of Pediatric Surgery, University of Jena, Germany
| | - A Richter-Unruh
- Dept. of Pediatric Endocrinology, University of Münster, Germany
| | - B Köhler
- Dept. of Pediatric Endocrinology and Diabetology, Charite - University of Berlin, Germany
| | - I Leuschner
- Dept. of Pathology, University of Kiel, Germany
| | - H-J Mentzel
- Section of Pediatric Radiology, University of Jena, Germany
| | - A Moss
- Division of Pediatric Endocrinology and Diabetes, Dept. of Pediatrics and Adolescent Medicine, University of Ulm, Germany
| | - K Schweizer
- Institute for Sex Research and Forensic Psychiatry, University Medical Center, Hamburg-Eppendorf, Germany
| | - R Stein
- Department of Pediatric, Adolescent and reconstructive Urology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - P Wieacker
- Institute of Human Genetics, University of Münster, Germany
| | - C Wiesemann
- Institute of Medical Ethics and History of Medicine, University of Göttingen, Germany
| | - L Wünsch
- Dept. of Pediatric Surgery, University of Lübeck, Germany
| | - H Richter-Appelt
- Institute for Sex Research and Forensic Psychiatry, University Medical Center, Hamburg-Eppendorf, Germany
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Andrews J, Moss A, Doris M, Pawade T, Adamson P, Macnaught G, Lucatelli C, Newby DE, Dweck MR. P371218F-flouride PET MR in valvular and coronary heart disease; a pilot investigational study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J Andrews
- University of Edinburgh, Cardiology, Edinburgh, United Kingdom
| | - A Moss
- University of Edinburgh, Cardiology, Edinburgh, United Kingdom
| | - M Doris
- University of Edinburgh, Cardiology, Edinburgh, United Kingdom
| | - T Pawade
- University of Edinburgh, Cardiology, Edinburgh, United Kingdom
| | - P Adamson
- University of Edinburgh, Cardiology, Edinburgh, United Kingdom
| | - G Macnaught
- University of Edinburgh, Cardiology, Edinburgh, United Kingdom
| | - C Lucatelli
- University of Edinburgh, Cardiology, Edinburgh, United Kingdom
| | - D E Newby
- University of Edinburgh, Cardiology, Edinburgh, United Kingdom
| | - M R Dweck
- University of Edinburgh, Cardiology, Edinburgh, United Kingdom
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DeSouza K, Zammit R, Simpson L, Watson L, Bracewell K, Whitfield C, Bloomfield D, Simcock R, Sinha R, Westwell S, Moss C, Moss A, Sham J, Patel G. Defining the Older Patient Population (>65 Years) Treated for Metastatic Breast Cancer (mBC) Within the Sussex Cancer Network. Clin Oncol (R Coll Radiol) 2018. [DOI: 10.1016/j.clon.2018.02.009] [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: 10/17/2022]
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Quesada Dorador A, Quesada-Ocete B, Kutyifa V, Klein H, Jimenez-Bello J, Marin-Gomez MC, Biton Y, Mcnitt S, Polonsky B, Paya R, Zareba W, Goldenberg I, Moss A. P321Effect of biventricular pacing on ventricular remodeling in asymptomatic heart failure patients with ischemic cardiomyopathy. Europace 2018. [DOI: 10.1093/europace/euy015.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Quesada Dorador
- University General Hospital of Valencia, Department of Cardiology, Valencia, Spain
| | | | - V Kutyifa
- University of Rochester, Heart Research Follow-up Program Cardiology Division, Rochester, United States of America
| | - H Klein
- University of Rochester, Heart Research Follow-up Program Cardiology Division, Rochester, United States of America
| | - J Jimenez-Bello
- University General Hospital of Valencia, Department of Cardiology, Valencia, Spain
| | - M C Marin-Gomez
- University General Hospital of Valencia, Department of Cardiology, Valencia, Spain
| | - Y Biton
- University of Rochester, Heart Research Follow-up Program Cardiology Division, Rochester, United States of America
| | - S Mcnitt
- University of Rochester, Heart Research Follow-up Program Cardiology Division, Rochester, United States of America
| | - B Polonsky
- University of Rochester, Heart Research Follow-up Program Cardiology Division, Rochester, United States of America
| | - R Paya
- University General Hospital of Valencia, Department of Cardiology, Valencia, Spain
| | - W Zareba
- University of Rochester, Heart Research Follow-up Program Cardiology Division, Rochester, United States of America
| | - I Goldenberg
- Chaim Sheba Medical Center, Department of Cardiology, Tel Hashomer, Israel
| | - A Moss
- University of Rochester, Heart Research Follow-up Program Cardiology Division, Rochester, United States of America
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Curland N, Gethöffer F, van Neer A, Ziegler L, Heffels-Redmann U, Lierz M, Baumgärtner W, Wohlsein P, Völker I, Lapp S, Bello A, Pfankuche VM, Braune S, Runge M, Moss A, Rautenschlein S, Jung A, Teske L, Strube C, Schulz J, Bodewes R, Osterhaus ADME, Siebert U. Investigation into diseases in free-ranging ring-necked pheasants ( Phasianus colchicus) in northwestern Germany during population decline with special reference to infectious pathogens. EUR J WILDLIFE RES 2018; 64:12. [PMID: 32214944 PMCID: PMC7087779 DOI: 10.1007/s10344-018-1173-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 05/08/2017] [Revised: 11/06/2017] [Accepted: 01/19/2018] [Indexed: 11/29/2022]
Abstract
The population of ring-necked pheasants (Phasianus colchicus) is decreasing all over Germany since the years 2008/2009. Besides impacts of habitat changes caused by current rates of land conversion, climatic influences or predators, a contribution of infectious pathogens needs also to be considered. Infectious and non-infectious diseases in free-living populations of ring-necked pheasants have been scarcely investigated so far. In the present study, carcasses of 258 deceased free-ranging pheasants of different age groups, predominantly adult pheasants, collected over a period of 4 years in the states of Lower Saxony, North Rhine–Westphalia and Schleswig-Holstein, were examined pathomorphologically, parasitologically, virologically and bacteriologically, with a focus set on infectious pathogens. A periocular and perinasal dermatitis of unknown origin was present in 62.3% of the pheasants. Additional alterations included protozoal cysts in the skeletal musculature (19.0%), hepatitis (21.7%), enteritis (18.7%), gastritis (12.6%), and pneumonia (11.7%). In single cases, neoplasms (2.6%) and mycobacteriosis (1.7%) occurred. Further findings included identification of coronaviral DNA from trachea or caecal tonsils (16.8%), siadenoviral DNA (7.6%), avian metapneumoviral RNA (6.6%), and infectious bursal disease viral RNA (3.7%). Polymerase chain reaction (PCR) on herpesvirus, avian influenza virus (AIV), paramyxovirus type 1 (PMV-1), avian encephalomyelitis virus (AEV), and chlamydia were negative. Based on the present results, there is no indication of a specific pathogen as a sole cause for population decline in adult pheasants. However, an infectious disease can still not be completely excluded as it may only affect reproduction effectivity or a certain age group of pheasants (e.g., chicks) which were not presented in the study.
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Affiliation(s)
- N Curland
- 1Institute for Terrestrial and Aquatic Wildlife Research, University of Veterinary Medicine Hannover, Foundation, Bischofsholer Damm 15, 30173 Hannover, Germany
| | - F Gethöffer
- 1Institute for Terrestrial and Aquatic Wildlife Research, University of Veterinary Medicine Hannover, Foundation, Bischofsholer Damm 15, 30173 Hannover, Germany
| | - A van Neer
- 1Institute for Terrestrial and Aquatic Wildlife Research, University of Veterinary Medicine Hannover, Foundation, Bischofsholer Damm 15, 30173 Hannover, Germany
| | - L Ziegler
- 2Clinic for Birds, Reptiles, Amphibians and Fish, Justus Liebig University Giessen, Frankfurter Strasse 91, 35321 Giessen, Germany
| | - U Heffels-Redmann
- 2Clinic for Birds, Reptiles, Amphibians and Fish, Justus Liebig University Giessen, Frankfurter Strasse 91, 35321 Giessen, Germany
| | - M Lierz
- 2Clinic for Birds, Reptiles, Amphibians and Fish, Justus Liebig University Giessen, Frankfurter Strasse 91, 35321 Giessen, Germany
| | - W Baumgärtner
- 3Department of Pathology, University of Veterinary Medicine Hannover, Foundation, Buenteweg 17, 30559 Hannover, Germany
| | - P Wohlsein
- 3Department of Pathology, University of Veterinary Medicine Hannover, Foundation, Buenteweg 17, 30559 Hannover, Germany
| | - I Völker
- 3Department of Pathology, University of Veterinary Medicine Hannover, Foundation, Buenteweg 17, 30559 Hannover, Germany
| | - S Lapp
- 3Department of Pathology, University of Veterinary Medicine Hannover, Foundation, Buenteweg 17, 30559 Hannover, Germany
| | - A Bello
- 3Department of Pathology, University of Veterinary Medicine Hannover, Foundation, Buenteweg 17, 30559 Hannover, Germany
| | - V M Pfankuche
- 3Department of Pathology, University of Veterinary Medicine Hannover, Foundation, Buenteweg 17, 30559 Hannover, Germany
| | - S Braune
- 4Lower Saxony State Office for Consumer Protection and Food Safety (LAVES), Food and Veterinary Institute Braunschweig/Hannover, Eintrachtweg 17, 30173 Hannover, Germany
| | - M Runge
- 4Lower Saxony State Office for Consumer Protection and Food Safety (LAVES), Food and Veterinary Institute Braunschweig/Hannover, Eintrachtweg 17, 30173 Hannover, Germany
| | - A Moss
- 5Lower Saxony State Office for Consumer Protection and Food Safety (LAVES), Food and Veterinary Institute Oldenburg, Philosophenweg 38, 26121 Oldenburg, Germany
| | - S Rautenschlein
- 6Clinic for Poultry, University of Veterinary Medicine Hannover, Foundation, Buenteweg 17, 30559 Hannover, Germany
| | - A Jung
- 6Clinic for Poultry, University of Veterinary Medicine Hannover, Foundation, Buenteweg 17, 30559 Hannover, Germany
| | - L Teske
- 6Clinic for Poultry, University of Veterinary Medicine Hannover, Foundation, Buenteweg 17, 30559 Hannover, Germany
| | - C Strube
- 7Institute for Parasitology, Center for Infection Medicine, University of Veterinary Medicine Hannover, Foundation, Buenteweg 17, 30559 Hannover, Germany
| | - J Schulz
- 8Institute for Animal Hygiene, Animal Welfare and Farm Animal Behaviour, University of Veterinary Medicine Hannover, Foundation, Bischofsholer Damm 15, 30173 Hannover, Germany
| | - R Bodewes
- Department of Viroscience, Erasmus MC, P.O. Box 2040, Ee1726, 3000 CA Rotterdam, The Netherlands
| | - A D M E Osterhaus
- 10Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Foundation, Buenteweg 17, 30559 Hannover, Germany
| | - U Siebert
- 1Institute for Terrestrial and Aquatic Wildlife Research, University of Veterinary Medicine Hannover, Foundation, Bischofsholer Damm 15, 30173 Hannover, Germany
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Moss A, Wabitsch M, Kromeyer-Hauschild K. Referenzwerte für den Body-Mass-Index für Kinder, Jugendliche und Erwachsene in Deutschland. ACTA ACUST UNITED AC 2017. [DOI: 10.1055/s-0037-1618928] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungDie in den Leitlinien der “Arbeitsgemeinschaft Adipositas im Kindes- und Jugendalter” (AGA) empfohlenen BMI-Referenzwerte haben sich in der Praxis bewährt. Um eine kontinuierliche Beurteilung der BMI-Entwicklung von der Adoleszenz bis ins junge Erwachsenenalter zu gewährleisten, wird hier eine Modifikation der bestehenden Perzentile im Altersbereich von 15 bis 18 Jahren vorgeschlagen. Dafür wurden die Daten dieser Altersgruppe mit den Daten des Bundes-Gesundheitssurvey 1998 (BGS98) zusammengeführt und für 15- bis 79-Jährige Perzentilwerte mittels der LMS-Methode nach Cole und Green (2) berechnet. Um einen kontinuierlichen Übergang zwischen den hier neu berechneten BMI-Perzentilen und der AGA-Referenz zu erhalten, erfolgte dann eine Interpolation zwischen beiden Perzentil Scharen (einschließlich L- und S-Werten) im Altersbereich von 15–16 Jahren.Die hier vorgestellten Perzentilwerte für den BMI für 15- bis 79-Jährige ermöglichen in Kombination mit der AGA-Referenz (0 bis 15 Jahre) eine kontinuierliche Betrachtung der BMI-Entwicklung von der Kindheit bis ins Erwachsenalter.
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Fallowfield L, May S, Matthews L, Jenkins V, Mackay J, Arbon A, Hack B, Hall J, Harper-Wynne C, Hinde S, Moss A, Thanopoulou E, Westwell S, Wlaszly D, Simcock R, Patel G, Bloomfield D. Enhancing decision-making about adjuvant chemotherapy in ER+, HER2- early breast cancer (EBC) following EndoPredict testing. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.039] [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: 11/13/2022] Open
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Kutyifa V, Vermilye K, Daimee U, McNitt S, Klein H, Moss A, Goldenberg I. P6417Extended wearable cardioverter defibrillator use in patients at-risk for sudden death. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6417] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cikes M, Sanchez Martinez S, Biering Sorensen T, Pouleur A, Knappe D, Kutyifa V, Moss A, Stein K, Bijnens B, Solomon S. 5118Machine-learning characterization of myocardial deformation patterns to identify responders to resynchronization therapy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.5118] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Heilman RL, Green EP, Reddy KS, Moss A, Kaplan B. Potential Impact of Risk and Loss Aversion on the Process of Accepting Kidneys for Transplantation. Transplantation 2017. [DOI: 10.1097/tp.0000000000001715] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Backes Y, Moss A, Reitsma JB, Siersema PD, Moons LMG. Response to Zhang et al. Am J Gastroenterol 2017; 112:514-515. [PMID: 28270673 DOI: 10.1038/ajg.2016.579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Y Backes
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Moss
- Department of Endoscopic Services, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, Melbourne Medical School-Western Precinct, The University of Melbourne, St. Albans, Victoria, Australia
| | - J B Reitsma
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P D Siersema
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Leon M G Moons
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
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Backes Y, Moss A, Reitsma JB, Siersema PD, Moons LMG. Narrow Band Imaging, Magnifying Chromoendoscopy, and Gross Morphological Features for the Optical Diagnosis of T1 Colorectal Cancer and Deep Submucosal Invasion: A Systematic Review and Meta-Analysis. Am J Gastroenterol 2017; 112:54-64. [PMID: 27644737 DOI: 10.1038/ajg.2016.403] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/02/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Optical diagnosis of T1 colorectal cancer (CRC) and T1 CRC with deep submucosal invasion is important in guiding the treatment strategy. The use of advanced imaging is not standard clinical practice in Western countries. A systematic review and meta-analysis were conducted comparing the accuracy of narrow band imaging (NBI), magnifying chromoendoscopy (MCE), and gross morphological features (GMF) seen with conventional view for the optical diagnosis of T1 CRC and deep submucosal invasion. METHODS A literature search identified studies on the optical diagnosis of T1 CRC and deep invasion using NBI, MCE, or GMF. Pooled estimates (PE) of sensitivity and specificity across studies reporting on NBI or MCE were compared using a random effects bivariate meta-regression approach, and a paired analysis focusing on studies that performed both techniques within the same patient was performed. RESULTS Thirty-three studies with 31,568 polyps were included. For the optical diagnosis of T1 CRC, both NBI (4 studies; PE 0.85, 95% confidence interval (CI) 0.75-0.91) and MCE (5 studies; PE 0.90, 95% CI 0.83-0.94) yielded higher sensitivity as compared with GMF (3 studies; range 0.21-0.46). No significant preference for NBI or MCE was found (sensitivity relative risk (RR) 0.93, 95% CI 0.79-1.09, P=0.37; specificity RR 0.98, 95% CI 0.86-1.11, P=0.74). Similarly, for the optical diagnosis of deep invasion, both NBI (13 studies; PE 0.77, 95% CI 0.68-0.84) and MCE (17 studies; PE 0.81, 95% 0.75-0.87) yielded higher sensitivity as compared with GMF (6 studies; range 0.18-0.88), and no significant preference for either NBI or MCE was found (sensitivity RR 0.92, 95% CI 0.76-1.11, P=0.36; specificity RR 1.00, 95% CI 0.96-1.04, P=0.92). CONCLUSIONS This review supports the use of advanced imaging techniques in preference to GMF to reduce the risk of performing piecemeal resection for T1 CRCs or unnecessary surgical referral for lesions amendable to endoscopic resection. A preference for either NBI or MCE could not be observed.
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Affiliation(s)
- Y Backes
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Moss
- Department of Endoscopic Services, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, Melbourne Medical School-Western Precinct, The University of Melbourne, St Albans, Victoria, Australia
| | - J B Reitsma
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P D Siersema
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L M G Moons
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
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Abstract
Thrombocytopenia has previously been reported after right lobe resection for organ donation. The mechanism(s) of low platelets after right hepatectomy is unclear and several hypotheses have been proposed including a decrease in thrombopoietin, and hepatic insufficiency resulting in relative portal hypertension following hepatic resection. However, there has previously not been any comparison between patients who undergo hepatic resection for neoplasia vs. for living organ donation. We compared platelet values in the postoperative period of patients who underwent right hepatectomy for living donation (n = 93) to those who underwent hepatectomy for neoplasia (n = 21). There was no significant difference in platelet values between the two groups at one month (291.2 ± 100 vs. 285.73 ± 159, p = NS), three months (223.8 ± 61 vs. 185.27 ± 80, p = NS) and at 12 months (212 ± 44 vs. 191 ± 60, p = NS). We conclude that thrombocytopenia is not uncommon following hepatic lobe resection, and is unaffected by the indication for hepatectomy.
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Affiliation(s)
- Abimbola Adike
- Division of Gastroenterology and Transplant Hepatology, Mayo Clinic, Arizona, USA
| | - Jorge Rakela
- Division of Gastroenterology and Transplant Hepatology, Mayo Clinic, Arizona, USA
| | | | - Adyr Moss
- Department of Transplant Surgery, Mayo Clinic, Arizona, USA
| | - Elizabeth Carey
- Division of Gastroenterology and Transplant Hepatology, Mayo Clinic, Arizona, USA
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Hauner H, Moss A, Berg A, Bischoff S, Colombo-Benkmann M, Ellrott T, Kanthak U, Kunze D, Stefan N, Teufel M, Wabitsch M, Wirth A. Prävention und Therapie der Adipositas. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0042-114746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- H. Hauner
- Klinik für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München
| | - A. Moss
- Universitätsklinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Ulm
| | - A. Berg
- Institut für Sport und Sportwissenschaft der Universität Freiburg, Freiburg
| | - S. Bischoff
- Institut für Ernährungsmedizin, Universität Hohenheim, Stuttgart
| | | | - T. Ellrott
- Institut für Ernährungspsychologie, Georg-August-Universität, Göttingen
| | - U. Kanthak
- Adipositaschirurgie Selbsthilfe Deutschland e. V
| | - D. Kunze
- Kinderendokrinologische Praxis, München
| | - N. Stefan
- Institute of Diabetes Research and Metabolic Diseases IDM, Universitätsklinikum Tübingen
| | - M. Teufel
- Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Tübingen
| | - M. Wabitsch
- Universitätsklinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Ulm
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Abstract
Millions of Americans regularly use herbal supplements, but many are unaware of the potential hidden dangers. Numerous supplements have been associated with hepatotoxicity and, indeed dietary/herbal supplements represent an increasingly common source of acute liver injury. We report a case of acute liver failure requiring liver transplantation associated with the use of Garcinia cambogia, a supplement widely promoted for weight loss. When patients present with acute hepatitis or liver failure from an unknown etiology, a careful history of supplement use should be performed.
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Affiliation(s)
- Rebecca Corey
- Transplantation Center, Mayo Clinic, Phoenix, AZ, USA
| | | | - Andrew Singer
- Division of Transplantation Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Adyr Moss
- Division of Transplantation Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Maxwell Smith
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, USA
| | - Jessica Noelting
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA
| | - Jorge Rakela
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA
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Affiliation(s)
- Adyr Moss
- Division of Transplant Surgery, Mayo Clinic, Arizona, USA
| | - Bruce Kaplan
- Division of Nephrology and Hypertension, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, Arizona, 85044, USA
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Batra RK, Heilman RL, Smith ML, Thomas LF, Khamash HA, Katariya NN, Hewitt WR, Singer AL, Mathur AK, Huskey J, Chakkera HA, Moss A, Reddy KS. Rapid Resolution of Donor-Derived Glomerular Fibrin Thrombi After Deceased Donor Kidney Transplantation. Am J Transplant 2016; 16:1015-20. [PMID: 26689853 DOI: 10.1111/ajt.13561] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 08/16/2015] [Revised: 09/11/2015] [Accepted: 09/29/2015] [Indexed: 01/25/2023]
Abstract
The aim of this study was to determine the clinical and histologic outcomes related to transplanting kidneys from deceased donors with glomerular fibrin thrombi (GFT). We included all cases transplanted between October 2003 and October 2014 that had either a preimplantation biopsy or an immediate postreperfusion biopsy showing GFT. The study cohort included 61 recipients (9.9%) with GFT and 557 in the control group without GFT. Delayed graft function occurred in 49% of the GFT group and 39% in the control group (p = 0.14). Serum creatinine at 1, 4, and 12 months and estimated GFR at 12 months were similar in the two groups. Estimated 1-year graft survival was 93.2% in the GFT group and 95.1% in the control group (p = 0.22 by log-rank). Fifty-two of the 61 patients in the GFT group (85%) had a 1-month protocol biopsy, and only two biopsies (4%) showed residual focal glomerular thrombi. At the 1-year protocol biopsy, the prevalence of moderate to severe interstitial fibrosis and tubular atrophy was 24% in the GFT group and 30% in the control group (p = 0.42). We concluded that GFT resolves rapidly after transplantation and that transplanting selected kidneys from deceased donors with GFT is a safe practice.
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Affiliation(s)
- R K Batra
- Department of Surgery, Mayo Clinic, Phoenix, AZ
| | - R L Heilman
- Department of Medicine, Mayo Clinic, Phoenix, AZ
| | - M L Smith
- Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ
| | - L F Thomas
- Department of Medicine, Mayo Clinic, Phoenix, AZ
| | - H A Khamash
- Department of Medicine, Mayo Clinic, Phoenix, AZ
| | | | - W R Hewitt
- Department of Surgery, Mayo Clinic, Phoenix, AZ
| | - A L Singer
- Department of Surgery, Mayo Clinic, Phoenix, AZ
| | - A K Mathur
- Department of Surgery, Mayo Clinic, Phoenix, AZ
| | - J Huskey
- Department of Medicine, Mayo Clinic, Phoenix, AZ
| | - H A Chakkera
- Department of Medicine, Mayo Clinic, Phoenix, AZ
| | - A Moss
- Department of Surgery, Mayo Clinic, Phoenix, AZ
| | - K S Reddy
- Department of Surgery, Mayo Clinic, Phoenix, AZ
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Affiliation(s)
- M. Esson
- The North of England Zoological Society; Chester Zoo; Caughall Road Upton Chester CH2 1LH United Kingdom
| | - A. Moss
- The North of England Zoological Society; Chester Zoo; Caughall Road Upton Chester CH2 1LH United Kingdom
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